摘要
目的评估婴儿期主动脉弓离断(IAA)的诊断及术前处理。方法回顾性分析本院2001年1月-2007年11月诊断为IAA的53例婴儿临床表现、辅助检查[超声心动图(Echo)、螺旋CT、MRI、心血管造影等]、术前处理、手术治疗预后等临床资料。结果男38例,女15例;年龄1d～12(3.05±3.53)个月,新生儿占50.94%;体质量2.18～10.0(4.32±1.60)kg。首发症状:90.57%患儿有气促,83.02%患儿有喂养困难;83.02%患儿有不同程度的充血性心功能不全,37.74%患儿心功能Ⅲ级。病例均有不同程度的股动脉搏动减弱。53例均行Echo检查,Echo检查确诊为IAA38例;提示IAA或重度主动脉缩窄(CoA)6例,经CT检查诊断为IAA;提示重度CoA9例,经CT或手术诊断为IAA。33例行CT检查,其中15例行手术者,心血管畸形与手术所见一致。3例行MRI检查。7例行心血管造影。结合Echo、CT、MRI、心血管造影及手术结果,53例中A型35例,B型15例,C型3例。术前处理主要为维持动脉导管开放、抗心力衰竭治疗及支持治疗。经适当的内科处理后,大部分患儿充血性心力衰竭症状有不同程度改善。手术治疗26例,存活16例,围术期死亡10例,主要死因为严重低心排出量。结论Echo对本病的诊断有一定的局限性,Echo结合CT或MRI可以替代Echo结合心导管造影诊断IAA的传统方法,方便、安全。合适的术前处理有利于患儿顺利过渡到手术,有利于手术的成功。
Objective To evaluate diagnosis and preoperative management of cases with interrupted aortic arch （ IAA ） in infancy. Methods Fifty - three infants who were admitted to our hospital from Jan. 2001 to Nov. 2007 were involved. Clinical data, findings of echo- cardiogram （Echo）, spiral CT, MRI, angioearcliography, preoperative management, surgical repair and postoperative outcome were analyzed retrospectively. Results There were 38 boys and 15 girls, weighted 2.18 - 10.0（4.32±1.60） kg ,aged 1 day to 12 （3.05 ±3.53） months, of which 50.94% were neonates. Symptoms at presentation were 90.57% with tachypnea and 83.02% with difficulty in feeding. Eighty three point zero two percentage cases had different degree of congestive heart failure,37.74% of which were in grade m heart function. All cases had weakened femoral pulse. All cases were performed Echo, 38 cases of them diagnosed as IAA, 6 cases as IAA or severe eoaretation of aorta （CoA） ; they were diagnosed as IAA by CT, and 9 as severe CoA who were diagnosed as IAA via CT or operation. Thirty - three cases were performed CT, of which 15 underwent surgical repair, cardiovascular abnormalities revealed by CT were the same as those in surgical findings. Three cases were taken MRI,and 7 cases were performed angiocardiography. According to the results of Echo, CT, MRI, angiocardiography and surgical findings ,35 cases were type A, 15 cases were type B and 3 cases were type C. Preoperative treatment included maintaining patent ductus areriosis, management of heart failure and supportive treatment. After proper preoperative management of medication, most cases with congestive heart failure were improved. Twentysix cases underwent surgical repair, 16 survived, 10 died during perioperative stage. Main cause of death was severe low cardiac output. Conclusions Value of Echo in diagnosis of IAA is limi-ted. Combination of Echo with CT or MRI is a convenient and safe way to diagnose IAA, it can replace the traditional method of Echo combined with angiocardi
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第24期1927-1929,共3页
Journal of Applied Clinical Pediatrics
基金
"十一.五"国家科技支撑计划心脑肺血管病防治研究项目资助
广东省科学研究基金项目资助(2006B36007011)
关键词
主动脉弓离断
先天性心脏病
诊断
治疗
interrupted aortic arch
congenital heart disease
diagnosis
treatment
