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  • Title: [The limitation of transthoracic echocardiography in diagnosing partial anomalous pulmonary venous drainage].
    Author: Zhang J, Gao Y, Yang JL, Chen WD, Huang GY, Ma XJ.
    Journal: Zhonghua Er Ke Za Zhi; 2017 May 04; 55(5):360-363. PubMed ID: 28482387.
    Abstract:
    Objective: To improve the diagnostic accuracy of transthoracic echocardiography (TTE) by analyzing its limitations in diagnosing partial anomalous pulmonary venous drainage (PAPVD). Method: This was a retrospective analysis of PAPVD patients seen at the Children's Hospital of Fudan University from October 1 2006 to October 1 2016. The echocardiographic data were compared to findings on multi-slice spiral CT (MSCT), cardiac catheterization or surgery. The echocardiography machines used were Philip IE33, GE Vivid 7 and Vivid i with frequency ranging from 5.0 MHz to 7.5 MHz. The cardiac structure was analyzed according to Van Praagh segments. Result: A total of 43 cases of PAPVD were enrolled, male∶ female ratio 20∶23 with average age (27.9±21.4) months. Among them, 3 cases were simple PAPVD and 40 cases had other associated congenital heart diseases. TTE was successful in diagnosing 29 cases (67%) while 14 cases were missed. The diagnostic rate for right pulmonary vein drainage into superior vena cava, right atrium, inferior vena cava were 5/10, 17/20, and 3/5 respectively while left pulmonary vein drainage into left innominate vein was only 1/4. Added TTE images to re-exam the 9 of the 14 missed cases, 5 cases of abnormal drainage from right superior pulmonary vein were diagnosed, while 4 cases of drainage from right lower or left pulmonary vein were only picked up by indirect signs. Conclusion: The distance of the pulmonary veins from the routine ultrasound view and the possibility of branch number variation may limit the accuracy of TTE in diagnosing PAPVD, especially for drainage from right lower and left pulmonary vein. But TTE is still the preferred diagnostic method. The diagnostic rate could be increased by paying special attention to non-routine views including the suprasternal fossa, the right parasternal and subcostal area. 目的： 分析经胸超声心动图(TTE)诊断部分型肺静脉异位引流(PAPVD)的局限性，为临床提高诊断率提供参考。 方法： 临床资料回顾性分析2006年10月1日至2016年10月1日复旦大学附属儿科医院经多排螺旋CT(MSCT)、心导管及手术证实为PAPVD患儿的超声心动图资料。超声心动图机器为Philip IE33、GE Vivid 7和Vivid i。经胸探头频率为5.0～7.5 MHz。TTE根据Van Praagh节段分析法进行心脏结构诊断。 结果： 共43例PAPVD，男∶女＝20∶23，年龄(27.9±21.4)个月。单纯PAPVD3例，合并其他先天性心脏病40例。TTE诊断29例，漏诊14例，诊断率为67%。对右肺静脉回流上腔静脉、右房或下腔静脉和左肺静脉回流左无名静脉诊断率分别为5/10、17/20、3/5和1/4。增加TTE切面观对其中漏诊的9例PAPVD重新检查，可诊断5例右上肺静脉异位引流，4例右下或左肺静脉异位引流为间接征象提示诊断。 结论： 肺静脉位于TTE远场以及存在支数变异，TTE对PAPVD诊断存在局限性，尤其是右下及左侧肺静脉，但仍是首选的影像学检查方法。重视胸骨上、右侧胸骨旁及剑突下等非常规切面观，可提高超声心动图对PAPVD的诊断率。.
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