摘要
目的探讨双源CT成像(DSCTA)在诊断小儿内脏心房不定位综合征中的临床价值。方法回顾性分析2007年至2013年4月武汉亚洲心脏病医院收治的内脏心房不定位综合征小儿病例9例,术前行低剂量DSCTA前门控扫描,同期行超声心动图检查。CT扫描范围自胸廓入口至上腹部,多平面重建图显示心内结构、心外大血管走行及肺脏、肝脏、脾脏形态,分析其影像特征,评价手术适应证。结果 CT诊断左房异构5例,其中1例为房间隔缺损,1例为房间隔缺损合并室间隔缺损,1例单心室,2例右室双出口,气管均呈双左结构,双侧动脉下支气管。合并腹部内脏反位4例,心室左袢并镜像右位心1例,下腔静脉肝段缺如3例,双侧上腔静脉3例,主动脉右弓右降2例,完全性肺静脉异位引流1例。CT诊断右房异构4例,3例为单心室,1例为右室双出口,气管呈双右结构,双侧动脉上支气管,水平肝,胃泡位于右上腹,合并部分型肺静脉异位引流1例,大动脉转位1例,右侧房室无连接1例。CT发现心外主要血管畸形21处,CT发现心外主要血管畸形14处。依据心室及肺动脉发育情况选择手术方式,其中5例行解剖矫治,1例行双向Glenn术,2例行全腔肺动脉连接术,1例术后因低氧及多脏器衰竭死亡。术后随访半年至7年。结论 DSCTA可明确诊断内脏心房不定位综合征,清晰显示心内、心外解剖畸形、体静脉、肺静脉回流及肺动脉发育,指导外科手术方式选择,是临床中心脏超声检查重要补充。
Objective To evaluate the clinical value of dual-source computed tomography angiography （DSCTA） in di- agnosis of the heterotaxy syndrome. Methods Nine patiens with heterotaxy syndrome underwent DSCTA and echocar- diography before operation, then, retrospective analysis was performed. Prospective ECG-triggering DSCTA scanning with low dosage was applied, scanning range was from the superior aperture of thorax to the epigastrium, and then anom- alies of the heart, great vessels, lung, spleen, and liver were observed by means of muhiplanar reconstruction. Result Left atrium isomerism was seen in 5 cases, 1 was atrial septal defect （ASD）, 1 was ASD and ventricular septal defect （VSD）, 1 was single ventricle （SV） , and 2 were double outlet of right ventricle （DORV）. Bilateral morphologic left bronchi, bilaterally hyparterial bronchus and polysplenia were identified, accompanied with abnormal abdominal viscer- al position in 4 cases, left ventricular loops and mirror dextrocardia in 1 case, interrupted inferior vena cava and double superior vena cava in 3 cases, right aortic arch in 2 cases, total anomalous pulmonary venous connection in 1 case, and a right-sided stomach in 4 cases. Right atrial isomerism was seen in 4 cases, 3 of which were associated with SV. Bilater- al morphologic right bronchi, bilaterally eparterial bronchus, asplenia, and symmetrical liver were identified in the pa- tients, accompanied with a right-sided stomach in 2 cases. As well as right-sided atrioventricular connectionless in 1case and transposition of the great artery in 1 case. The main vascular malformations outside the heart were 21 de- tected with DSCTA , contrasting to 14 detected with echocardiography. In the 9 patients, 5 cases were per-formed anatomic surgical correction, 3 cases were performed palliative treatment, 1 case died of persistent hypoxia and function failure in multiple organ after Fanton operation. Following-up time was from half year to seven years. Conclu- sion DSCTA can accurately diagnose heter
出处
《中国实用儿科杂志》
CSCD
北大核心
2014年第9期700-704,共5页
Chinese Journal of Practical Pediatrics
