Comparative study in imaging diagnosis and the operation findings of 155 cases with complicated congenital cardiac anomalies
Xiao-jing Ma Yuan Yuan Yan Chen Jing-jing Wang
Wuhan Asia Heart Hospital Image center (430022)
马小静
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Methods The transthoracic echocardiography examinations were performed on all the cases .In the 84 cases of group A ,20 of them (23.8%) underwent cardiac angiography exams, in the 71 cases of group B ,all of them underwent 64- slices CT exams.
Results In the 155 cases, there are 69 cases of double-outlet right ventricle (DORV),24 cases of single ventricle(SV),21 cases of pulmonary atresia (PA),20 cases of transposition of great arteries(TGA),9 cases of aortic coarctation (AC),5 cases of aortic-pulmonary window (A-P Window ,one of them complicates with interrupted aortic arch and anomalous origin of right pulmonary artery from the ascending aorta),3 cases of common arterial trunk(CAT),2 cases of tricuspid atresia (TA),1 case of anomalous origin of right pulmonary artery from the ascending aorta, and 1 case of interrupted aortic arch (IAA). In group A , the results of the echocardiogram and cardiac angiography were consistent with the operation findings, and 2 of them were found with abnormal origin of the coronary artery (2/20，10％). In all the 71 cases of group B, the results of the echocardiogram and 64- slices CT were consistent with the operation findings, but in the results of CT, 6 cases （8.5％）were found with abnormal origin of the coronary artery ,2 cases （2.8％）with solitary coronary artery,2 cases （2.8％）with stenosis of left pulmonary artery ,1 case（1.4％） with development malformation of aortic arch. Also in the results of CT,16 cases （22.5％）were found with persistent left superior vena cava, but in the results of echocardiogram,10 cases were diagnosed with it , and the other 6 cases were missed diagnosed. All of the 155 patients underwent the surgical procedures, and 7 of them were cured in two stages. The corrective operation of DORV were performed in 41 cases, and the modified Fontan procedure in 28 cases, the bidirectional Glenn shunt in 27 cases, the Blalock-Taussing shunt in 17 cases , the Rastelli procedure in 20 cases, the repair of aortic coarctation in 9 cases, Arterial Switch procedure in 2 cases, the corrective operation of PA in 4 cases, the corrective operation of A-P window in 4 cases, the corrective operation of A-P window and interrupted aortic arch also ligation of patent ductus arteriosus in 1 case, the reconstruction procedure of right pulmonary artery in 1 case, the corrective operation of the anomalous origin of right pulmonary artery in 2 cases, the corrective operation of TGA and repair of Ventricular septal defec(VSD) in 2 cases, the corrective operation of CAT and ligation of patent ductus arteriosus in 1 case, the Nikaidoh procedure in 3 cases.
Conclusions The hearts with congenital complicated cardiac anomalies ofen contain complicated ,varied and multiple deformations, and the echocardiography is the primary method for diagnosis. The echocardiography can provide distinct images of the cardiac structure, and the relationship between abdominal organs and the heart , also it can make the evaluation of the real time haemodynamics and cardiac function easy. While the spiral CT has obviously superiority in diagnosis of abnormal origin of the coronary artery , malformations of aortic arch and descending aorta, pulmonary branch stenosis,, and abnormal connections of systemic and pulmonary veins. So combining echocardiography with CT in the diagnosis of congenital complicated cardiac anomalies can make it reliable and accurate, and is the optimal method in present.
