摘要
目的：探讨先天性主动脉-左室通道的影像诊断与外科治疗。方法 ：4例病人,男2例,年龄分别为2岁、2岁6月,女2例,年龄分别为3岁6月、5岁,经超声心动图和多层螺旋CTA诊断为先天性主动脉-左室通道。结果：多层螺旋CTA诊断先天性主动脉-左室通道4例,其中Ⅲ型1例、Ⅱ型3例,2例于左冠窦、右冠窦间沿主动脉管壁见一通道,宽径约5～6 mm,相应主动脉壁轻度扩张（Ⅱ型）;1例左冠窦与左室侧壁心肌内见一通道并开口于左室腔,宽径约5 mm,相应主动脉壁呈瘤样扩张（Ⅱ型）;1例于右、无冠窦间与主动脉瓣下流出道间见异常通道,宽径约4.3 mm,合并膜周部瘤并凸向右室流出道（Ⅲ型）。超声心动图诊断先天性主动脉-左心室通道Ⅲ型1例、Ⅱ型3例,2例于于主动脉左、右冠瓣交界处见一通道走行至左室流出道,宽径约5～6 mm,合并主动脉瓣中度返流（Ⅱ型）;1例左冠窦与左室侧壁基底段水平见一通道并开口于左室腔,宽径约5～6 mm,相应主动脉壁呈瘤样扩张（Ⅱ型）;1例于右、无冠瓣环外侧见主动脉与左室间的双向血流通道,宽径约4.5 mm,通道间隔呈瘤样扩张并凸向右室流出道,且合并主动脉瓣中-重度返流（Ⅲ型）。1例拒绝手术,3例接受手术治疗,术中见主动脉瓣与主动脉壁之间存在一裂隙样结构,并通向左心室腔,2例合并有主动脉瓣关闭不全,同时行主动脉瓣成形术及异常管道封闭术,1例行异常通道单纯封闭术,3例均治愈出院。结论：先天性主动脉-左室通道属罕见的先天性心血管畸形,常合并主动脉瓣关闭不全,需早期诊断,尽早手术治疗,避免出现左心室重构与心力衰竭。
Objective： To evaluate the imaging diagnosis and surgical treatment of aortic-left ventricular tunnel. Methods：Four cases（2 males and 2 females） of congenital aortic-left ventricular tunnel（ALVT） were analyzed retrospectively, age ranged from 2 to 5 years. All patients were diagnosed by multi-spiral CTA（MSCTA） and echocardiography. Results： MSCTA and echocardiography showed the tunnel that bypassed the aortic valve and terminated in the left ventricle chamber. There were 1case of ALVT with type Ⅲ and 3 cases with type Ⅱ. Two cases had a tunnel of 5～6 mm to the outflow tract of left ventricle, moderate aortic regurgitation and mildly dilated ascending aorta, and located at the edge of the aortic root between the left and right sinus approximating to the aortic valve（type Ⅱ）. One case had a tunnel of 5～6 mm to the chamber of left ventricle and aneurism-like enlargement of the Valsalva sinus between the left sinus and ante-latus wall of left ventricle（type Ⅱ）.One case had a tunnel of 4～5 mm, associated with moderate to severe aortic regurgitation, located at the edge of the aortic root between the right and noncoronary sinus approximating to the aortic valve, with an aneurysm located at the perimembranous ventricular septum sticking out to the outflow tract of right ventricular（type Ⅲ）. One case was discharged without surgery.Three cases were operated with better functional results. The operation showed an abnormal tunnel that bypassed the aortic valve and terminated in the left ventricle chamber and showed the dilated ascending aorta with an aneurism-like enlargement of the Valsalva sinus, and the aneurysm sticking out to the outflow of right ventricle could also be seen at the perimembranous ventricular septum. The aortic regurgitation was detected in 2 cases. The aortic-left ventricular tunnel repair and the aortic valvuloplasty were performed. Conclusion： Aortic-left ventricular tunnel is a rare congenital abnormal communication between the aorta and the left ventr
出处
《中国临床医学影像杂志》
CAS
北大核心
2015年第4期251-254,259,共5页
Journal of China Clinic Medical Imaging
