Van Hare G F, Silverman N H
Department of Pediatrics, University of California, San Francisco School of Medicine.
J Am Coll Cardiol. 1989 Mar 1;13(3):673-86. doi: 10.1016/0735-1097(89)90610-4.
Saline contrast echocardiography was performed in 889 children from June 1976 through February 1988. One-third of these studies were in postoperative patients. A patent foramen ovale was identified by finding right to left shunting on venous contrast injection in 37% of 127 children studied with a structurally normal heart. The incidence of such shunting was greater at younger ages (55% younger than 1 month versus 22% older than 1 month). In most patients with an atrial or ventricular septal defect, some right to left shunting was demonstrable. The technique was useful in distinguishing different forms of atrial septal defect and identifying muscular ventricular septal defects that were difficult to image directly. The technique was used in the catheterization laboratory to aid in the identification of congenital coronary artery fistulas and was diagnostic in two cases of pulmonary arteriovenous malformation. In patients with situs abnormalities, the technique was useful in identifying the systemic venous connections to the atria. Contrast echocardiography was also used in postoperative evaluations. The technique was useful in identifying patch leaks and residual defects after Senning, Mustard and Fontan operations, and after closure of atrial and ventricular septal defects. Most patients were found to have no superior vena cava obstruction by contrast echocardiography after the Senning or Mustard procedure. Contrast echocardiography continues to be a useful technique in the diagnosis of a wide spectrum of congenital heart disease, as well as in the postoperative evaluation of congenital heart surgery.
1976年6月至1988年2月期间，对889名儿童进行了盐水对比超声心动图检查。其中三分之一的检查是针对术后患者。在127名心脏结构正常的儿童中，通过静脉注射造影剂发现右向左分流，从而确定了卵圆孔未闭，占37%。这种分流的发生率在较年轻的年龄段更高（1个月以下的婴儿为55%，而1个月以上的为22%）。在大多数房间隔或室间隔缺损的患者中，都可显示出一些右向左分流。该技术有助于区分不同类型的房间隔缺损，并识别难以直接成像的肌部室间隔缺损。该技术在导管室中用于辅助识别先天性冠状动脉瘘，并且对两例肺动静脉畸形具有诊断价值。在存在心脏位置异常的患者中，该技术有助于识别体静脉与心房的连接。对比超声心动图还用于术后评估。该技术有助于识别Senning、Mustard和Fontan手术以及房间隔和室间隔缺损封堵术后的补片渗漏和残余缺损。通过对比超声心动图发现，大多数患者在Senning或Mustard手术后没有上腔静脉梗阻。对比超声心动图仍然是诊断多种先天性心脏病以及先天性心脏手术术后评估的有用技术。
