对比增强经颅多谱勒超声对心房右向左分流患者的诊断价值的分析

目的:比较对比增强经颅多普勒超声与经胸壁超声心动图、经食管超声心动图对心房右→左分流患者的鉴别诊断价值。方法:回顾性分析2014年9月至2018年11月哈尔滨医科大学附属第一医院经手术证实的41例心房右→左分流患者对比增强经颅多普勒超声及经胸壁超声心动图的检查所见及诊断结果,并回顾性分析其中29例患者对比增强经颅多普勒超声、经胸壁超声心动图及经食管超声心动图的检查所见及诊断结果。结果:在经手术证实的41例心房右→左分流患者中,对比增强经颅多普勒超声检查阳性结果 41例,阴性结果 0例,诊断准确性为100%;经胸壁超声心动图检查阳性结果 20例,阴性结果 21例,诊断准确性为48.8%。其中,同时进行对比增强经颅多普勒超声、经胸壁超声心动图及经食管超声心动图检查的29例患者中,经胸壁超声心动图阳性结果 12例,阴性结果 17例,诊断准确性为41.4%;经食管超声心动图检查阳性结果 24例,阴性结果 5例,诊断准确性为82.8%。结论:对比增强经颅多普勒超声可提高心房右→左分流的诊断准确率,其与经胸壁超声心动图及经食管超声心动图结合应用可提高心房右→左分流的鉴别诊断能力。

Diagnostic value of Contrast Enhanced Transcranial Doppler for the Atrial Right-to-left Shunt Patients

ABSTRACT Objective: To compare the clinical value of contrast enhanced transcranial Dopple ultrasound, transthoracic echocardiography and transesophageal echocardiography in diagnosing atrial right to left shunt patients. Methods: The clinical manifestations of 41 right to left shunt patients which were confirmed by postoperative pathology were retrospectively analyzed in the First Affiliated Hospital of Harbin Medical University from September 2014 to November 2018. The results were compared between the contrast enhanced transcranial Dopple ultrasound and transthoracic echocardiography. 29 of them were even retrospectively analyzed and compared the results between the contrast enhanced transcranial Dopple ultrasound and transesophageal echocardiography. Results: To 41 right to left shunt patients who were confirmed by postoperative pathology, contrast enhanced transcranial doppler ultrasound showed positive results in 41 cases and negative results in 0 cases. The accuracy of diagnosis of atrial right to left shunt was 100% for contrast enhanced transcranial Dopple ultrasound. But for transthoracic echocardiography, twenty cases had positive results and 21 cases had negative results. The accuracy of diagnosis of atrial right to left shunt was 48.8% for transthoracic echocardiography. Contrast enhanced transcranial doppler echocardiography, transthoracic echocardiography and transesophageal echocardiography were performed in 29 patients. Transthoracic echocardiography had positive results in 12 cases and negative results in 17 cases, with the diagnostic accuracy of 41.4%. The results of transesophageal echocardiography were positive in 24 cases and negative in 5 cases, with the diagnostic accuracy of 82.8%. The contrast enhanced transcranial doppler ultrasound with the diagnostic accuracy of 100%. Conclusion: Contrast enhanced transcranial doppler ultrasound can improve the diagnostic accuracy of atrial right to left shunt, and its combined application with transthoracic echocardiography and transesophageal echocardiography can improve the differential diagnosis ability of atrial right to left shunt.