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目的初步探讨先天性心脏病合并Chiari网(CN)诊疗中的超声指导价值。方法收集12例二维超声心动图(2DE)诊断先天性心脏病合并CN拟行手术的患儿为研究对象,2DE、3DE及多普勒技术相结合对CN进行诊断分型、CN相关性疾病排除,术中监测及术后评估。结果 12例患儿中房间隔缺损(ASD)5例;ASD和部分型肺静脉异位引流(PAPVC)1例,动脉导管未闭(PDA)2例,肺动脉瓣狭窄(PS)2例。5例行传统外科手术治疗,2例行经胸小切口封堵术,5例行经皮介入术。术前超声诊断CN呈网状型5例,呈条索状型7例,3例CN切除者2例呈网状型,1例呈条索型,与超声诊断相符。超声检测结果所有病例均无CN相关性疾病发生。3例中小型ASD封堵后CN被封堵器完全夹闭,及时发现PS经皮介入球囊扩张术后三尖瓣圆锥乳头肌撕脱1例并与CN进行了鉴别,即刻行乳头肌撕脱修补术,术后恢复良好。结论超声可对CN进行精确诊断与鉴别评估,在Chiari网合并先天性心脏病诊疗中具有重要的指导价值。
Objective To investigate the value of ultrasound guidance in the diagnosis and treatment of congenital heart disease (Chiari). Methods Twelve patients with congenital heart disease complicated with congenital heart disease underwent 2DE echocardiography (2DE) were enrolled in this study. The patients were diagnosed by 2DE, 3DE and Doppler technique. CN - related diseases Exclusion, intraoperative monitoring and postoperative evaluation. Results There were 5 cases of atrial septal defect (ASD) in 12 cases, 1 case of ASD and partial pulmonary venous drainage (PAPVC), 2 cases of patent ductus arteriosus (PDA) and 2 cases of pulmonary valve stenosis (PS). 5 cases were treated by traditional surgery, 2 cases were performed transcatheter closure of small incision, and 5 cases were treated by percutaneous intervention. Preoperative ultrasound diagnosis of CN was reticular in 5 cases, 7 cases were in the form of cords, 3 cases of CN resection in 2 cases were reticular, 1 cases were cords, consistent with the diagnosis of ultrasound. Ultrasound results in all cases of CN-related diseases. 3 cases of small and medium ASD occlusion CN was completely occluded occluder, PS found in time after percutaneous balloon dilatation of the tricuspid cone papillary muscle avulsion in 1 case and were identified with CN, immediate tearing Decompensation, postoperative recovery is good. Conclusion Ultrasound can be accurate diagnosis of CN and differential assessment, Chiari network with congenital heart disease diagnosis and treatment has an important guiding value.