摘要
目的探讨部分型肺静脉异位引流的临床特点及诊断方法。方法随访本院1例漏诊的肺静脉异常的部分型肺静脉异位引流患者,分析其临床资料,并回顾1979年至2008年国内42篇相关文献进行复习。结果本院1例患者行经胸超声心动图疑诊为"原发性肺动脉高压",随访该患者于外院右心导管、经食管超声心动图及CT血管造影(CTA)检查诊断为部分型肺静脉异位引流伴肺静脉异常,最终经手术证实并纠治,术后一般情况良好。国内相关文献报道了1965年至2007年共482例经手术证实的部分型肺静脉异位引流患者:右侧肺静脉异位引流占88.51%(393/444例),异位引流至右房者占77.80%(347/446例),1支或2支肺静脉异位者分别占41.43%和52.94%(162/391例,207/391例),合并房间隔缺损者占76.74%(363/473)。其中293例经胸超声确诊或疑诊(并进一步检查),20例经食管超声确诊,23例经CTA确诊,53例经右心导管确诊或疑诊,16例经心血管造影确诊。结论部分型肺静脉异位引流常常伴有房间隔缺损,且以右侧肺静脉异位引流至右房者居多。目前,CTA是诊断部分型肺静脉异位引流最佳的无创检查手段,超声心动图则是诊断该病最常用的无创检查手段,两者合理互补将有助于提高部分型肺静脉异位引流及同时伴随的心内畸形的确诊率。
Objective To explore the clinical characteristics and optimal diagnostic methods for partial anomalous pulmonary venous drainage(PAPVD). Methods The clinical data of a PAPVD patient with anatomicly abnormal pulmonary vein proven by missed diagnosis was analysed and 42 related domestic references from 1979 to 2008 were reviewed. Results A patient suspected as “primary pulmonary hypertension”underwent transthoracic echocardiography (TTE), right heart catheter(RHC), transesophageal echocardiography (TEE) and angio-CT (CTA) from outside the hospitals and was then diagnosed as PAPVD. The diagnose was then proven by operation and the patient recovered well after operation. 482 PAPVD cases proven by operation from 1965 to 2007 were reported domestically. Analyses of these references showed that most anomalous drainage involved right. Pulmonary Vein (PV) (88.51%, 393/444) and right atrium (77.80%, 347/446) and in most cases only one (41.43%, 62/391) or two (52.94%, 207/391) PV were involved. 363 of 473 reported cases were found to suffer atrium septum defect (ASD) as well. 293 cases were diagnosed or suspected suffering PAPVD by TTE, 20 by TEE, 23 by CTA, 53 by RHC and 16 by cardiac angiography. Conclusions PAPVD usually occurred with ASD and presented disorders involving right PV and right atrium. Nowadays, CTA maintains the optimal invasive tool for PAPVD while echocardiography is most commonly used in practice. In conclusion, it may lead to better detection of PAPVD and concomitant deformations by combination of both methods.
出处
《中国医学前沿杂志（电子版）》
2013年第12期90-93,共4页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
部分型肺静脉异位引流
超声心动图
血管造影
房间隔缺损
Partial anomalous pulmonary venous drainage
Echocardiography
Angiography
Atrium septum defect
