Candell Riera J, Rius Daví A, Aguadé Bruix S, Castell Conesa J, García del Castillo H, Ortega Alcalde D, Soler Soler J
Servicio de Cardiología, Hospital General Universitario de la Vall d'Hebron, Barcelona.
Rev Esp Cardiol. 1993 Apr;46(4):225-34.
The diagnostic yield of echocardiography, radionuclide ventriculography (first pass and multiple gated) and contrast ventriculography was evaluated in 11 patients in whom a diagnosis of left ventricular pseudoaneurysm had been made during the last ten years. The diagnosis was made by two dimensional echocardiography (associated with Doppler in the last 5 patients) in 8 of 11 patients (sensitivity: 73%). The major limitation of the technique, in addition to the impossibility of an adequate recording due to a suboptimal acoustic window, is the poor definition of the neck of the pseudoaneurysm, particularly in the inferior localization. By contrast, echocardiography is the only technique which permits the direct visualization of thrombi within the pseudoaneurysm. Multiple gated radionuclide ventriculography was diagnostic in 7 of 10 patients (sensitivity: 70%). Its major limitations are the poorer spatial resolution to visualize the pseudoaneurysm neck and the thrombi within the cavity. First pass radionuclide ventriculography was diagnostic in 4 of 6 patients (sensitivity: 67%). In one of them it improved on the diagnostic yield of the multiple gated technique. Contrast ventriculography was diagnostic in 5 of 7 patients (sensitivity: 71%). The diagnosis was missed due to technical problems in one patient and to significant thrombosis within the pseudoaneurysm in another. Thus, none of the imaging studies has optimal sensitivity. Therefore, all play a complementary role in the diagnosis of ventricular pseudoaneurysm.
对过去十年间确诊为左心室假性动脉瘤的11例患者进行了超声心动图、放射性核素心室造影（首次通过法和多门控法）及对比心室造影的诊断效能评估。11例患者中有8例通过二维超声心动图（最近5例联合多普勒）确诊（敏感性：73%）。该技术的主要局限性，除了因声学窗口欠佳无法进行充分记录外，还有假性动脉瘤颈部显示不清，尤其是在下壁部位。相比之下，超声心动图是唯一能直接观察到假性动脉瘤内血栓的技术。10例患者中有7例通过多门控放射性核素心室造影确诊（敏感性：70%）。其主要局限性在于观察假性动脉瘤颈部及腔内血栓的空间分辨率较差。6例患者中有4例通过首次通过法放射性核素心室造影确诊（敏感性：67%）。其中1例患者中，该方法提高了多门控技术的诊断效能。7例患者中有5例通过对比心室造影确诊（敏感性：71%）。1例患者因技术问题漏诊，另1例因假性动脉瘤内有大量血栓漏诊。因此，没有一种影像学检查具有最佳敏感性。所以，所有检查在心室假性动脉瘤的诊断中都发挥着互补作用。
