Wippermann C F, Redel D A, Menschik T, Weinsheimer H R, Mittelbach V, Lè T P
Universitäts-Kinderklinik Bonn.
Z Kardiol. 1989 Mar;78(3):187-96.
In part 1 of this study 50 healthy children and 56 patients with known VSD were examined by color-Doppler-echocardiography to derive criteria for the diagnosis of a VSD by this technique. Using a defined Nyquist velocity the healthy children showed a monochrome ventricular bloodflow pattern. In patients with VSD and an interventricular pressure gradient greater than 15 mm Hg a turquois-yellow jet could be seen additionally in the ventricle with the lower pressure. The same pattern could be observed within the defect itself, except for four patients, in whom the VSD could not be visualized by two-dimensional echocardiography. In these patients, however, the VSD could be localized by tracing the jet to the septal endocardium. In patients with equal left and right ventricular pressures a monochrome transseptal bloodflow could be seen. Its color pattern was not significantly different from the normal bloodflow pattern. In these cases it was difficult to diagnose a small VSD, if the defect itself could not be visualized. Thus, the following criteria for the diagnosis of a VSD by color-Doppler-echocardiography were derived depending on the interventricular pressure gradient: 1) Interventricular pressure gradient greater than 15 mm Hg: visualization of the VSD-jet including its origin at the septal endocardium. 2) Equal left and right ventricular pressures: visualization of the VSD as echo drop-out as well as a transseptal bloodflow. Using these criteria, sensitivity and specificity of color-Doppler-echocardiography in the detection of VSD were evaluated in part II; 234 consecutive patients, of which 119 had a VSD, were examined. All had undergone cardiac catheterisation. A high sensitivity of 98.3% and a specificity of 99.1% were found. Diagnostic problems remain in patients with a small VSD and also in patients with equal left and right ventricular pressures. In particular, multiple VSD with equal left and right ventricular pressures are difficult to visualize completely, as compared to cases with significant interventricular pressure gradients.
在本研究的第一部分，对50名健康儿童和56名已知患有室间隔缺损（VSD）的患者进行了彩色多普勒超声心动图检查，以得出用该技术诊断VSD的标准。使用规定的奈奎斯特速度时，健康儿童显示出单色的心室血流模式。在室间隔缺损且心室间压力梯度大于15 mmHg的患者中，在压力较低的心室中还可额外看到蓝绿色-黄色的血流束。除了4名患者外，在缺损本身内也可观察到相同的模式，这4名患者的室间隔缺损无法通过二维超声心动图显示。然而，在这些患者中，可通过追踪血流束至间隔心内膜来定位室间隔缺损。在左右心室压力相等的患者中，可看到单色的跨间隔血流。其颜色模式与正常血流模式无显著差异。在这些情况下，如果缺损本身无法显示，则很难诊断出小的室间隔缺损。因此，根据心室间压力梯度得出了以下用彩色多普勒超声心动图诊断室间隔缺损的标准：1）心室间压力梯度大于15 mmHg：显示室间隔缺损血流束，包括其起源于间隔心内膜。2）左右心室压力相等：将室间隔缺损显示为回声失落以及跨间隔血流。使用这些标准，在第二部分中评估了彩色多普勒超声心动图检测室间隔缺损的敏感性和特异性；对234例连续患者进行了检查，其中119例患有室间隔缺损。所有患者均接受了心导管检查。结果发现敏感性高达98.3%，特异性为99.1%。对于小室间隔缺损患者以及左右心室压力相等的患者，仍存在诊断问题。特别是，与心室间压力梯度明显的病例相比，左右心室压力相等的多发室间隔缺损很难完全显示。
