Boccanelli A, Picchio E, Gambelli G, Siclari F, Pezzella A, Giovannini E, Prati P L
G Ital Cardiol. 1980;10(10):1394-402.
Three patients with corrected transposition of the great arteries (CTGA) have been studied by means of single plane (M-mode) and two-dimensional (2-D) echocardiography: the first study was performed after surgical closure of a VSD and the remaining two before cardiac catheterization. The following M-mode findings can suggest the diagnosis in CTGA: the interventricular septum (IVS) may not be visualized, there is lack of continuity between the posterior a-v valve (tricuspid) echoes and the anterior great artery (aorta), the posterior a-v valve leaflets may show some abnormalities in shape. The measurement of systolic time intervals of both semilunar valves can help in distinguishing the pulmonary artery from the aorta; further information can be obtained by means of peripheral venous contrast injection, which, in absence of right-to-left shunt, opacifies the posterior great vessel (pulmonary). The 2-D view of the heart allows the identification of the morphological type of ventricle and of the spatial great arteries relationship. The posteriorly and left located ventricle is recognized as morphologically right, because of the tricuspidal shape of its a-v valve: its attachment to IVS is lower than that of the mitral valve (4-chambers view) and three leaflets may be evident (short-axis); 3 papillary muscles and gross trabeculations can be identified (short axis and 4-chambers views, respectively). In long-axis the anterior vessel (aorta) runs parallel to the sternum; in short-axis both vessels are imaged as adjacent circles; by means of peripheral contrast injection, in conditions without right-to-left-shunt, the right and posterior vessel is recognized as a pulmonary artery. The differential diagnosis is discussed with d-transposition, Fallot's tetralogy, Taussig-Bing anomaly, common trunk, univentricular heart. According to our experience, the diagnosis of CTGA and associated defects can be made by M-mode and 2-D echocardiography.
我们通过单平面(M型)和二维(2D)超声心动图对3例矫正型大动脉转位(CTGA)患者进行了研究:首例研究在室间隔缺损手术闭合后进行,其余两例在心脏导管检查前进行。以下M型超声心动图表现可提示CTGA的诊断:室间隔(IVS)可能无法显示,后房室瓣(三尖瓣)回声与前大动脉(主动脉)之间缺乏连续性,后房室瓣叶的形状可能存在一些异常。测量两个半月瓣的收缩时间间期有助于区分肺动脉和主动脉;通过外周静脉造影剂注射可获得更多信息,在无右向左分流的情况下,造影剂可使后大动脉(肺动脉)显影。心脏的二维视图可识别心室的形态类型以及大血管的空间关系。位于后方和左侧的心室在形态上被认为是右心室,因为其房室瓣呈三尖瓣形状:其与室间隔的附着点低于二尖瓣(四腔心视图),可能可见三个瓣叶(短轴视图);可分别在短轴和四腔心视图中识别出3个乳头肌和粗大的小梁。在长轴视图中,前方血管(主动脉)与胸骨平行;在短轴视图中,两根血管均显示为相邻的圆形;通过外周造影剂注射,在无右向左分流的情况下,右侧和后方的血管被识别为肺动脉。文中讨论了与d型转位、法洛四联症、陶西格-宾氏畸形、共同动脉干、单心室的鉴别诊断。根据我们的经验,M型和二维超声心动图可对CTGA及相关缺陷做出诊断。