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目的评价彩色多普勒超声心动图对先天性血管环(CVR)的诊断价值,分析超声心动图漏诊的原因,旨在提高其对CVR诊断的准确率。方法回顾性分析103例经外科手术证实为CVR患儿的经胸超声心动图资料,以手术结果为标准,与手术、CTA对比分析其声像图特点。结果 103例CVR构成类型:肺动脉吊带61例,超声心动图诊断准确率96.7%(59/61),漏诊率3.3%(2/61);双主动脉弓21例,超声心动图准确率57.1%(12/21),漏诊率42.9%(9/21);右位主动脉弓伴迷走左锁骨下动脉19例,超声心动图诊断准确率15.8%(3/19),漏诊率84.2%(16/19),左位主动脉弓伴迷走右锁骨下动脉2例,上述血管环畸形CTA全部诊断。103例CVR中伴有心内畸形77例,超声心动图全部诊断,而CTA漏误诊率11.7%(9/77)。结论超声心动图对于诊断肺动脉吊带及心内畸形的灵敏度高,但对双主动脉弓及迷走锁骨下动脉畸形易漏诊;与CTA结合能更好地明确血管环病变的组成及气管形态异常,为手术计划提供完整的信息。
Objective To evaluate the value of color Doppler echocardiography in the diagnosis of congenital vascular rings (CVR) and to analyze the causes of missed diagnosis of echocardiography in order to improve its diagnostic accuracy for CVR. Methods The data of transthoracic echocardiography of 103 surgically-proven children with CVR were retrospectively analyzed. According to the results of surgery, they were compared with those of surgery and CTA. Results There were 61 cases of pulmonary artery stenosis in 103 cases of CVR. The diagnostic accuracy of echocardiography was 96.7% (59/61) and the rate of misdiagnosis was 3.3% (2/61). In 21 cases of double aortic arch, the echocardiographic accuracy was 57.1% (12 / 21). The rate of misdiagnosis was 42.9% (9/21). Right aortic arch was associated with left subclavian artery in 19 cases, diagnostic accuracy of echocardiography was 15.8% (3/19), misdiagnosis rate was 84.2% (16/19) Left aortic arch with vagal right subclavian artery in 2 cases, all of the vascular ring deformity CTA diagnosis. There were 77 cases with intracardiac malformations in 103 cases of CVR. Echocardiography was diagnosed in all. The misdiagnosis rate of CTA was 11.7% (9/77). Conclusions Echocardiography has high sensitivity in diagnosing pulmonary artery stenosis and intracardiac deformity, but it is easy to misdiagnose the bilateral aortic arch and vagal subclavian artery malformation. The combination of CTA and CTA can better define the composition of vascular ring lesion and tracheal abnormality, Provide complete information.