Wong M L, McCrindle B W, Mota C, Smallhorn J F
Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1995 Aug;26(2):503-7. doi: 10.1016/0735-1097(95)80029-g.
This study was undertaken to determine the accuracy of routine echocardiography in the detection of partial anomalous pulmonary venous drainage.
Although there are occasional case reports of the echocardiographic appearance of partial anomalous pulmonary venous drainage, no large series have addressed the accuracy of this technique in a large cohort of patients.
Between January 1983 and December 1993, 50 patients with partial anomalous pulmonary venous drainage (with or without an associated atrial septal defect as the only other significant intracardiac defect) were identified from the data base at the Hospital For Sick Children, Toronto. Routine echocardiographic reports were reviewed, and the results were compared with surgical or catheterization findings. Risk factors related to diagnostic errors were sought using a Fisher exact test, chi-square analysis, t test and Kruskal-Wallis analysis of variance.
Confirmation of the diagnosis was available in 45 patients whose data were subsequently used for risk factor analysis. The median age at echocardiography was 4.1 years (range 1 month to 18 years). Right-sided drainage was present in 43 patients (86%), with left-sided drainage in 7 (14%). Thirteen patients had an intact atrial septum, 7 a patent foramen ovale and 30 a secundum atrial septal defect. Right ventricular dilation was observed in 46 patients. Two had normal dimensions (two not assessed). The diagnosis was missed by echocardiography in 15 (33%) of the 45 patients with a confirmed diagnosis. Year of study and use of color flow mapping were the only significant variables related to detection rate (7% missed diagnosis with vs. 62% without the use of color flow, p < 0.0005). The median year of missed diagnosis was 1985 versus 1990 (p < 0.002). Transesophageal echocardiography accurately defined the site of drainage in all three patients in whom it was utilized.
Two-dimensional echocardiography in conjunction with color flow mapping is a valuable tool for the diagnosis of partial anomalous pulmonary venous drainage.
本研究旨在确定常规超声心动图检测部分性肺静脉异位引流的准确性。
尽管偶尔有关于部分性肺静脉异位引流超声心动图表现的病例报告，但尚无大型系列研究探讨该技术在大量患者中的准确性。
在1983年1月至1993年12月期间，从多伦多病童医院的数据库中识别出50例部分性肺静脉异位引流患者（有或无相关房间隔缺损作为唯一其他重要的心内缺损）。回顾常规超声心动图报告，并将结果与手术或心导管检查结果进行比较。使用Fisher精确检验、卡方分析、t检验和Kruskal-Wallis方差分析寻找与诊断错误相关的危险因素。
45例患者可确诊，其数据随后用于危险因素分析。超声心动图检查时的中位年龄为4.1岁（范围1个月至18岁）。43例患者（86%）为右侧引流，7例（14%）为左侧引流。13例患者房间隔完整，7例卵圆孔未闭，30例继发孔房间隔缺损。46例患者观察到右心室扩大。2例尺寸正常（2例未评估）。在45例确诊患者中，15例（33%）超声心动图漏诊。研究年份和彩色血流图的使用是与检出率相关的唯一显著变量（使用彩色血流图时漏诊率为7%，未使用时为62%，p<0.0005）。漏诊的中位年份为1985年与1990年（p<0.002）。经食管超声心动图在所有3例使用该技术的患者中准确确定了引流部位。
二维超声心动图结合彩色血流图是诊断部分性肺静脉异位引流的有价值工具。
