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目的探讨超声心动图评估完全型肺静脉异位连接(TAPVC)中肺静脉病变的价值。方法收集55例TAPVC患儿的超声心动图资料,并与CTA及术中所见进行对比。结果应用超声心动图根据肺静脉引流部位对55例TAPVC患儿进行分类,分为心上型24例、心内型20例、心下型7例及混合型4例。15例垂直肺静脉梗阻中,心上型的梗阻多出现在垂直静脉与无名静脉或上腔静脉之间,心下型的梗阻均出现在垂直静脉与肝静脉或门静脉之间。肺静脉狭窄4例,其中3例局限性狭窄均为心内型,出现在分支肺静脉与共同肺静脉腔或右心房之间,1例弥漫性狭窄为心下型。分支肺静脉异常9例,其中超声心动图仅检出1例,而CTA检出8例。结论超声心动图能对TAPVC中的肺静脉的引流、梗阻和分支肺静脉近端的狭窄做出更为全面的评价。CTA评估分支肺静脉的汇入和数目异常及远端肺静脉的成像方面优于超声心动图。
Objective To investigate the value of echocardiography in the evaluation of pulmonary venous disease in complete pulmonary vein anomalies (TAPVC). Methods The echocardiographic data of 55 children with TAPVC were collected and compared with CTA and intraoperative findings. Results Echocardiography was used to classify 55 cases of TAPVC patients according to the pulmonary venous drainage site. There were 24 patients with supracardiac type, 20 patients with intracardiac type, 7 patients with subcardiac type and 4 patients with mixed type. In 15 cases of vertical pulmonary venous obstruction, supraocardial obstruction mostly occured between the vertical vein and the anonymous vein or superior vena cava, and the subtype of heart obstruction occurred between the vertical vein and hepatic vein or portal vein. Pulmonary vein stenosis in 4 cases, of which 3 cases of localized stenosis were intracardiac type, appeared in the branch pulmonary veins and common pulmonary vein or right atrium, a case of diffuse stenosis for the subtype. Branch pulmonary vein abnormalities in 9 cases, of which echocardiography was detected in only 1 case, while CTA detected in 8 cases. Conclusions Echocardiography can provide a more complete assessment of pulmonary venous drainage, obstruction and proximal pulmonary veins stenosis in TAPVC. CTA is superior to echocardiography in assessing the inflow and number of anomalous pulmonary veins and the imaging of distal pulmonary veins.