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目的 :探讨超声心动图检查诊断主动脉窦瘤破裂(ruptured sinus of valsalva aneurysm,RSVA)的特征性表现及产生误诊和漏诊的原因。方法:对近7年经我院心脏外科手术证实的24例RSVA患者进行回顾性分析,观察其术前超声图像的特点,并探讨超声诊断RSVA中发生误诊和漏诊的原因。结果:24例患者中,病灶发生于右冠窦者19例(79%),发生于无冠窦者5例(21%);而破裂时由右冠窦瘤破入右心室者最多(18例,占75%),由无冠窦瘤破入右心房者次之(4例,17%)。RSVA最常见的合并症为室间隔缺损(ventricular septal defect,VSD)(15/24,在18例右冠窦瘤破入右心室患者中有14例),且多为嵴上型(11例);其次为主动脉瓣反流(14/24)。与外科手术结果对照,超声心动图检查的RSVA检出率为91.7%,但易漏诊合并的VSD(5例,漏诊率33.3%)。结论:超声心动图可准确诊断RSVA、破入部位及其他合并的心血管畸形,但检查时应注意与VSD鉴别,并注意是否合并VSD。
Objective: To explore the echocardiographic diagnosis of ruptured sinus of ruptured sinus of ruptured sinus (RSVA) of the characteristics of the performance and misdiagnosis and missed diagnosis. Methods: A retrospective analysis was performed on 24 patients with RSVA confirmed by cardiac surgery in our hospital in recent 7 years. The characteristics of preoperative ultrasound images were observed. The causes of misdiagnosis and missed diagnosis in RSVA by ultrasound were discussed. RESULTS: Of the 24 patients, 19 (79%) had lesions in the right coronary artery and 5 (21%) occurred in the absence of the coronary sinus. Most of the lesions were ruptured from the right coronary sinus (18 Cases, accounting for 75%), followed by non-coronary sinus aneurysm ruptured into the right atrium (4 cases, 17%). The most common comorbidity of RSVA was ventricular septal defect (VSD) (15/24, 14 of 18 patients with right coronary sinus tears penetrating the right ventricle), mostly supercristal (11) Followed by aortic regurgitation (14/24). Compared with the surgical results, the echocardiographic RSVA detection rate was 91.7%, but the misdiagnosed VSD (5 cases, missed diagnosis rate 33.3%). CONCLUSIONS: Echocardiography can accurately diagnose RSVA, sites of dissection, and other comorbid cardiovascular malformations, but care should be taken to differentiate them from VSD and to consider whether to incorporate the VSD.