经胸超声心动图诊断二叶式主动脉瓣畸形及其并发症的临床价值

摘要

Objective To explore the clinical values of trans-thoracic echocardiography in the diagnosis of congenital bicuspid aortic valve(BAV) and its complications.Methods Data of 43 cases of BAV with subtypes including the combined aortic stenosis,regurgitation,vegetation formation and the dilation of ascending aorta were collected and analyzed retrospectively. The results were compared with the trans-esophageal echocardiography(TEE) and surgery.Results Altogether 41 cases of BAV cases were confirmed by TEE(24 cases) or operations(17 cases),2 cases were misdiagnosed.The diagnostic accuracy was 95.3%for BAV diagnosed by TTE.In these 41 cases,29 cases(70.7%) were L-R crown flap infused type,10 cases(24.4%) were R-N crown flap infused type and 2 cases were L-N crown flap type.Aorta dilation was observed in 16 cases.There were 4 cases(9.7%)with simple BAV without stenosis or closure.16 cases(39.0%) with mild aortic stenosis and 4 cases(9.7%) with mild regurgitation.In 17 cases accept operation,there were 10 cases with moderate to severe stenosis accompanied by closure insufficiency,2 cases with mild stenosis accompanied by severe closure insufficiency and vegetation formation,5 cases with moderate to severe closure insufficiency of the aortic valve and 4 cases with other cardiac abnormalities.The rate of aortic dilatation in L-R type was the highest.The age of patients accept operation was significantly higher than the patients were not accept operation(P＜0 . 05). Conclusion Trans-thoracic echocardiography is the first approach on the screening and follow-up of the diagnosis and the associated complications of BAV,which can provide the detailed information on aortic valve and aorta to decide the operations indications and the strategies.%目的 探讨经胸超声心动图诊断二叶式主动脉瓣畸形(BAV)及其并发症的临床意义.方法 回顾性分析我院经胸超声心动图诊断的BAV患者43例,超声分析其分型、瓣膜病、主动脉扩张及心内畸形等并发症,并与经食管超声心动图及手术结果进行比较分析.结果 43例经胸超声心动图初诊BAV患者,经手术(17例)或经食管超声(24例)确诊41例,2例误诊,经胸超声心动图诊断准确率95.3%.其中左、右冠瓣融合(L-R)型29例(70.7%),右、无冠瓣融合(R-N)型10例(24.4%),左、无冠瓣融合(L-N)型2例.主动脉扩张16例(39.0%).单纯BAV不伴狭窄、关闭不全4例(9.7%);主动脉瓣轻度狭窄16例(39.0%),轻度关闭不全4例(9.7%);17例进行手术的患者中,中至重度狭窄伴关闭不全10例,其中轻度狭窄伴重度关闭不全及赘生物形成2例,主动脉瓣中重度关闭不全5例.其他心内畸形4例.L-R型发生瓣膜病、主动脉扩张比率最高;手术患者发生中重度并发症者及发病年龄均显著高于未手术者,差异均有统计学意义(均P＜0.05).结论 经胸超声心动图能提供BAV的超声分型,明确合并瓣膜病、主动脉扩张及其他心内畸形情况,为手术适应证选择及治疗提供全面准确的信息,是BAV及其并发症确诊及随访的首选检测手段.