Yang Yali, Zhang Li, Wang Xinfang, Lü Qing, He Lin, Wang Jing, Wang Bin, Li Ling, Yuan Li, Liu Jinfeng, Ge Shuping, Xie Mingxing
Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.
The Heart Center, St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2017 Mar 14;12(3):e0173122. doi: 10.1371/journal.pone.0173122. eCollection 2017.
To evaluate the value and improve the diagnostic accuracy of echocardiography in the diagnosis of a sinus of Valsalva aneurysm (SVA) with rare pathological patterns.
Echocardiographic features and surgical findings from 270 Chinese patients with SVA treated in the last 18 years (1995-2013) at the Union Hospital were compared retrospectively; 22 of 270 cases had rare patterns.
The patients with SVA, a rare origin, a rare extending position, or a rare course accounted for 3.4%, 7.4%, and 0.4% of the 270 cases, respectively. The three most common aneurysmal complications of the patients with rare patterns were severe aortic regurgitation (16), obstruction of the ventricular outflow tract or valvular orifice (3), and conduction disturbance (3). The origin, course, extending position and rupture status of the SVAs determined by echocardiography were entirely consistent with surgical findings in 81.8% of the 22 cases. With the exception of one failed diagnosis of an aneurysmal wall dissection and one misdiagnosis of a descending aortic dissection, the echocardiographic results of SVA complications and associated cardiovascular lesions were also confirmed.
We could accurately diagnose SVAs with rare pathological patterns by echocardiographic identification of distinguishing features. However, for several conditions, we could not accurately identify the origin or course of the aneurysm or define its relationship to adjacent structures using conventional echocardiography alone. Therefore, we recommend combining conventional echocardiography with different imaging techniques, such as transesophageal echocardiography, three-dimensional echocardiography, computed tomography angiography, and aortic angiography.
评估超声心动图在诊断具有罕见病理类型的瓦氏窦瘤（SVA）中的价值并提高其诊断准确性。
回顾性比较18年来（1995 - 2013年）在协和医院接受治疗的270例中国SVA患者的超声心动图特征和手术结果；270例中有22例具有罕见类型。
SVA起源罕见、延伸位置罕见或走行罕见的患者分别占270例的3.4%、7.4%和0.4%。具有罕见类型的患者最常见的三种瘤样并发症为严重主动脉瓣反流（16例）、心室流出道或瓣膜口梗阻（3例）和传导障碍（3例）。22例中81.8%的病例经超声心动图确定的SVA起源、走行、延伸位置及破裂情况与手术结果完全一致。除1例假阴性诊断为瘤壁夹层及1例假阳性诊断为降主动脉夹层外，SVA并发症及相关心血管病变的超声心动图结果也得到证实。
通过超声心动图识别特征可准确诊断具有罕见病理类型的SVA。然而，对于几种情况，仅使用传统超声心动图无法准确识别瘤体的起源或走行，也无法确定其与相邻结构的关系。因此，我们建议将传统超声心动图与不同的成像技术相结合，如经食管超声心动图、三维超声心动图、计算机断层血管造影和主动脉血管造影。
