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1. 上海交通大学医学院附属上海儿童医学中心
2. 华东师范大学
纸质出版日期:2023,
网络出版日期:2023-3-6,
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刘贻曼, 张志芳, 沈蓉, 等. 超声心动图和CTA对儿童迷走锁骨下动脉的术前诊断价值及术后随访分析[J]. 临床超声医学杂志, 2023,25(2).
The diagnostic value and postoperative follow-up analysis of echocardiography and CTA in children with aberrant subclavian artery[J]. Journal of Clinical Ultrasound in Medicine, 2023,25(2).
目的:分析超声心动图和CTA对迷走锁骨下动脉(aberrant subclavian artery
ASA)的术前诊断情况
评估迷走锁骨下动脉术后的随访结果。方法:回顾性分析192例经心胸外科手术证实为ASA的患儿资料。结果:192例患儿中
189例为右位主动脉弓伴迷走左锁骨下动脉(right aortic arch and aberrant left subclavian artery
RAA-ALSA)
3例为左位主动脉弓伴迷走右锁骨下动脉(left aortic arch and aberrant right subclavian artery
LAA-ARSA)。132例合并其他心脏结构畸形
常见合并畸形有Kommerell憩室96例、房间隔缺损/卵圆孔未闭89例、室间隔缺损51例、左侧上腔静脉残存20例、动脉导管未闭17例。192例患儿中
超声心动图准确诊断上述ASA共124例
占64.6%;漏误诊68例
占35.4%;CTA准确诊断上述ASA共174例
占90.6%
漏误诊18例
占9.4%;在132例常见合并畸形中
超声心动图漏诊2例卵圆孔未闭;CTA诊断漏诊47例房间隔缺损/卵圆孔未闭
漏诊3例小室间隔缺损;在96例行迷走左锁骨下动脉移植或Kommerell憩室切除的术后患儿中随访发现
行迷走锁骨下动脉移植及Kommerell憩室切除的81例患儿吻合口均无明显梗阻
且14例经CTA评估气管压迫均较术前减轻。结论:超声心动图和CTA在术前诊断ASA中各有优势和不足
在术后的随访过程中可以分别评估吻合口及气管压迫的情况
因此
联合超声心动图及CTA进行多模态检查
可以更准确的诊断ASA及合并心脏畸形
同时也能更全面的评估术后恢复效果。
Objective To analyze the preoperative diagnosis of aberrant subclavian artery (ASA) by echocardiography and CTA
and to evaluate the postoperative follow-up results. Methods Data of 192 childrens with ASA confirmed by cardiothoracic surgery were retrospectively analyzed. Results In 192 childrens
189 cases were right aortic arch with aberrant left subclavian artery (RAA-ALCA). 3 cases were left aortic arch with aberrant right subclavian artery (LAA-ARLA). 132 cases combine with other common cardiac structural malformations. The common malformations included 96 cases of Kommerell diverticulum
89 cases of atrial septal defect/patent foramen ovale
51 cases of ventricular septal defect
20 cases of left superior vena cava remaining
17 cases of patent ductus arteriosus. In 192 cases
echocardiography accurately diagnosed ASA in 124 cases (64.6%); 68 cases (35.4%) were misdiagnosed. A total of 174 cases (90.6%) were accurately diagnosed by CTA
and 18 cases (9.4%) were missed and misdiagnosed. In 132 cases complicated with other cardiac structural malformations
Echocardiography missed diagnosis of patent foramen ovale in 2 cases
47 cases of atrial septal defect/patent foramen ovale and small ventricular septal defect were missed by CTA diagnosis. In the follow-up of 96 children who underwent vagal left subclavian artery transplantation or Kommerell diverticulectomy
81 children who underwent vagal subclavian artery transplantation and Kommerell diverticulectomy had no obvious anastomotic obstruction
and 14 patients underwent CTA. Evaluated tracheal compression was less than preoperative.Conclusions Echocardiography and CTA in the preoperative diagnosis of ASA each have advantages and disadvantages
can respectively in the process of postoperative follow-up evaluation anastomotic and airway pressure situation
therefore
the joint multimodal inspections on echocardiography and CTA
can be more accurate diagnosis of ASA and merge heart abnormalities
as well as a more comprehensive evaluation of postoperative recovery effect.
超声心动图CTA迷走锁骨下动脉Kommerell憩室
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