Chin A J, Alboliras E T, Barber G, Murphy J D, Helton J G, Pigott J D, Norwood W I
Division of Cardiology, Children's Hospital of Philadelphia, Pennsylvania 19104.
J Am Coll Cardiol. 1990 Jun;15(7):1637-42. doi: 10.1016/0735-1097(90)92840-x.
The use of Doppler color flow imaging and axial contrast angiography in the preoperative detection of additional ventricular septal defects (in the setting of a known large defect) were compared in a prospective fashion. One hundred seventy-nine infants with two ventricles (each of at least normal size) and a large, nonrestrictive ventricular septal defect underwent reparative surgery before 2 years of age. The reference standard for the presence of additional defects was intraoperative verification or (in cases in which the surgeon did not visualize any additional defect) subsequent identification at postoperative angiography, postoperative color Doppler examination or reoperation. Only six patients (3%) had additional ventricular septal defects confirmed at the time of repair; an additional five (3%) had defects found only postoperatively. The negative predictive value of Doppler color flow imaging and angiography was 0.95 (168 of 176) and 0.97 (168 of 174), respectively. The sensitivity was 0.27 (3 of 11) and 0.45 (5 of 11), respectively. For certain malformations with a very low prevalence of additional muscular defects (such as perimembranous ventricular septal defect with normally aligned great arteries), a clinical trial of reparative surgery without prior invasive study appears reasonable.
以前瞻性方式比较了多普勒彩色血流成像和轴向对比血管造影在术前检测额外室间隔缺损（已知存在大的缺损情况下）的应用。179例具有两个心室（每个心室至少大小正常）且存在大的、非限制性室间隔缺损的婴儿在2岁前接受了修复手术。额外缺损存在的参考标准为术中确认，或（在外科医生未发现任何额外缺损的情况下）术后血管造影、术后彩色多普勒检查或再次手术时的后续识别。只有6例患者（3%）在修复时被确认存在额外的室间隔缺损；另有5例（3%）仅在术后发现缺损。多普勒彩色血流成像和血管造影的阴性预测值分别为0.95（176例中的168例）和0.97（174例中的168例）。敏感性分别为0.27（11例中的3例）和0.45（11例中的5例）。对于某些额外肌部缺损患病率非常低的畸形（如大动脉正常排列的膜周部室间隔缺损），在没有先前侵入性研究的情况下进行修复手术的临床试验似乎是合理的。
