Yao Q, Hu X, Pa M, Huang G
Children's Hospital of Fudan University, No. 399 Wanyuan Road, Shanghai, P.R. China.
Herz. 2013 Aug;38(5):539-43. doi: 10.1007/s00059-012-3728-4. Epub 2013 Jan 23.
To compare the diagnostic accuracy of non-electrocardiogram-gated (non-ECG-gated) multidetector computed tomography angiography (MDCTA) with transthoracic echocardiography (TTE) in the evaluation of infracardiac total anomalous pulmonary venous connection (TAPVC) in neonate and infant patients.
Nine patients aged from 2 days to 3 months were included in this study. All clinical and imaging data were reviewed. Compared with findings from surgery, the diagnostic accuracy of MDCTA and TTE was calculated in three respects: the path of the drainage vein, the drainage site, and the stenosis of the vein.
Images acquired from all patients were eligible for diagnosis and reconstruction. The sites of the drainage point were all clarified and the drainage vessels were oriented by axial and reconstructed images. Stenosis was found at 13 sites, including mild stenosis at the diaphragmatic level (n = 3), distortion or stenosis at the drainage site (n = 5), and hypogenesis of the pulmonary vein branch (n = 5). TTE misdiagnosed the upward-flowing collateral vessels as the drainage veins in 2 patients and misidentified the drainage site in 7 patients, yielding an accuracy of 77.8% and 22.9%, respectively. It identified stenosis at four sites at the drainage site in concordance with MDCTA. The hypogenesis of the pulmonary vein branch was not detected and the stenosis at the diaphragmatic level was not suggested by TTE.
For infracardiac TAPVC, non-ECG-gated MDCTA is superior to TTE and can facilitate the preoperative evaluation when combined with TTE.
比较非心电图门控（非ECG门控）多层螺旋计算机断层血管造影（MDCTA）与经胸超声心动图（TTE）在评估新生儿和婴儿心内型完全性肺静脉异位连接（TAPVC）中的诊断准确性。
本研究纳入9例年龄从2天至3个月的患者。回顾所有临床和影像数据。与手术结果相比，从引流静脉路径、引流部位和静脉狭窄三个方面计算MDCTA和TTE的诊断准确性。
所有患者获取的图像均适合诊断和重建。通过轴位图像和重建图像明确了引流点的位置并确定了引流血管的走行。在13个部位发现狭窄，包括膈肌水平轻度狭窄（n = 3）、引流部位扭曲或狭窄（n = 5）以及肺静脉分支发育不全（n = 5）。TTE将2例患者向上走行的侧支血管误诊为引流静脉，7例患者误诊了引流部位，诊断准确率分别为77.8%和22.9%。TTE与MDCTA一致地识别出4个引流部位的狭窄。TTE未检测到肺静脉分支发育不全，也未提示膈肌水平的狭窄。
对于心内型TAPVC，非ECG门控的MDCTA优于TTE，与TTE联合使用时可有助于术前评估。
