主動脈瓣下隔膜的漏診分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

趙洋 ,  金巖 , 于巖 , 方敏華

北部戰區總醫院心血管外科（沈陽 110016）;

Corresponding?author：

金巖, Email: 13309888850@163.com

Keywords：

先天性心臟病; 主動脈瓣下隔膜; 漏診; 心臟超聲; 增強CT

DOI：

10.7507/1007-4848.202002018

Video：

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目的總結主動脈瓣下隔膜（subaortic membrane，SM）的漏診情況及常見原因，以提高診斷的準確率。方法篩選我院 2011 年 1 月至 2019 年 9 月間 SM 漏診的 14 例患者，其中男 10 例、女 4 例，手術時平均年齡（50.1±14.5）歲。回顧性分析術前心臟超聲及 CT 等檢查結果。結果 92.3% （13/14）漏診患者是成人，所有成人患者均有較嚴重主動脈瓣病變，術前及術中未發現明顯左室流出道梗阻，術中探查見瓣下隔膜均與主動脈瓣距離小（<5 mm），及與贅生物、鈣化灶關系密切。所有患者均伴有其它心臟疾病，最多為主動脈瓣二葉化畸形（8/14，57.1%），其次為感染性心內膜炎（4/14，28.6%，其中 2 例合并主動脈瓣二葉化畸形）。術中隔膜組織均完全切除，大多數進行主動脈瓣人工瓣置換（12/14，85.7%）。所有患者隨訪至 2020 年 1 月均無復發。結論合并其它畸形或者瓣膜疾病的 SM 在未造成左室流出道梗阻時可能造成漏診，主動脈瓣發育異常或感染性心內膜炎患者應注意檢查主動脈瓣下結構。部分漏診患者的瓣下隔膜可能是繼發性病變。結合心臟超聲和增強 CT 檢查是診斷 SM 的有效方法，增加三維重建可提高本病診斷率。

Citation： 趙洋, 金巖, 于巖, 方敏華. 主動脈瓣下隔膜的漏診分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1495-1499. doi: 10.7507/1007-4848.202002018 Copy

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10.	武彧, 呂清, 王新房. 超聲心動圖對主動脈瓣下狹窄的診斷價值. 臨床超聲醫學雜志, 2012, 2(14): 104-106.
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13.	Ko SM, Song MG, Hwang HK. Bicuspid aortic valve: spectrum of imaging findings at cardiac MDCT and cardiovascular MRI. AJR Am J Roentgenol, 2012, 198(1): 89-97.
14.	邵曉宇. 基于 CT 影像處理的心臟腔室四維建模及分析系統設計. 南昌航空大學, 2017.
15.	Song Y, Yang DH, ó Hartaigh B, et al. Geometric predictors of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a 3D computed tomography analysis. Eur Heart J Cardiovasc Imaging, 2018, 19(10): 1149-1156.
16.	孟存忠, 高揚, 劉坤, 等. 雙源 CT 在成人主動脈瓣二瓣化畸形診斷中的應用價值. 中國臨床醫學影像雜志, 2016, 27(9): 629-633, 669.

1. 易定華, 徐志云, 王輝山, 主編. 心臟外科學(第 2 版). 北京: 人民軍醫出版社, 2016. 966-975.
2. Kemna EH, Tjalsma H, Willems HL, et al. Hepcidin: from discovery to differential diagnosis. Haematologica, 2008, 93(1): 90-97.
3. Barboza LA, Garcia Fde M, Barnoya J, et al. Subaortic membrane and aorto-septal angle: an echocardiographic assessment and surgical outcome. World J Pediatr Congenit Heart Surg, 2013, 4(3): 253-261.
4. Kim KH, Kim HK, Chang SA, et al. Subaortic membrane late after surgical correction of tetralogy of Fallot. Korean J Intern Med, 2012, 27(4): 455-458.
5. Butany J, Vaideeswar P, David TE. Discrete subaortic membranes in adults--a clinicopathological analysis. Cardiovasc Pathol, 2009, 18(4): 236-242.
6. Pigeon C, Ilyin G, Courselaud B, et al. A new mouse liver-specific gene, encoding a protein homologous to human antimicrobial peptide hepcidin, is overexpressed during iron overload. J Biol Chem, 2001, 276(11): 7811-7819.
7. Michelena HI, Della Corte A, Prakash SK, et al. Bicuspid aortic valve aortopathy in adults: Incidence, etiology, and clinical significance. Int J Cardiol, 2015, 201: 400-407.
8. 梅舉, 章斌, 張寶仁, 等. 先天性主動脈瓣二葉化畸形的外科治療. 中國胸心血管外科臨床雜志, 2002, 9(2): 84-86.
9. de Agustin JA, Gomez de Diego JJ, Marcos-Alberca P, et al. Combined subaortic membrane and aortic valve stenosis: additive value of three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging, 2014, 15(4): 388.
10. 武彧, 呂清, 王新房. 超聲心動圖對主動脈瓣下狹窄的診斷價值. 臨床超聲醫學雜志, 2012, 2(14): 104-106.
11. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
12. 羅松, 黃鵬飛, 周長圣, 等. 雙源 CT 血管成像在先天性主動脈瓣葉畸形診斷中的應用. 實用放射學雜志, 2013, 29(2): 212-214.
13. Ko SM, Song MG, Hwang HK. Bicuspid aortic valve: spectrum of imaging findings at cardiac MDCT and cardiovascular MRI. AJR Am J Roentgenol, 2012, 198(1): 89-97.
14. 邵曉宇. 基于 CT 影像處理的心臟腔室四維建模及分析系統設計. 南昌航空大學, 2017.
15. Song Y, Yang DH, ó Hartaigh B, et al. Geometric predictors of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a 3D computed tomography analysis. Eur Heart J Cardiovasc Imaging, 2018, 19(10): 1149-1156.
16. 孟存忠, 高揚, 劉坤, 等. 雙源 CT 在成人主動脈瓣二瓣化畸形診斷中的應用價值. 中國臨床醫學影像雜志, 2016, 27(9): 629-633, 669.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

主動脈瓣下隔膜的漏診分析

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