经胸超声胸骨右缘切面对Stanford A型主动脉夹层诊断价值的研究

目的:通过经胸超声心动图获取胸骨右缘升主动脉长短轴切面观察Stanford A型主动脉夹层患者的升主动脉结构,探讨对该类患者进行检查时该切面的应用价值。方法:31例经CTA或手术证实为A型主动脉夹层的连续性患者,超声心动图检查除常规通过胸骨左缘切面观察升主动脉结构外,均做胸骨右缘切面以进一步观察升主动脉结构,包括最大内径,有无撕脱内膜及内膜活动情况,同时应用常规胸骨左缘切面和胸骨右缘切面对A型主动脉夹层能够清晰显示出的病例比例加以比较。结果:胸骨左缘切面能够清晰显示升主动脉结构9例,占比例29%。胸骨右缘切面能够清晰显示升主动脉结构20例,比例65%。将两种切面结合能够清晰显示升主动脉结构的比例升高到74%。胸骨右缘肋间切面测得的升主动脉最大径线数值与CTA结果的一致性更好。结论:胸骨右缘肋间切面对A型主动脉夹层显示的清晰度更好,有助于临床诊断,具有重要的参考价值,值得临床广泛推广。

Diagnostic Value of the Right Parasternal Window of Transthoracic Echocardiography in the Diagnosis of Stanford A Aortic Dissection

ABSTRACT Objective: We observed ascending aorta structure in patients with Stanford A aortic dissection by using transthoracic echocardiography to obtain the long and short axis of the right parasternal intercostal window. The purpose of this study is to explore the application value of this echocardiographic window in this type of patients. Methods: The ascending aorta of 31 successive patients with type A aortic dissection confirmed by CTA or surgery was observed by the echocardiographic left parasternal window and right parasternal window, including the maximal inner diameter, the avulsion and activity of the intima. The proportion which could clearly displayed struture of ascending aorta in this two windows was compared. Results: The left parasternal window clearly displayed the structure of the ascending aorta in 9 cases, with a proportion of 29%. The right parasternal window clearly displayed the ascending aorta structure in 20 cases, with a proportion of 65%. The proportion of combining two kinds of windows increased to 74%. The maximum diameter of ascending aorta measured by the right parasternal window is more consistent with that of CTA. Conclusion: The right parasternal intercostal window has great significance in diagnosising type A aortic dissection and deserved be widely popularized.