Lipshultz S E, Sanders S P, Mayer J E, Colan S D, Lock J E
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
J Am Coll Cardiol. 1988 Feb;11(2):373-8. doi: 10.1016/0735-1097(88)90105-2.
Two-dimensional and Doppler echocardiography were compared with cardiac catheterization and angiography in the preoperative evaluation of ostium primum atrial septal defect. Preoperative echocardiographic examinations as well as operative reports of all patients (33 patients aged 2 months to 23 years at surgery) with ostium primum atrial septal defect or transitional atrioventricular (AV) canal defect having had echocardiography and surgical repair at The Children's Hospital, Boston from July 1983 to January 1986 were retrospectively reviewed. Original cardiac catheterization and angiographic reports also were reviewed. Preoperative echocardiography resulted in no false positive or false negative primary diagnoses when compared with the diagnoses obtained at preoperative angiography or surgery. Doppler assessment of mitral regurgitation correlated well with angiographic (93% agreement) and intraoperative (85% agreement) assessments of mitral regurgitation to within two diagnostic categories on the six level scoring system used. There was reasonably good agreement between the two-dimensional echocardiographic estimate of right ventricular systolic pressure and that measured at catheterization when expressed as percent of the simultaneous left ventricular pressure. Seven of nine ventricular septal defects observed intraoperatively were noted on preoperative echocardiography; five of these defects were detected on preoperative angiography. A variety of other surgically confirmed associated cardiovascular defects were observed by both preoperative techniques. However, echocardiography appeared to be superior to angiography for evaluation of AV valve morphology and papillary muscle architecture. This study implies that in children with typical clinical and two-dimensional echocardiographic and Doppler findings for ostium primum atrial septal defect or transitional AV canal defect, routine preoperative cardiac catheterization and angiography are unnecessary.
在原发孔型房间隔缺损的术前评估中，对二维及多普勒超声心动图与心导管检查和血管造影进行了比较。回顾性分析了1983年7月至1986年1月在波士顿儿童医院接受超声心动图检查和手术修复的所有原发孔型房间隔缺损或过渡型房室通道缺损患者（33例，手术时年龄2个月至23岁）的术前超声心动图检查结果以及手术报告。同时也回顾了原始的心导管检查和血管造影报告。与术前血管造影或手术获得的诊断相比，术前超声心动图未出现假阳性或假阴性的初步诊断。在使用的六级评分系统中，二尖瓣反流的多普勒评估与血管造影（一致性为93%）和术中（一致性为85%）对二尖瓣反流的评估在两个诊断类别范围内具有良好的相关性。当以同时测得的左心室压力的百分比表示时，二维超声心动图对右心室收缩压的估计与心导管检查测得的值之间存在合理良好的一致性。术中观察到的9个室间隔缺损中有7个在术前超声心动图中被发现；其中5个缺损在术前血管造影中被检测到。两种术前检查技术均观察到了多种其他经手术证实的相关心血管缺损。然而，在评估房室瓣形态和乳头肌结构方面，超声心动图似乎优于血管造影。这项研究表明，对于具有典型临床、二维超声心动图和多普勒表现的原发孔型房间隔缺损或过渡型房室通道缺损患儿，术前常规的心导管检查和血管造影是不必要的。
