成人右旋心及合并畸形彩色多普勒超声心动图特征

摘要

Purpose To explore the imaging characteristics of color Doppler echocardiography(CDE) on adult dextrocardia with cardiovascular malformations.Materials and Methods Thirty patients with dextrocardia with cardiovascular malformations were detected by CDE and the imaging characteristics of CDE were investigated.All cases underwent angiocardiography examination as control.26 cases were proved by surgery.Results All cases were diagnosed correctly, according to CDE imaging features.The imaging features of CDE of adult dextrocardia with cardiovascular malformation are very obvious: ①Adult dextrocardia usually includes 4 kinds of congenital heart disease,among which type SLL corrective transposition of the great arteies are common (80％) ,type AⅢ double-inlet ventricle ( 10.0％) ,type SLL double outlet of right ventricle (6.7％) and isolated atrial septal defect (3.3％) is rare.②No matter which kind of congenital heart disease adult dextrocardia combined, CDE results all showed orthotopic heart.③Adult dextrocardia which combined corrective transposition of the great arteies,double-inlet ventricle and double outlet of right ventricle is left-transposition.④Among adult dextrocardia combined with complex congenital heart disease,many of them emerged pulmonary stenosis (93.3％) ,in which color Doppler flow imaging showed multicoloured enchase jet bouquet of blood flow signals through pulmonary artery.⑤In cases of atral septal defect and ventricular septal defect, color Doppler flow imaging showed left to right or bidirection multicoloured enchase shunt bouquet of blood flow signals across interatrial septum or interventricular septum.Conclusion The characteristics of CDE on adult dextrocardia and cardiovascular deformity are obvious.CDE can be used to diagnose this correctly, when the operators of CDE has an excellent demand of the anatomy of this disease.The exploration technique of the disease is obviously different from those of normal position heart.Before examination,reading chest X-ray imaging will be helpful to enhance the accuracy and efficiency of diagnosis.%目的 探寻成人右旋心及合并畸形的彩色多普勒超声心动图(CDE)特征.资料与方法 应用CDE检查30例成人右旋心及合并畸形,寻找成人右旋心及合并畸形CDE特征,所有病例均心血管造影对照,26例手术证实.结果 根据CDE特征,对所有病例全部做出正确诊断.成人右旋心及合并畸形CDE特征明显:①成人右旋心合并4种先天性心脏病,其中SLL型矫正性大动脉转位(80.0%)多见,AⅢ型心室双入口(10.0%)、SLL型右心室双出口(6.7%)和孤立性房间隔缺损(3.3%)少见.②成人右旋心无论合并那种先天性心脏病,CDE表现均为心房正位.③成人右旋心合并矫正性大动脉转位、心室双入口和右心室双出口的大动脉均为左转位.④成人右旋心合并复杂先天性心脏病多有肺动脉狭窄(93.3%).肺动脉狭窄时,彩色多普勒血流显像显示过肺动脉五彩镶嵌射流束血流信号.⑤合并房间隔缺损和室间隔缺损时,彩色多普勒血流显像显示过房间隔或室间隔左向右或双向五彩镶嵌分流束血流信号.结论 成人右旋心及合并畸形的CDE特征明显,应用CDE对成人右旋心及合并畸形可做出正确诊断,但检查者必须熟练掌握本病解剖.在探查手法上与正常位心脏明显不同,检查前阅读X线正位胸片对CDE正确诊断有帮助,并可提高检查效率.