【摘要】：目的:探討術(shù)前主動(dòng)脈右冠狀動(dòng)脈竇瘤破裂經(jīng)室間隔缺損突入右室流出道的經(jīng)胸超聲心動(dòng)圖診斷和鑒別診斷。方法:回顧2010年2月至2016年9月在湘雅二醫(yī)院及湘雅醫(yī)學(xué)院附屬�？卺t(yī)院術(shù)前經(jīng)胸超聲心動(dòng)圖診斷主動(dòng)脈右冠狀動(dòng)脈竇瘤破裂經(jīng)室間隔缺損突入右室流出道的患者19例,對(duì)照分析患者臨床癥狀、超聲心動(dòng)圖和術(shù)中病變發(fā)現(xiàn)。結(jié)果:術(shù)中病變發(fā)現(xiàn)16例符合術(shù)前超聲心動(dòng)圖診斷,其中11例胸骨左緣2~3肋聽診可聞及連續(xù)性機(jī)器樣雜音,伴有收縮期震顫,彩色多普勒顯像右心室側(cè)探及收縮期為主的連續(xù)性血流頻譜,術(shù)前超聲心動(dòng)圖及術(shù)中病變證實(shí)室間隔缺損位置大小及右竇瘤破裂經(jīng)室間隔缺損口突入右室流出道;其中3例還合并其他復(fù)雜心臟病。3例與術(shù)前診斷不符合,聽診聞及雜音,不伴有震顫;術(shù)前超聲心動(dòng)圖及術(shù)中病變發(fā)現(xiàn)右竇瘤破裂口大、冗長,其中1例合并主動(dòng)脈瓣狹窄并關(guān)閉不全、先天主動(dòng)脈瓣二瓣化畸形,1例合并主動(dòng)脈瓣中-重度反流,1例合并肺部感染,3例術(shù)中病變都未發(fā)現(xiàn)室間隔缺損。結(jié)論:術(shù)前經(jīng)胸超聲心動(dòng)圖診斷右竇瘤破裂經(jīng)室間隔缺損突入右室流出道是術(shù)前首選、快捷和無創(chuàng)的檢查方法,采用超聲心動(dòng)圖各階段觀察程序與方法能較好地觀察主動(dòng)脈竇瘤破裂及室間隔缺損的位置、形態(tài)大小、毗連關(guān)系和是否合并其他心臟疾病,通過超聲多普勒顯像能發(fā)現(xiàn)右竇瘤破裂經(jīng)室間隔缺損突入右室流出道的血流頻譜特征。
[Abstract]:Objective: to investigate the transthoracic echocardiographic diagnosis and differential diagnosis of ruptured aortic right coronary sinus aneurysm (RCA) through ventricular septal defect (VSD) into right ventricular outflow (RVF) before operation. Methods: from February 2010 to September 2016, 19 patients with ruptured aneurysm of right coronary sinus into right ventricular outflow were diagnosed by transthoracic echocardiography in Xiangya second Hospital and Haikou Hospital of Xiangya Medical College. Clinical symptoms, echocardiography and intraoperative lesions were compared and analyzed. Results: 16 cases of intraoperative pathological changes were found to be in accordance with preoperative echocardiographic diagnosis. Among them, 11 cases with systolic tremor were found to be audible and continuous machine-like murmur by auscultation on the left side of sternum. Color Doppler imaging showed continuous flow spectrum of right ventricular lateral exploration and systolic phase. The location of ventricular septal defect was confirmed by preoperative echocardiography and intraoperative lesions, and the rupture of right sinus tumor through the orifice of ventricular septal defect into the right ventricular outflow tract. Among them, 3 cases with other complicated heart diseases were not in accordance with preoperative diagnosis, auscultation and murmur were not accompanied by tremor, preoperative echocardiography and intraoperative lesions revealed that the ruptured orifice of right sinus aneurysm was large and long. One patient with aortic valve stenosis and insufficiency, one with congenital aortic valve bivalvular malformation, one with moderate to severe aortic valve reflux, one with pulmonary infection and no ventricular septal defect. Conclusion: preoperative transthoracic echocardiography in diagnosis of ruptured right sinus aneurysm through ventricular septal defect into the right ventricular outflow tract is the first choice, rapid and non-invasive examination method. The location, size, contiguity and association of aortic sinus aneurysm and ventricular septal defect (VSD) were observed by echocardiographic procedures and methods. The flow spectrum of right sinus aneurysm ruptured through ventricular septal defect (VSD) into the right ventricular outflow (RVF) can be found by ultrasound Doppler imaging.
【作者單位】： 中南大學(xué)湘雅二醫(yī)院心血管外科;中南大學(xué)湘雅醫(yī)學(xué)院附屬海口醫(yī)院;
【基金】：海南省自然科學(xué)基金(20168318)~~
【分類號(hào)】：R541.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 華瑋;許燕;施仲偉;;超聲心動(dòng)圖診斷主動(dòng)脈竇瘤破裂的準(zhǔn)確性評(píng)價(jià)[J];診斷學(xué)理論與實(shí)踐;2016年03期

2 洪丹丹;顏如玉;王清木;吳文海;白蓉;劉慧蘭;劉建平;;超聲心動(dòng)圖診斷主動(dòng)脈竇瘤破裂合并室間隔缺損[J];中國臨床醫(yī)學(xué)影像雜志;2015年07期

3 李泉水,李沿江,皮小蘭,章春泉,徐翔;彩色多普勒超聲對(duì)主動(dòng)脈竇瘤破裂的定位和血流動(dòng)力學(xué)變化的研究[J];中國超聲醫(yī)學(xué)雜志;1998年03期

【共引文獻(xiàn)】

相關(guān)期刊論文 前8條

1 梁雄飛;楊一峰;林巍;;術(shù)前經(jīng)胸超聲心動(dòng)圖診斷主動(dòng)脈右冠狀動(dòng)脈竇瘤破裂經(jīng)室間隔缺損突入右室流出道與術(shù)中對(duì)照[J];中南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2017年07期

2 潘翠珍;王春生;舒先紅;;術(shù)中經(jīng)食管超聲心動(dòng)圖監(jiān)測外傷性主動(dòng)脈竇壁缺損修補(bǔ)術(shù)一例[J];中華臨床醫(yī)師雜志(電子版);2007年06期

3 趙新;羅萍;溫建中;龔琦;鄧青;劉惠芬;熊t$t$;;超聲心動(dòng)圖對(duì)主動(dòng)脈竇瘤破裂合并畸形的診斷價(jià)值[J];江西醫(yī)學(xué)院學(xué)報(bào);2005年06期

4 孫俊紅,高彩榮,牛四平,呂曉革,侯養(yǎng)棟;單純性先天性主動(dòng)脈竇瘤破裂猝死1例[J];法醫(yī)學(xué)雜志;2005年01期

5 阮雯,潘翠珍,王春生,舒先紅;超聲心動(dòng)圖診斷主動(dòng)脈右冠竇瘤破入右房右室1例[J];上海醫(yī)學(xué)影像;2004年04期

6 李泉水,熊華花,許曉華,李沿江,劉燕娜,黃敏,蔡建華;超聲對(duì)主動(dòng)脈竇瘤破裂的瘤體形狀及合并室間隔缺損頻譜特點(diǎn)的研究[J];中國超聲醫(yī)學(xué)雜志;2001年12期

7 明庭學(xué),任庭春;彩色多普勒超聲診斷主動(dòng)脈竇瘤破裂[J];云南醫(yī)藥;2000年06期

8 張軍,李軍,錢蘊(yùn)秋,岳瑾琢,徐揚(yáng),張俊,徐暉,王曉敏;瓦氏竇瘤破裂及其合并畸形的超聲診斷價(jià)值[J];中國超聲醫(yī)學(xué)雜志;2000年02期

【二級(jí)參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 劉愛軍;李志強(qiáng);李剛;李斌;朱耀斌;李曉鋒;劉迎龍;;伴室間隔缺損的主動(dòng)脈竇瘤破裂患者主動(dòng)脈瓣反流外科技術(shù)探討[J];心肺血管病雜志;2014年02期

2 隋桂玲;;干下型室間隔缺損合并右冠竇瘤的超聲診斷分析[J];濟(jì)寧醫(yī)學(xué)院學(xué)報(bào);2009年01期

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張薇,張運(yùn),張梅,蔡恒,陳文強(qiáng),王燕,季曉平,葛志明;實(shí)時(shí)三維超聲心動(dòng)圖對(duì)室間隔缺損診斷的實(shí)驗(yàn)研究[J];中華超聲影像學(xué)雜志;2003年02期

2 李靖,劉延玲,呂秀章,朱振輝,許聞橋,王浩,李建蓉,李芝聲,姚征,孫博;實(shí)時(shí)三維超聲心動(dòng)圖在室間隔缺損診斷中的應(yīng)用[J];中華超聲影像學(xué)雜志;2003年07期

3 李正華;馮晨;紀(jì)濤;陳毓秀;徐杰;;室間隔缺損114例報(bào)告[J];現(xiàn)代醫(yī)用影像學(xué);2007年02期

4 ;解放軍總醫(yī)院成功實(shí)施世界首例全機(jī)器人微創(chuàng)下室間隔缺損手術(shù)[J];微創(chuàng)醫(yī)學(xué);2009年06期

5 張小杉;哈斯;吳曉萍;王曉磊;朱憲明;劉志平;王雅皙;;經(jīng)胸與經(jīng)食管超聲心動(dòng)圖在室間隔缺損術(shù)前對(duì)照研究中的應(yīng)用價(jià)值[J];疾病監(jiān)測與控制;2012年01期

6 羅星照;;小型室間隔缺損的自然閉合[J];國外醫(yī)學(xué)參考資料(兒科學(xué)分冊(cè));1974年02期

7 劉玉秀;;室間隔缺損[J];國外醫(yī)學(xué)參考資料(兒科學(xué)分冊(cè));1976年02期

8 汪曾煒;;室間隔缺損72例的外科治療[J];遼寧醫(yī)學(xué)雜志;1978年06期

9 周苓怡;;單純室間隔缺損的自發(fā)性關(guān)閉率[J];國外醫(yī)學(xué).心血管疾病分冊(cè);1988年03期

10 賀家(T呉，

本文編號(hào)：2155420