成人法洛三联症彩色多普勒超声心动图特征和规律性研究

摘要

目的:探讨成人法洛三联症(TOF)彩色多普勒超声心动图(CDE)特征和规律性,分析房间隔缺损(ASD)血流动力学与肺动脉瓣狭窄(PS)程度的关系.提高诊断准确率.方法:应用CDE检查62例成人TOF(14～57岁.平均24.8岁),二维超声心动图(2DE)测量ASD大小.连续多普勒(CW)估测跨肺动脉瓣压力阶差,与心导管和手术对照.其中52例行心导管检查,14例行介入治疗,48例外科手术治疗.结果:根据CDE特征表现对56例做出正确诊断,诊断准确率90.3％,误诊继发孔ASD和PS各3例.2DE测量ASD直径5～33(18±12)mm与手术测量ASD直径7～35(21±13)mm呈正相关(r＝0.52,P＜0.001);CW估测跨肺动脉瓣压力阶差36～154(93±52)mmHg与心导管测量跨肺动脉瓣压力阶差30～140(86±50)mmHg呈正相关(r＝0.67,P＜0.001).彩色多普勒血流显像(CDFI)显示过房间隔分流束血流信号,其中左向右(61.3％)、双向(22.6％)、右向左(11.3％)和无分流(4.8％).根据CDE筛选14例适应证实施介入治疗全部获得成功.结论:成人TOF的CDE特征明显,CDFI显示过ASD分流束血流信号呈多样化,与PS程度密切相关,CDE对成人TOF有特异性诊断价值,介入治疗前应用CDE判断ASD大小、位置和PS程度非常重要.%Objective:To study the imaging characteristics and regularity of color Doppler echocardiography (CDE) of a-dult trilogy of Fallot (TOF), to analyze the relationship between the hemodynamics of atrial septal defect (ASD) and the degree of pulmonary stenosis (PS) and to improve the diagnostic accuracy. Methods: Sixty-two patients with adult TOF (14～57 years old. Mean 24. 8 years old) were examined by CDE, ASD size were measured by two-dimensional echocardiography (2DE). And transpulmonary valve pressure gradient was estimated by continuous wave Doppler (CW). At the same time comparing with cardiac catheterization and surgery. 52 cases were compared with angiocardiography. 14 cases underwent interventional therapy, and 38 cases were verified by operation. Results: Based on CDE characteristics, fifty-six patients were correctly diagnosed, with 90. 3% of diagnosis accuracy. 3 cases were misdiagnosed as secondum ASD and 3 cases was misdiagnosed as PS. The diameter of ASD was 5 mm to 33 mm (18±12) mm by 2DE. While the diameter was 7 mm to 35 mm (21 ± 13) mm by surgical measurement, they were positively correlated ( r = 0. 52. P <0. 001). Transpulmonary valve pressure gradient estimating by CW was 36 mmHg to 154 mmHg (93±52) mmHg. While the pressure gradient was 30 mmHg to 140 mmHg by cardiac catheterization (86±50) mmHg. They were positively correlated ( r = 0. 67. P <0. 001). The shunt throuh interatrial septum was shown by color Doppler flow imaging (CDFI). 4 kinds of directions through ASD included left to right (61. 3%). Two-way (22. 6%), right to left (11. 3 %) and no shunt (4. 8%). 14 cases indicated for interventional treatment by CDE screening were all succeeded in interventional treatment. Conclusion: The characteristics in adult of TOF by CDE were obvious. CDFI showed the shunt was diversified, and closely correlated with PS degree. CDE had characteristic diagnostic value. It was very important for judging the size, location of ASD and PS degree by CDE before interventional treatment.