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中华妇幼临床医学杂志(电子版) ›› 2019, Vol. 15 ›› Issue (06) : 662 -668. doi: 10.3877/cma.j.issn.1673-5250.2019.06.009

所属专题： 文献；

论著

医学影像学在肺动脉吊带诊断中的价值
赵福敏1, 谢亮2, 陈娇3,†(), 郭楠3, 刘丹3, 伍婷3, 朱琦3   
  1. 1. 四川大学华西第二医院放射科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041
    2. 四川大学华西第二医院，西部妇幼医学研究院血管重构与发育缺陷研究室，成都　610041
    3. 四川大学华西第二医院超声科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041
  • 收稿日期:2019-07-10 修回日期:2019-11-11 出版日期:2019-12-01
  • 通信作者: 陈娇

Effects of medical imaging examinations for diagnosis of pulmonary artery sling before and after delivery

Fuming Zhao1, Liang Xie2, Jiao Chen3,†(), Nan Guo3, Dan Liu3, Ting Wu3, Qi Zhu3   

  1. 1. Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    2. The Vascular Remodeling and Developmental Defects Research Unit, West China Institute of Women and Children′s Health, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    3. Department of Ultrasound, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2019-07-10 Revised:2019-11-11 Published:2019-12-01
  • Corresponding author: Jiao Chen
  • About author:
    Corresponding author: Chen Jiao, Email:
  • Supported by:
    National Key Research and Development Plan Project(2017YFC0113905); Key Research and Development Project of Science & Technology Department of Sichuan Province(2019YFS0403, 2016FZ0061); Popularization and Application Project of Sichuan Health and Family Planning Commission(17PJ415, 16PJ234); People-Benefiting Technology Research and Development Project of Chengdu Science and Technology Bureau(2016-HM01-00102-SF)
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引用本文：

赵福敏, 谢亮, 陈娇, 郭楠, 刘丹, 伍婷, 朱琦. 医学影像学在肺动脉吊带诊断中的价值[J]. 中华妇幼临床医学杂志(电子版), 2019, 15(06): 662-668.

Fuming Zhao, Liang Xie, Jiao Chen, Nan Guo, Dan Liu, Ting Wu, Qi Zhu. Effects of medical imaging examinations for diagnosis of pulmonary artery sling before and after delivery[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(06): 662-668.

目的

探讨医学影像学在肺动脉吊带(PAS)诊断中的应用价值。

方法

选择2017年1月至2019年1月，在四川大学华西第二医院经生后手术确诊的4例PAS患儿为研究对象。采取回顾性分析法，分析这4例PAS患儿的胎儿超声心动图、胎儿心脏MRI、小儿超声心动图及小儿多层螺旋CT血管成像的影像学资料及其临床特征。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①PAS患儿胎儿超声心动图检查的基本切面，包括肺动脉长轴切面、三血管切面及三血管-气管切面的主要征象为，肺动脉分叉结构消失、左肺动脉异常起源于右肺动脉、左肺动脉于气管后方绕行及"C"形血管环；次要征象为左肺动脉内径小于右肺动脉。②PAS患儿的胎儿心脏MRI检查结果提示，于肺动脉干可见，左肺动脉起源于右肺动脉，并走行于气管后方。③PAS患儿的小儿超声心动图检查的基本切面为大动脉短轴切面，主要征象为肺动脉分叉结构消失、左肺动脉异常起源于右肺动脉。④PAS患儿的小儿多层螺旋CT血管成像主要表现为，左肺动脉起源于右肺动脉，并走行于气管后方，气管受压。

结论

PAS患儿产前采取的诊断方法，主要依赖于胎儿超声心动图，而胎儿心脏MRI可为超声检查提供补充证据。对PAS患儿出生后，可采用小儿超声心动图及小儿多层螺旋CT血管成像等多种影像学检查方法进行综合评估。

关键词: 肺动脉吊带, 超声检查，产前, 超声心动描记术, 多层螺旋CT, 磁共振成像, 胎儿
Objective

To study effects of medical imaging examinations for diagnosis of children pulmonary artery sling (PAS) before and after delivery.

Methods

From January 2017 to January 2019, a total of 4 children with PAS who were diagnosed by undergoing cardiac surgery in West China Second University Hospital, Sichuan University were selected into this study. Data of medical imaging examinations and clinical manifestations of 4 children with PAS, including fetal echocardiogram, fetal MRI, pediatric echocardiogram and multi-slice spiral CT angiography were analyzed retrospectively. This study was in line with the requirements of World Medical Association of Helsinki revised in 2013.

Results

①Fetal echocardiogram detected difference of long axis section of pulmonary artery, three blood vessels section and three blood vessel-trachea section. The main ultrasonic signs were bifurcation structure of the pulmonary artery disappeared, abnormal left pulmonary artery originated from the right pulmonary artery, the left pulmonary artery traced behind the trachea forming " C" shaped vascular ring. And secondary ultrasonic sign was diameter of the left pulmonary artery was smaller than that of the right pulmonary artery. ② Fetal cardiac MRI revealed the left pulmonary artery arising from the right pulmonary artery and going behind the trachea in the pulmonary artery trunk level. ③ Detections by pediatric echocardiogram were short axis section of the great artery, and its main ultrasonic signs were bifurcation of pulmonary artery disappeared, as well as abnormal left pulmonary artery originated from the right pulmonary artery. ④ Main manifestations of multi-slice spiral CT angiography in children revealed that the left pulmonary artery originated from the right pulmonary artery and traced behind the trachea, and the trachea was compressed.

Conclusions

Diagnosis of fetal PAS mainly depends on fetal echocardiogram, fetal cardiac MRI can provide supplementary diagnosis for ultrasound. Diagnosis of PAS children should be comprehensive evaluation by pediatric echocardiogram, multi-slice spiral CT angiography and other imaging methods.

Key words: Pulmonary artery sling, Ultrasonography, prenatal, Echocardiography, Multi-slice spiral CT, Magnetic resonance imaging, Fetus
图1 肺动脉吊带胎儿(患儿No. 1，孕妇接受胎儿超声心动图检查时孕龄为29＋5孕周)的胎儿超声心动图(图1A：肺动脉长轴切面的二维图像显示，肺动脉发出右肺动脉，左肺动脉由右肺动脉发出后向气管左后方绕行；图1B：三血管-气管切面的二维图像显示，肺动脉发出右肺动脉，左肺动脉由右肺动脉发出后向气管左后方绕行，形成血管环环绕气管)
图2 肺动脉吊带患儿(患儿No. 4，孕妇接受胎儿心脏MRI检查时孕龄为24＋5孕周)的胎儿心脏MRI检查结果
图3 肺动脉吊带患儿(患儿No. 2，男性，年龄为生后15 d)的小儿超声心动图
图4 肺动脉吊带患儿(患儿No. 1，男性，年龄为5个月)的小儿多层螺旋CT血管成像(图4A：小儿横轴位增强CT显示，左肺动脉源自右肺动脉，向左后方走行，环绕气管下端，形成"C"形环；图4B：小儿CT三维立体血管成像显示，肺动脉发出右肺动脉，左肺动脉由右肺动脉发出后向左后方绕行，形成"C"形环)
表1 本组4例肺动脉吊带患儿产前及产后医学影像学检查结果
患儿编号(No.) 胎儿超声心动图
检查时胎龄(周) 心率(次/min) 肺动脉前向血流速度(cm/s) 肺动脉(mm) 左肺动脉(mm) 右肺动脉(mm) CVP(分) 诊断结果
1 29＋5 152 0.53 6.7 2.8 3.9 10 PAS
2 23＋6 148 0.75 6.6 1.5 2.3 10 PAS
3 26＋3 149 0.49 6.0 2.2 3.0 10 PAS
4 24＋5 145 0.55 5.8 2.5 5.8 9 PAS、LSVC
患儿编号(No.) 胎儿心脏MRI 小儿多层螺旋CT血管成像 小儿超声心动图
检查时年龄 左肺动脉走行 受压气管内径(mm) 诊断结果 检查时年龄 诊断结果
1 无 生后5个月 气管后方 3.0 完全型PAS 生后44 d PAS、PDA
2 无 生后1 d 气管后方 3.8 完全型PAS 生后15 d PAS、PFO
3 无 生后2 d 气管后方 2.0 完全型PAS 生后2 d PAS、PFO、PDA
4 PAS、LSVC 生后3个月 气管后方 2.0 完全型PAS、LSVC 生后32 d PAS、PFO、LSVC
表2 4例肺动脉吊带患儿的临床特征
患儿编号(No.) 性别 娩出胎龄(周) 娩出方式 出生体重(g) 生后1-5-10 min Apgar评分(分) 呼吸系统症状 心脏杂音 合并心外畸形 手术方式 接受手术时年龄(月)
1 男 37 自然分娩 2 600 9-10-10 气促、喘鸣 无 尿道下裂 PAS矫治术 8
2 男 39 自然分娩 2 670 9-10-10 气促、喘鸣 无 无 PAS矫治术 5
3 男 37 剖宫产术分娩 2 340 8-10-10 气促 无 无 PAS矫治术 6
4 男 38 自然分娩 2 700 9-10-10 反复肺炎 无 无 PAS矫治术＋支气管成形术 11
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