Objective: To evaluate the application of echocardiography in diagnosis of pediatric pulmonary artery sling.
Methods: Twenty-five children diagnosed as pulmonary artery sling in the Children's Hospital, Zhejiang University School of Medicine from July 2012 to August 2017, and 50 healthy children(control group) were enrolled in the study. Echocardiography was performed in all subjects. The origins of the left pulmonary artery(LPA) and right pulmonary artery(RPA) were observed; the internal diameters of LPA, RPA and main pulmonary artery(MPA) were measured; and the ratios of LPA/MPA and RPA/MPA were calculated. The value of RPA/MPA and LPA/MPA in diagnosing pulmonary artery sling was evaluated by ROC curve.
Results: Echocardiography showed that the internal diameters of RPA were increased in all patients; while the LPA and blood flow signals in common pulmonary arterial bifurcation were not found in 24 cases, in whom the MPA was directly extended to the RPA, and the LPA was from the massive RPA. The ultrasound of one special case showed that there was no distinct bifurcation of MPA; the MPA walked to the right and then to the left with no change in the internal diameter. There were significant differences in RPA/MPA(0.50±0.05 vs. 0.71±0.15, t=7.06, P<0.01) and LPA/MPA(0.52±0.05 vs. 0.39±0.09, t=6.94, P<0.01) between controls and the patients. ROC curve analysis showed that the AUC of RPA/MPA and LPA/MPA in diagnosis of pulmonary artery sling were 0.90 and 0.89, respectively. When taking 0.60 as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RPA/MPA in diagnosis of pulmonary artery sling were 79%, 100%, 100%, 91% and 93%, respectively. When taking 0.43 as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LPA/MPA in diagnosis of pulmonary artery sling were 71%, 96%, 89%, 87% and 88%, respectively.
Conclusions: s Echocardiography can effectively diagnose pediatric pulmonary artery sling. The RPA/MPA ratio of 0.60 and the LPA/MPA ratio of 0.43 can be used as cutoff values for diagnosis.
目的: 探讨超声心动图显像诊断儿童肺动脉吊带的价值。
方法: 收集2012年7月至2017年8月浙江大学医学院附属儿童医院25例确诊肺动脉吊带患儿的临床资料。所有患儿均行常规超声心动图检查，观察左、右肺动脉（LPA、RPA）起源，测量肺总动脉（MPA）内径和LPA、RPA内径，计算LPA内径/MPA内径和RPA内径/MPA内径，并与50名超声心动图检查正常同龄儿童（对照组）的数值进行比较。应用ROC曲线评估RPA内径/MPA内径和LPA内径/MPA内径诊断肺动脉吊带的价值。
结果: 25例肺动脉吊带患儿超声心动图检查均显示RPA起始处明显增宽，24例患儿MPA分叉处无LPA回声及血流信号，MPA直接延续为RPA，细小LPA发自粗大RPA；1例特殊病例超声心动图检查显示MPA无明显分叉，向右行走一段后绕向左侧且内径与MPA大致相同。肺动脉吊带患儿RPA内径/MPA内径和LPA内径/MPA内径分别为0.71±0.15和0.39±0.09，而对照组为0.50±0.05和0.52±0.05，组间差异有统计学意义（ t=7.06和6.94，均 P < 0.01）。ROC曲线分析结果显示，RPA内径/MPA内径和LPA内径/MPA内径诊断肺动脉吊带的AUC分别为0.90和0.89。以0.60为诊断节点，RPA内径/MPA内径诊断肺动脉吊带的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为79%、100%、100%、91%、93%；以0.43为诊断节点，LPA内径/MPA内径诊断肺动脉吊带的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为71%、96%、89%、87%、88%。
结论: 超声心动图显像可用于肺动脉吊带的早期诊断，RPA内径/MPA内径和LPA内径/MPA内径是诊断肺动脉吊带的可靠参数，有助于量化肺动脉吊带的诊断。