总结经胸超声心动图（TTE）检查对成人型主动脉缩窄（COA）漏诊的原因，提出规范化扫查流程改进策略，降低漏诊风险。

回顾性分析2013年1月至2025年2月在南昌大学第二附属医院超声科接受TTE检查且经手术、计算机断层扫描血管造影（CTA）或心血管造影确诊为成人型COA的患者45例，依据质量控制实施时间分为改进前组（2013年1月至2019年1月）23例，改进后组（2019年2月至2025年2月）22例。规范化扫查流程的核心改进内容包括：系统扫查胸骨上窝切面获取清晰的主动脉弓长轴图像以评估其形态及狭窄特征；常规在腹主动脉长轴切面获取多普勒频谱评估其血流动力学特征。对比改进前、后2组漏诊率，通过Fisher精确检验评估组间差异，计算相对风险及需治数。

改进前TTE诊断成人型COA漏诊率为34.78%（8/23）；改进后漏诊率降至4.55%（1/22），差异具有统计学意义（P=0.004）；相对风险为0.13，95%可信区间：0.02~0.87，提示改进后漏诊风险降低87%；需治数为4，提示每实施规范化检查4例成人型COA患者可避免1例漏诊。

掌握成人型COA的超声心动图特征，实施规范化扫查流程可显著降低TTE对成人型COA的漏诊率。

To summarize the causes of missed diagnosis in adult-type coarctation of the aorta (COA) by transthoracic echocardiography (TTE) and propose an optimized standardized scanning protocol to reduce diagnostic omissions.

A retrospective analysis was performed on 45 surgically/radiologically confirmed adult-type COA cases (23 pre-protocol optimization and 22 post-protocol optimization) diagnosed via TTE at the Second Affiliated Hospital of Nanchang University between January 2013 and February 2025. The core enhancements of the standardized scanning protocol included: systematically scanning the suprasternal notch view to obtain clear long-axis images of the aortic arch for assessing its morphology and stenosis characteristics, and routinely acquiring Doppler spectra in the abdominal aorta long-axis view (typically at the diaphragmatic level) to evaluate its hemodynamic features. The missed diagnosis rates pre- and post-protocol optimization were compared using the Fisher's exact test, with relative risk (RR) and number needed to treat (NNT) calculated.

The missed diagnosis rate by TTE significantly decreased from 34.78% (8/23) pre-protocol optimization to 4.55% (1/22) post-protocol optimization (P=0.004). The RR reduction was 87% (RR=0.13, 95% confidence interval: 0.02–0.87), and the NNT of 4 indicated that standardized protocol prevented one missed diagnosis per four patients.

Understanding the echocardiographic characteristics of adult-type COA and implementing the standardized scanning protocol can significantly reduce the missed diagnosis of adult-type COA by TTE.