San Román J A, Vilacosta I, Zamorano J, Castillo J A, Rollán M J, Villanueva M A, Almería C, Sánchez-Harguindey L
Servicio de Cardiología, Hospital Universitario de San Carlos, Madrid.
Rev Esp Cardiol. 1993 Dec;46(12):810-5.
Transthoracic echocardiography is the most useful noninvasive method to diagnose atrial septal defect. It is suggested by some authors that transesophageal echocardiography is more accurate than transthoracic echocardiography in this setting. Our aim was to compare the usefulness of both techniques in: 1) diagnosing atrial septal defect, 2) detecting associated anomalies and 3) postoperative assessment.
Pre and postoperative transthoracic and transesophageal echocardiography were performed in 27 patients in whom diagnosis of atrial septal defect was confirmed at surgery.
Transthoracic echocardiography demonstrated the defect in 20 patients (74%) (8 ostium primum, 10 ostium secundum and 2 sinus venosus). The 27 patients (100%) were correctly diagnosed by transesophageal echocardiography (8 ostium primum, 12 ostium secundum and 7 sinus venosus). Defect size determined by transthoracic echocardiography had a poor correlation with the surgical measurement (r = 0.34). A good correlation was obtained when transesophageal versus surgical defect size measurements were compared (r = 0.85; p < 0.05). Transesophageal echocardiography was superior in detecting associated anomalies (5 patients with anomalous partial pulmonary venous drainage, 3 persistence of left superior vena cava and 1 atrial septal aneurysm). Moreover, this technique better determined residual atrial septal defect, and detected a postsurgical inferior vena cava connection to the left atrium.
Transesophageal echocardiography is superior to transthoracic echocardiography in diagnosing atrial septal defect sinus venosus type, detecting associated anomalies and postoperative assessment. Transthoracic echocardiography is diagnostic in the majority of patients with atrial septal defect ostium primum and ostium secundum types.
经胸超声心动图是诊断房间隔缺损最有用的无创方法。一些作者认为，在此情况下经食管超声心动图比经胸超声心动图更准确。我们的目的是比较这两种技术在以下方面的实用性：1）诊断房间隔缺损；2）检测相关异常；3）术后评估。
对27例手术中确诊为房间隔缺损的患者进行了术前和术后经胸及经食管超声心动图检查。
经胸超声心动图在20例患者（74%）中显示出缺损（8例原发孔型、10例继发孔型和2例静脉窦型）。经食管超声心动图对27例患者（100%）做出了正确诊断（8例原发孔型、12例继发孔型和7例静脉窦型）。经胸超声心动图测定的缺损大小与手术测量值的相关性较差（r = 0.34）。比较经食管超声心动图与手术缺损大小测量值时，相关性良好（r = 0.85；p < 0.05）。经食管超声心动图在检测相关异常方面更具优势（5例部分肺静脉异位引流、3例左上腔静脉持续存在和1例房间隔瘤）。此外，该技术能更好地确定残余房间隔缺损，并检测到术后下腔静脉与左心房的连接。
经食管超声心动图在诊断静脉窦型房间隔缺损、检测相关异常及术后评估方面优于经胸超声心动图。经胸超声心动图对大多数原发孔型和继发孔型房间隔缺损患者具有诊断价值。
