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目的:总结心上型完全性肺静脉异位引流(TAPVC)超声心动图的诊断特点及对围术期临床转归的指导意义。方法:对2010年6月至2015年6月5年间我院儿童心脏中心收治的心上型TAPVC患儿的超声心动图及临床资料进行回顾性分析。结果:经超声心动图诊断并外科手术证实为心上型TAPVC 69例,男性46例,女性23例,中值年龄5.0个月(21d~180个月)。69例术前超声心动图诊断均与手术诊断一致,符合率100%。设定超声测量房间隔交通≤5mm为限制性房间隔交通(限制性房水平分流)。本组研究提示限制性房间隔交通组就诊年龄(P=0.005)、体表面积(P=0.015),经皮血氧饱和度(P=0.039),房间隔交通直径指数(P<0.001)等均明显低于房间隔交通直径>5mm患儿组(非限制性分流);而肺动脉收缩压(P=0.002),右心室舒张末径指数,右心室与左心室前后径比值则明显高于非限制性分流组(P<0.001),且术后ICU时间明显长于非限制性分流组(P=0.01)。结论:超声心动图是诊断心上型TAPVC首选且准确的方法。心上型TAPVC尽早诊断手术预后良好。房水平分流大小,引流血管是否梗阻,术前右心室与左心室内径比值与心上型TAPVC患儿围术期转归密切相关。
OBJECTIVE: To summarize the diagnostic features of eardiac pulmonary ectopic drainage (TAPVC) echocardiography and its guiding significance for the clinical outcome of perioperative period. Methods: Echocardiography and clinical data of patients with suprarenal cardiac TAPVC who were admitted to Children’s Heart Center of our hospital from June 2010 to June 2015 were retrospectively analyzed. Results: 69 cases of supranuclear TAPVC were confirmed by echocardiography and surgically confirmed. There were 46 males and 23 females. The median age was 5.0 months (ranged from 21 days to 180 months). 69 cases of preoperative echocardiographic diagnosis are consistent with the surgical diagnosis, the rate of 100%. Set the ultrasonic measurement of atrial septal traffic ≤ 5mm for atrial septal traffic (limiting the level of shunt). Our study suggests that the age at diagnosis (P = 0.005), body surface area (P = 0.015), percutaneous oxygen saturation (P = 0.039), atrial septal transit diameter index (P <0.001) (P = 0.002), right ventricular end-diastolic index, right ventricular and left ventricular anterior-posterior diameter ratio was significantly higher than the unrestricted (P <0.001), and the duration of postoperative ICU was significantly longer than that of the unrestricted shunt (P = 0.01). Conclusion: Echocardiography is the first choice and accurate method for the diagnosis of supratentorial TAPVC. Cardiac TAPVC early diagnosis and good prognosis. Atrial shunt size, drainage of blood vessels obstruction, preoperative right ventricular and left ventricular diameter ratio and perioperative outcome of cardiac TAPVC children are closely related.