目的 探讨经胸超声心动图诊断儿童先天性左心耳瘤的图像特点.资料与方法 分析2017年7月—2021年4月广州市妇女儿童医疗中心经胸超声心动图诊断并手术或CT确诊的7例先天性左心耳瘤的病例资料及随访结果,总结其声像图特征.结果 7例均表现为左前外侧一囊性暗区,多位于心包腔内,壁光整,薄,内有血流与左心房相通,彩色多普勒提示交通口处血流呈双向.7例中,1例为单纯左心耳瘤,手术后预后良好,2例合并近闭合的室间隔缺损,长期随访中,1例合并左心室发育不良综合征放弃治疗后死亡;3例合并复杂性先天性心脏病,均行相应手术治疗,预后良好,所有病例均无明显心律失常,未见明显血栓回声.结论 经胸超声心动图可以早期发现并诊断儿童先天性左心耳瘤.

先天性冠状动脉瘘是指冠状动脉和心腔或大血管间存在异常交通，是一种少见疾病，瘘入右心室壁内极为罕见。本文报道1例6岁男性儿童右冠状动脉右心室壁内瘘形成巨大夹层瘤，准确诊断并成功手术治疗的病例。冠状动脉心室壁内瘘存在破裂风险，发现后应尽早手术；超声心动图及冠状动脉造影对冠状动脉瘘诊断具有重要意义。

目的 探讨左室收缩功能正常的左冠状动脉异常起源于肺动脉(ALCAPA)患儿的超声心动图特点.方法 回顾性分析2010年1月至2019年12月广州市妇女儿童医疗中心收治并经手术证实的13例左心室射血分数(LVEF)≥55％的ALCAPA患儿的超声心动图特征和临床资料.结果 13例ALCAPA患儿均可见右冠状动脉增宽,其他超声征象包括左冠状动脉血流逆灌12例、左冠状动脉直接开口于肺动脉9例、肺动脉内逆灌血流7例、心肌侧枝血流8例、左室明显增大8例、二尖瓣功能不全7例、左室心内膜纤维化5例.<1岁ALCAPA患儿的心肌侧枝血流信号不明显,左心室大小正常或轻度增大且二尖瓣功能良好;≥1岁患儿可见丰富侧枝血管、左室明显扩大以及二尖瓣功能不全.4例误诊的ALCAPA左冠状动脉均起源于肺动脉右后方.结论 超声心动图可准确诊断左室收缩功能正常的ALCAPA,如果超声科医生在怀疑该诊断时能全面探查冠状动脉的起源和血流方向,可减少漏诊和误诊.

1病例资料 女,3月龄,因"咳嗽伴发热1周"于2017年8月至广州医科大学附属广州市妇女儿童医疗中心(我院)就诊.出生时体检发现心脏杂音,当地医院诊断为"左冠状动脉-右室瘘、动脉导管未闭、卵圆孔未闭",未行处理.患儿平素无反复呼吸道感染;吃奶时有气促,有间断,无呛咳;大小便未见异常. 患儿系G1P1,足月剖宫产,无窒息抢救史,出生体重3000g.父母均体健,否认近亲结婚,否认遗传病史.家族成员无类似病史.

Objective To discuss the value of color Doppler echocardiography in diagnosis of scimitar syndrome .Methods The echocardiographic results of 6 patients with a diagnosis of scimitar syndrome were reviewed retrospectively .Their sonographic and hemodynamic characteristics were also analyzed connected with the reports in the literature .Results Three cases had dextrocardia and the others had mesocardia .All cases got right ventricular dimension enlargement .Total or partial of right pulmonary venous connection to the inferior vena cava were 3 cases respectively .All cases had right pulmonary artery hypoplasia .All of 6 cases echocardiographic results were in accordance with the findings by CT angiography and 4 cases were confirmed by operation .Conclusions The sonographic features of scimitar syndrome were obvious ,and echocardiography was contribute to early diagnosis of scimitar syndrome .

Objective To explore the accuracy of echocardiography with sequential segmental diagnosis andMSCT in the preoperative diagnosis of pulmonary atresia (PA) with ventricular septal defect (VSD).Methods A total of 45 children with PA/VSD underwent TTE and MSCT before operation.Set the surgery result as standard,the diagnostic efficiency of TTE and MSCT on every segment of heart and major vessels were analyzed and compared.Results Comparing with the operation results,the accuracy of TTE and MSCT were 100％,in diagnosis of the connection of cavity vein,pulmonary vein and atrials,the ventricular location and connection to atrials,ventricular level shunt and connection of ventricular and arteries.The difference of accuracy,sensitivity and specificity betweer TTE and MSCT in diagnosis of pulmonary development and patent ductus arteriosus were not statistically significant (all P＞0.05),however it was statistically significant on the diagnosis of shunt in atrial septa,collateral circulation and coronary artery origins aspects (all P＜0.05).Conclusion Both of TTE and MSCT can be used to diagnose the PA/VSD accurately.MSCT is more reliable to detect the coronary artery origin and the collaterals between aorta and pulmonary artery,and TTE with sequential segmental diagnosis is more sensitive to find small shunt in atrial septa,especially.