主动脉瓣下隔膜的漏诊分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

赵洋 ,  金岩 , 于岩 , 方敏华

北部战区总医院心血管外科（沈阳 110016）;

Corresponding author：

金岩, Email: 13309888850@163.com

Keywords：

先天性心脏病; 主动脉瓣下隔膜; 漏诊; 心脏超声; 增强CT

DOI：

10.7507/1007-4848.202002018

Video：

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目的总结主动脉瓣下隔膜（subaortic membrane，SM）的漏诊情况及常见原因，以提高诊断的准确率。方法筛选我院 2011 年 1 月至 2019 年 9 月间 SM 漏诊的 14 例患者，其中男 10 例、女 4 例，手术时平均年龄（50.1±14.5）岁。回顾性分析术前心脏超声及 CT 等检查结果。结果 92.3% （13/14）漏诊患者是成人，所有成人患者均有较严重主动脉瓣病变，术前及术中未发现明显左室流出道梗阻，术中探查见瓣下隔膜均与主动脉瓣距离小（<5 mm），及与赘生物、钙化灶关系密切。所有患者均伴有其它心脏疾病，最多为主动脉瓣二叶化畸形（8/14，57.1%），其次为感染性心内膜炎（4/14，28.6%，其中 2 例合并主动脉瓣二叶化畸形）。术中隔膜组织均完全切除，大多数进行主动脉瓣人工瓣置换（12/14，85.7%）。所有患者随访至 2020 年 1 月均无复发。结论合并其它畸形或者瓣膜疾病的 SM 在未造成左室流出道梗阻时可能造成漏诊，主动脉瓣发育异常或感染性心内膜炎患者应注意检查主动脉瓣下结构。部分漏诊患者的瓣下隔膜可能是继发性病变。结合心脏超声和增强 CT 检查是诊断 SM 的有效方法，增加三维重建可提高本病诊断率。

Citation： 赵洋, 金岩, 于岩, 方敏华. 主动脉瓣下隔膜的漏诊分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1495-1499. doi: 10.7507/1007-4848.202002018 Copy

1.	易定华, 徐志云, 王辉山, 主编. 心脏外科学(第 2 版). 北京: 人民军医出版社, 2016. 966-975.
2.	Kemna EH, Tjalsma H, Willems HL, et al. Hepcidin: from discovery to differential diagnosis. Haematologica, 2008, 93(1): 90-97.
3.	Barboza LA, Garcia Fde M, Barnoya J, et al. Subaortic membrane and aorto-septal angle: an echocardiographic assessment and surgical outcome. World J Pediatr Congenit Heart Surg, 2013, 4(3): 253-261.
4.	Kim KH, Kim HK, Chang SA, et al. Subaortic membrane late after surgical correction of tetralogy of Fallot. Korean J Intern Med, 2012, 27(4): 455-458.
5.	Butany J, Vaideeswar P, David TE. Discrete subaortic membranes in adults--a clinicopathological analysis. Cardiovasc Pathol, 2009, 18(4): 236-242.
6.	Pigeon C, Ilyin G, Courselaud B, et al. A new mouse liver-specific gene, encoding a protein homologous to human antimicrobial peptide hepcidin, is overexpressed during iron overload. J Biol Chem, 2001, 276(11): 7811-7819.
7.	Michelena HI, Della Corte A, Prakash SK, et al. Bicuspid aortic valve aortopathy in adults: Incidence, etiology, and clinical significance. Int J Cardiol, 2015, 201: 400-407.
8.	梅举, 章斌, 张宝仁, 等. 先天性主动脉瓣二叶化畸形的外科治疗. 中国胸心血管外科临床杂志, 2002, 9(2): 84-86.
9.	de Agustin JA, Gomez de Diego JJ, Marcos-Alberca P, et al. Combined subaortic membrane and aortic valve stenosis: additive value of three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging, 2014, 15(4): 388.
10.	武彧, 吕清, 王新房. 超声心动图对主动脉瓣下狭窄的诊断价值. 临床超声医学杂志, 2012, 2(14): 104-106.
11.	Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
12.	罗松, 黄鹏飞, 周长圣, 等. 双源 CT 血管成像在先天性主动脉瓣叶畸形诊断中的应用. 实用放射学杂志, 2013, 29(2): 212-214.
13.	Ko SM, Song MG, Hwang HK. Bicuspid aortic valve: spectrum of imaging findings at cardiac MDCT and cardiovascular MRI. AJR Am J Roentgenol, 2012, 198(1): 89-97.
14.	邵晓宇. 基于 CT 影像处理的心脏腔室四维建模及分析系统设计. 南昌航空大学, 2017.
15.	Song Y, Yang DH, Ó Hartaigh B, et al. Geometric predictors of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a 3D computed tomography analysis. Eur Heart J Cardiovasc Imaging, 2018, 19(10): 1149-1156.
16.	孟存忠, 高扬, 刘坤, 等. 双源 CT 在成人主动脉瓣二瓣化畸形诊断中的应用价值. 中国临床医学影像杂志, 2016, 27(9): 629-633, 669.

1. 易定华, 徐志云, 王辉山, 主编. 心脏外科学(第 2 版). 北京: 人民军医出版社, 2016. 966-975.
2. Kemna EH, Tjalsma H, Willems HL, et al. Hepcidin: from discovery to differential diagnosis. Haematologica, 2008, 93(1): 90-97.
3. Barboza LA, Garcia Fde M, Barnoya J, et al. Subaortic membrane and aorto-septal angle: an echocardiographic assessment and surgical outcome. World J Pediatr Congenit Heart Surg, 2013, 4(3): 253-261.
4. Kim KH, Kim HK, Chang SA, et al. Subaortic membrane late after surgical correction of tetralogy of Fallot. Korean J Intern Med, 2012, 27(4): 455-458.
5. Butany J, Vaideeswar P, David TE. Discrete subaortic membranes in adults--a clinicopathological analysis. Cardiovasc Pathol, 2009, 18(4): 236-242.
6. Pigeon C, Ilyin G, Courselaud B, et al. A new mouse liver-specific gene, encoding a protein homologous to human antimicrobial peptide hepcidin, is overexpressed during iron overload. J Biol Chem, 2001, 276(11): 7811-7819.
7. Michelena HI, Della Corte A, Prakash SK, et al. Bicuspid aortic valve aortopathy in adults: Incidence, etiology, and clinical significance. Int J Cardiol, 2015, 201: 400-407.
8. 梅举, 章斌, 张宝仁, 等. 先天性主动脉瓣二叶化畸形的外科治疗. 中国胸心血管外科临床杂志, 2002, 9(2): 84-86.
9. de Agustin JA, Gomez de Diego JJ, Marcos-Alberca P, et al. Combined subaortic membrane and aortic valve stenosis: additive value of three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging, 2014, 15(4): 388.
10. 武彧, 吕清, 王新房. 超声心动图对主动脉瓣下狭窄的诊断价值. 临床超声医学杂志, 2012, 2(14): 104-106.
11. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
12. 罗松, 黄鹏飞, 周长圣, 等. 双源 CT 血管成像在先天性主动脉瓣叶畸形诊断中的应用. 实用放射学杂志, 2013, 29(2): 212-214.
13. Ko SM, Song MG, Hwang HK. Bicuspid aortic valve: spectrum of imaging findings at cardiac MDCT and cardiovascular MRI. AJR Am J Roentgenol, 2012, 198(1): 89-97.
14. 邵晓宇. 基于 CT 影像处理的心脏腔室四维建模及分析系统设计. 南昌航空大学, 2017.
15. Song Y, Yang DH, Ó Hartaigh B, et al. Geometric predictors of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a 3D computed tomography analysis. Eur Heart J Cardiovasc Imaging, 2018, 19(10): 1149-1156.
16. 孟存忠, 高扬, 刘坤, 等. 双源 CT 在成人主动脉瓣二瓣化畸形诊断中的应用价值. 中国临床医学影像杂志, 2016, 27(9): 629-633, 669.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

主动脉瓣下隔膜的漏诊分析

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