Dev V, Goswami K C, Shrivastava S, Bahl V K, Saxena A
Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Am Heart J. 1993 Oct;126(4):930-6. doi: 10.1016/0002-8703(93)90709-i.
Echocardiographic and Doppler data of 62 patients with ASOV are presented. Catheterization and angiography were performed in 38 cases and surgery in 25 of the 38. The origin of these aneurysms was the RCS in 56 cases, NCS in 5, and LCS in 1 case. Seven had unruptured aneurysms, 6 rising from RCS dissected into the ventricular septum, producing heart block in 4, AR in 5, mitral regurgitation in 1; 1 aneurysm rising from the LCS was asymptomatic. In other cases (n = 55) the aneurysm had ruptured into one of the cardiac chambers. Thirty-two of the 50 RCS aneurysms ruptured into the RVOT, 13 into the RV cavity, 2 into the RA, and 3 into the LV. Of the 5 NCS aneurysms, (3 ruptured into the RA, 1 into the RV, and 1 into both the RA and RV. Associated VSD was identified in 16 (25.8%) of 62 cases. All of these patients had RCS aneurysms that ruptured into the RVOT. Echocardiography missed VSD in three cases that at surgery were found to have VSD. AR was found in 34 of 62 cases. Echocardiography picked up discrete subaortic stenosis in two cases but missed subvalvar PS in 2 of the 3 cases. A detailed echocardiographic study (two-dimensional, Doppler, and color flow imaging) is accurate in the diagnosis of ASOV, in the identification of its site of origin and rupture, and in the evaluation of the associated defects; in the vast majority of cases, it can totally supplant the need for angiography.
本文呈现了62例主动脉窦瘤破裂（ASOV）患者的超声心动图和多普勒数据。38例患者进行了心导管检查和血管造影，其中25例接受了手术。这些动脉瘤起源于右冠状动脉窦（RCS）56例、无冠状动脉窦（NCS）5例、左冠状动脉窦（LCS）1例。7例为未破裂动脉瘤，6例起源于RCS并破入室间隔，4例导致心脏传导阻滞，5例导致主动脉反流（AR），1例导致二尖瓣反流；1例起源于LCS的动脉瘤无症状。在其他病例（n = 55）中，动脉瘤破裂入心脏腔室之一。50例RCS动脉瘤中，32例破入右心室流出道（RVOT），13例破入右心室腔，2例破入右心房（RA），3例破入左心室（LV）。5例NCS动脉瘤中，3例破入RA，1例破入RV，1例同时破入RA和RV。62例患者中有16例（25.8%）合并室间隔缺损（VSD）。所有这些患者的RCS动脉瘤均破入RVOT。超声心动图漏诊了3例手术中发现有VSD的病例。62例患者中有34例发现有AR。超声心动图在2例中发现了离散性主动脉瓣下狭窄，但在3例中有2例漏诊了瓣下肺动脉狭窄（PS）。详细的超声心动图研究（二维、多普勒和彩色血流成像）在ASOV的诊断、起源部位和破裂部位的识别以及相关缺陷的评估方面是准确的；在绝大多数情况下，它完全可以取代血管造影的需求。
