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目的:评价电子束计算机断层摄影(EBCT)在小儿先天性复杂型主动脉缩窄临床诊断中的价值。方法:回顾性分析自2003年7月至2005年7月于我院诊治的先天性复杂型主动脉缩窄(CoA)小儿患者60例,平均年龄1．64岁(28天-6岁)。所有患者均行经胸多普勒超声心动图检查和EBCT检查,其中39例行手术治疗。结果:60例中,每1例至少合并1种心血管畸形,合并室间隔缺损、动脉导管未闭、房间隔缺损分别为40、26、12例, 法乐四联症1例,右心室双出口2例。平均狭窄率(管腔最窄处与近心端正常主动脉内径比值)R=0．42±0．13(0．18- 0．75)。经手术治疗的39例中,38例证实为CoA,其中R≤1／2占84％(32／38),1例EBCT诊断无血液动力学意义,检出率为97．4％(38／39);经胸多普勒超声心动图漏诊11例,检出率为69．2％(27／39)。结论:EBCT有很高的时间分辨率,能清楚显示小儿CoA的大小、形态,检出率高于经胸多普勒超声心动图,对诊断有重要价值。由于经胸多普勒超声心动图在检出心内畸形有着优势,两者联合应用是小儿复杂型主动脉缩窄无创性检查的可靠方法。
Objective: To evaluate the value of electron beam computed tomography (EBCT) in the diagnosis of congenital complex aortic constriction in children. Methods: A retrospective analysis of 60 cases of congenital complex aortic constriction (CoA) in our hospital from July 2003 to July 2005 was performed. The average age was 1.64 years (28 days -6 years). All patients underwent transthoracic Doppler echocardiography and EBCT examination, of which 39 patients underwent surgical treatment. Results: There were at least one cardiovascular malformation in each of the 60 cases, with ventricular septal defect, patent ductus arteriosus, atrial septal defect 40, 26, 12 cases, tetralogy of Fallot, right ventricular double Export 2 cases. The average rate of stenosis (the ratio of the narrowest diameter of the lumen to the diameter of the proximal normal aorta) was 0.42 ± 0.13 (0.18- 0.75). Of the 39 surgically treated patients, 38 were confirmed as CoA, 84% (32/38) of whom were R ≤ 1/2, and 1 case of EBCT had no hemodynamic significance. The detection rate was 97.4% (38 / 39); 11 cases missed by transthoracic Doppler echocardiography, the detection rate was 69.2% (27/39). Conclusion: EBCT has a high temporal resolution. It can clearly show that the size, shape and detection rate of CoA in children are higher than transthoracic Doppler echocardiography, which is of great value in diagnosis. Because of the superiority of transthoracic Doppler echocardiography in detection of intracardiac deformity, the combination of the two is a reliable method for noninvasive examination of pediatric complex aortic constriction.