Echocardiographic diagnosis of rare pathological patterns of sinus of Valsalva aneurysm.
Echocardiographic diagnosis of rare pathological patterns of sinus of Valsalva aneurysm.
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Valsalva窦瘤罕见病理模式的超声心动图诊断
DOI：
10.1371/journal.pone.0173122
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Xie M
中科院分区：
文献类型：
--
作者：
Yang Y;Zhang L;Wang X;Lü Q;He L;Wang J;Wang B;Li L;Yuan L;Liu J;Ge S;Xie M
目的探讨超声心动图在诊断罕见病理类型的Valsalva窦瘤(SVA)中的价值，提高诊断准确率。方法回顾分析协和医院近18年(1995~2013)收治的270例SVA患者的超声心动图特征与手术结果，其中22例有少见的超声心动图表现。结果270例中，少见来源、少见伸展部位、少见病程的SVA分别占3.4%、7.4%、0.4%。在罕见类型的患者中，最常见的3种动脉瘤并发症是严重的主动脉瓣关闭不全(16例)、室流出道或瓣口阻塞(3例)、传导障碍(3例)。超声心动图对室上性心动过速的起源、走行、延伸位置及破裂状态的判断与手术结果完全一致，占81.8%。除1例动脉瘤样壁夹层误诊和1例降主动脉夹层误诊外，SVA并发症及相关心血管病变的超声心动图结果也得到证实。结论通过超声心动图特征识别，可准确诊断少见病理类型的室上性心动过速。然而，在某些情况下，仅用常规超声心动图不能准确地确定动脉瘤的起源或进程，也不能确定其与邻近结构的关系。因此，我们建议将常规超声心动图与不同的成像技术相结合，如经食道超声心动图、三维超声心动图、计算机断层血管成像和主动脉血管成像。
Objective To evaluate the value and improve the diagnostic accuracy of echocardiography in the diagnosis of a sinus of Valsalva aneurysm (SVA) with rare pathological patterns. Methods Echocardiographic features and surgical findings from 270 Chinese patients with SVA treated in the last 18 years (1995–2013) at the Union Hospital were compared retrospectively; 22 of 270 cases had rare patterns. Results The patients with SVA, a rare origin, a rare extending position, or a rare course accounted for 3.4%, 7.4%, and 0.4% of the 270 cases, respectively. The three most common aneurysmal complications of the patients with rare patterns were severe aortic regurgitation (16), obstruction of the ventricular outflow tract or valvular orifice (3), and conduction disturbance (3). The origin, course, extending position and rupture status of the SVAs determined by echocardiography were entirely consistent with surgical findings in 81.8% of the 22 cases. With the exception of one failed diagnosis of an aneurysmal wall dissection and one misdiagnosis of a descending aortic dissection, the echocardiographic results of SVA complications and associated cardiovascular lesions were also confirmed. Conclusion We could accurately diagnose SVAs with rare pathological patterns by echocardiographic identification of distinguishing features. However, for several conditions, we could not accurately identify the origin or course of the aneurysm or define its relationship to adjacent structures using conventional echocardiography alone. Therefore, we recommend combining conventional echocardiography with different imaging techniques, such as transesophageal echocardiography, three-dimensional echocardiography, computed tomography angiography, and aortic angiography.