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中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (02) : 150 -154. doi: 10.3877/cma.j.issn.1672-6448.2021.02.005

所属专题: 文献

心血管超声影像学

超声心动图与计算机断层扫描血管成像诊断儿童三房心及其预后分析
龚婷1, 计晓娟1,(), 郑敏2, 朱旭2, 朱昆3, 吴春2, 李静2   
  1. 1. 400014 重庆医科大学附属儿童医院超声科 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室
    2. 400014 重庆医科大学附属儿童医院心脏中心 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室
    3. 400014 重庆医科大学附属儿童医院放射科 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地 儿科学重庆市重点实验室
  • 收稿日期:2020-03-02 出版日期:2021-02-01
  • 通信作者: 计晓娟
  • 基金资助:
    中国博士后基金特别资助项目(2018T110949); 重庆市人力资源和社会保障局留学回国创新项目(cx2019065)

Diagnosis of children with cor triatriatum with echocardiography and computed tomographic angiography and prognosis analysis

Ting Gong1, Xiaojuan Ji1(), Min Zheng2, Xu Zhu2, Kun Zhu3, Chun Wu2, Jing Li2   

  1. 1. Department of Ultrasound, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
    2. Heart Center, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
    3. Department of Radiology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
  • Received:2020-03-02 Published:2021-02-01
  • Corresponding author: Xiaojuan Ji
引用本文:

龚婷, 计晓娟, 郑敏, 朱旭, 朱昆, 吴春, 李静. 超声心动图与计算机断层扫描血管成像诊断儿童三房心及其预后分析[J/OL]. 中华医学超声杂志(电子版), 2021, 18(02): 150-154.

Ting Gong, Xiaojuan Ji, Min Zheng, Xu Zhu, Kun Zhu, Chun Wu, Jing Li. Diagnosis of children with cor triatriatum with echocardiography and computed tomographic angiography and prognosis analysis[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(02): 150-154.

目的

探讨超声心动图(Echo)、计算机断层扫描血管成像(CTA)诊断儿童三房心(CT)的临床应用价值并分析其预后。

方法

以2009年5月至2019年5月重庆医科大学附属儿童医院手术治疗的49例CT患儿为研究对象,回顾性总结分析其Echo、CTA的影像学特征及患儿预后。

结果

本组49例患儿,心脏位置正常者48例(98.0%),镜面右位心1例(2.0%);左房三房心(CTS)47例(95.9%),右房三房心(CTD)2例(4.1%)。43例(87.7%)CTS和2例(4.1%)CTD均合并其他心脏畸形,常见合并的心脏畸形为房间隔缺损(71.4%)、肺静脉异位引流(28.6%)、室间隔缺损(24.5%),4例(8.2%)单纯CTS未合并其他心脏畸形。Echo漏诊CTS及合并心脏畸形10例(10/49),其中8例仅漏诊CTS;CTA漏诊CTS 6例(6/18),漏诊合并心脏畸形10例(10/18),相应的18例接受Echo和CTA的患儿,其Echo诊断符合率均为100%。Echo诊断CT及其合并心脏畸形的符合率均高于CTA(P均<0.05)。手术治疗后治愈出院42例(85.7%),7例(14.3%)死亡。

结论

Echo对CT及其合并心脏畸形的诊断优于CTA,二者联合可能对CT诊断及治疗具有重要价值。

Objective

To investigate the clinical application value of echocardiography(Echo) and computed tomographic angiography(CTA) in the diagnosis of cor triatriatum (CT) in children, and to analyze the prognosis.

Methods

A total of 49 CT children who underwent surgery at Children's Hospital of Chongqing Medical University from May 2009 to May 2019 were selected as the research subjects. The imaging features of Echo and CTA were analyzed retrospectively, and the prognosis outcome were analyzed.

Results

There were 29 males and 20 females, with a male-to-female ratio of 1.45:1. Their median age was 10 months and median body weight was 7 kg. There were 48(98.0%) cases with normal cardiac position, 1(2.0%) with mirror dextrocardia, 47(95.9%) with cor triatriatum sinister (CTS), and 2(4.1%) with cor triatriatum dexter (CTD). Forty-three (87.7%) cases of CTS and 2 (4.1%)cases of CTD were combined with other cardiac malformations, and the common cardiac malformations were atrial septal defect (71.4%),anomalous pulmonary venous connections (28.6%), and ventricular septal defect (24.5%). Four (8.2%) cases had simple CTS without other cardiac malformations. Ten cases of CTS with other cardiac malformations were missed by echocardiography(10/49), 6 cases of CTS were missed by CTA(6/18), 10 cases with associated cardiac malformations were missed by CTA(10/18), both of the Echo diagnostic coincidence rates of CTS and its associated cardiac malformations in the 18 patients underwent echocardiography and CTA were 100%, which were higher than those by CTA (P<0.05). After operation, 42(85.7%) cases were cured and 7(14.3%) died.

Conclusion

Echo is better than CTA in the diagnosis of CT and its associated cardiac malformations.The combination of the two may have important application value.

表1 49例三房心患儿合并心脏结构畸形情况
图1 三房心(CT)的二维超声心动图及彩色多普勒图像。于胸骨旁心尖四腔心切面示左房三房心CTS(箭头示左房内隔膜)合并房间隔缺损(ASD)
图2 三房心(CT)的计算机断层扫描血管成像(CTA)图像。于横断面示心脏增强显影(箭头示左房内隔膜)
表2 7例死亡患儿临床资料及合并心脏畸形
1
Rudienė V, Hjortshøj C, Glaveckaitė S, et al. Cor triatriatum sinistrum diagnosed in the adulthood: a systematic review[J]. Heart, 2019, 105(15):1197-1202.
2
Aliyu I, Ibrahim ZF. Cor-triatriatum dexter with associated cyanosis in a 3-month-old girl[J]. J Cardiovasc Echogr, 2018, 28(2):143-145.
3
曹铁生, 袁丽君, 段云友, 等. 超声心动图法测定肺动脉收缩压的可靠性和存在问题[J]. 第四军医大学学报, 2000, 21(11):1387-1389.
4
陈树宝.先天性心脏病影像诊断学[M].北京:人民卫生出版社, 2004:341-346.
5
贺新建, 魏九茹, 董凤群, 等. 单纯型梗阻型左侧三房心术后肺动脉高压恢复情况追踪与分析[J]. 中国超声医学杂志, 2016, 32(4):374-376.
6
Jha AK, Makhija N. Cor triatriatum: a review[J]. Semin Cardiothorac Vasc Anesth, 2017, 21(2):178-185.
7
Muggenthaler MM, Chowdhury B, Hasan SN, et al. Mutations in HYAL2, encoding hyaluronidase 2, cause a syndrome of orofacial clefting and cor triatriatum sinister in humans and mice[J]. PLoS Genet, 2017, 13(1): e1006470.
8
Raheja H, Namana V, Moskovits N, et al. Cor triatriatum sinistrum[J]. Arq Bras Cardiol, 2018, 110(1):101.
9
Shan SJ, Johnson PT, Fishman EK. Asymptomatic cor triatriatum: utility of 64-slice multidetector computed tomography with 3-dimensional volume rendering[J]. J Comput Assist Tomogr, 2009, 33(5):779-781.
10
Zhao Q, Wang J, Yang ZG, et al. Assessment of intracardiac and extracardiac anomalies associated with coarctation of aorta and interrupted aortic arch using dual-source computed tomography[J]. Sci Rep, 2019, 9(1):11656.
11
Rozema TK, Arruda J, Snyder CS. Cor triatriatum: a tale of two membranes[J]. CASE (Phila), 2019, 3(1): 25-27.
12
Elagha AA, Fuisz AR, Weissman G. Cardiac magnetic resonance imaging can clearly depict the morphology and determine the significance of cor triatriatum[J]. Circulation, 2012, 126(12):1511-1513.
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