| ObjectiveThe purpose of this study was to summarize the associated cardiac anomalies of double outlet right ventricle (DORV) in China and to explore their effects on surgical therapy.MethodsPatients with DORV who received surgery from January,2005 to April,2010 were included. The incidence of associated anomalies and the corresponding operation type were analyzed according to patients’operative records. The results were compared with peer studies to elucidate the features of various anomalies.Results368 patients with DORV were enrolled in this study. The most common associated abnormality was pulmonary stenosis (60.6%). And the second one was patent ductus arteriosus (26.9%), followed by atrial septal defect (25.2%). As for the cardiac malpositions, mirror dextrocardia arose most commonly (6.5%), while persistent left superior vena cava arose most commonly (17.4%) in sinus venesus abnormalities. Also, right aortic arch often coexisted with DORV (18.5%). And coronary anomalies accounted for 16.3%, half of which were with single coronary. The types of surgical procedure varied in the light of anatomical features of different DORV patients. Among all cases, intraventricular tunnel repair was mainly performed (267/368). And the second one was arterial switch operation (56/368). Mustard and Senning operation were seldom applied (7/368).ConclusionHigh incidence of cardiac anomalies was observed in DORV patients. The optimal operation time and type mainly depend on the pathological anatomy of different cases, and thus warrant early and correct diagnosis.ObjectiveThe aim of this study was to compare and evaluate the accuracy of echocardiography and cardioangiography in the diagnosis of DORV.Methods368 patients with DORV who received surgery from January,2005 to April,2010 were included. Eligible subjects of each comparison were selected among all cases according to its own inclusion criteria. The diagnoses of DORV by echocardiography and cardioangiography were recorded. The accuracy rate, misdiagnosis rate and missed diagnosis rate were calculated and compared with surgery. The causes of error diagnoses were analyzed preliminarily. And the results were compared with domestic peer studies.Results(1) Echocardiography vs. Surgery:All 368 cases of DORV were included. Compared with surgical finding, the accuracy rate of echocardiography was 89%, and the rates of misdiagnosis and missed diagnosis were 5% and 6%, respectively. (2) Cardioangiography vs. Surgery:188 cases were included. Compared with surgical diagnosis, the accuracy rate of cardioangiography was 76%, and the rates of misdiagnosis and missed diagnosis were 18% and 6%, respectively. (3) Echocardiography vs. Cardioangiography:188 cases were included. The accuracy rate of echocardiography was 96%, while that of cardioangiography was 76%. The comparison was of significant difference (paired chi square test, P<0.001), and the consistency of the two methods was poor (consistency test, Kappa=0.133, P=0.003). According to statistic, the accuracy rate of echocardiography diagnosis was higher than that of cardioangiography, and the rates of misdiagnosis and missed diagnosis of echocardiography were lower than those of cardioangiography (2% vs.18%,3% vs.6%).ConclusionThe qualitative diagnosis of DORV with echocardiography was superior to cardioangiography.The relationship between ventricular septal defect (VSD) and great arteries in DORV patients was usually divided into four types:(1) subaortic VSD; (2) subpulmonary VSD; (3) doubly committed VSD; (4) noncommitted or remote VSD.ObjectiveThe purpose of this study was to investigate the proportions of the four types of relationship between VSD and great arteries in DORV patients in China and to compare the accuracy of echocardiography and cardioangiography in the observation of their relationships.Methods368 patients with DORV who received surgery from January,2005 to April,2010 were included. Eligible subjects of each comparison were selected among all cases according to its own inclusion criteria. The proportions of the four types of relationships were counted on the basis of surgical results. The accuracy of echocardiography and cardioangiography in the determination of four types of relationships were calculated and compared with each other. The causes of error diagnoses were analyzed preliminarily. And the results were compared with peer studies.Results(1)Surgery:252 cases were included. According to the surgical findings, noncommitted VSD type was the most common one (39%), which was slightly higher than the subaortic VSD type (38%). Subpulmonary VSD type accounted for 17% and doubly committed VSD type accounted for 5%. There were only two patients with two separate VSDs under the aortic valve and pulmonary valve, respectively. (2) Echocardiography vs. Surgery:225 cases were included. Compared with the surgical findings, the accuracy rate of subaortic VSD type with echocardiography was the highest (86%), while that of doubly committed VSD type with echocardiography was the lowest (36%). The accuracy rates of the other two types were appropriate (65%). (3) Cardioangiography vs. Surgery:111 cases were included. Compared with the surgical findings, the accuracy rate of subaortic VSD type and subpulmonary type with cardioangiography were high (87% and 85%, respectively), and that of doubly committed VSD type with cardioangiography was the lowest (25%). The accuracy rate of the noncommitted VSD type was moderate (66%). (4) Echocardiography vs. Cardioangiography:106 cases were included. There was no significant difference between echocardiography and cardioangiography on detection of subaortic VSD, subpulmonary VSD and noncommitted VSD types. The coincidence rate of diagnosis of doubly committed VSD and subaortic-subpulmonary VSD types with echocardiography and cardioangiography were similar. The complete coincidence rate of echocardiography, cardioangiography and surgical diagnosis were 56%.ConclusionThere was no significant difference between echocardiography and cardioangiography for observing of four types of relationships between VSD and great arteries in DORV patients.The spacial relationship of great arteries in DORV patients was usually divided into four types:(1) normal relation; (2) D-malposition of the aorta; (3) anterior position of the aorta; (4) L-malposition of the aorta.ObjectiveThe aim of this study was to investigate the proportions of the four types of spacial relationship in DORV patients in China and to compare and evaluate the accuracy of echocardiography and cardioangiography in the determination of these relationships.Methods368 patients with DORV who received surgery from January,2005 to April,2010 were included. Eligible subjects of each comparison were selected among all cases according to its own inclusion criteria. The proportions of the four types of relationship were counted according to surgical findings. The accuracy of echocardiography and cardioangiography in the determination of four types of relationship were calculated and compared with each other.Results(1) Surgery:235 cases were included. According to the surgical results, D-malposition of the aorta type was the most common one (53%), the proportions of the normal relationship, L-malposition of the aorta and anterior position of the aorta types were 16%,19% and 12%, respectively. (2) Echocardiography vs. Surgery:210 cases were included. Compared with the surgical results, the total coincidence rate of echocardiography was 70%. The rates of the normal, D-malposition, L-malposition and anterior position types were 93%,69%,73% and 44%, respectively. (3) Cardioangiography vs. Surgery:136 cases were included. Compared with the surgical results, the total coincidence rate of cardioangiography was 79%. The rates of the normal, D-malposition, L-malposition and anterior position types were 87%, 83%,79% and 58%, respectively. (4) Echocardiography vs. Cardioangiography:129 cases were included. The accuracy rate of cardioangiography diagnosis of the D-malposition type was significantly higher than that of echocardiography (paired chi square test, P=0.021),and the consistency of the two methods was poor (consistency test, Kappa=0.332, P=0.003). There was no significant difference between echocardiography and cardioangiography diagnosis of the normal, L-malposition and anterior position types. The complete coincidence rate of echocardiography, cardioangiography and surgical diagnosis were 60%.ConclusionThe cardioangiography diagnosis of the D-malposition type was better than echocardiography. Whereas as for the other three types, there was no significant difference between echocardiography and cardioangiography diagnosis.The overriding of great arteries in DORV patients can be divided into four types:(1) overriding of the aorta; (2) overriding of the pulmonary artery; (3) both great arteries deriving from the right ventricle in their entirety; (4) overriding of both great arteries.ObjectiveThe purpose of this study was to investigate the proportions of the four types of overriding conditions of great arteries in DORV patients in China and to compare and evaluate the accuracy of echocardiography and cardioangiography in the determination of overriding conditions.Methods368 patients with DORV who received surgery from January,2005 to April,2010 were included. Eligible subjects of each comparison were selected among all cases according to its own inclusion criteria. The proportions of the four types of overriding conditions were counted on the basis of surgical results. The accuracy of echocardiography and cardioangiography in the determination of four types of overriding conditions were calculated and compared with each other. The causes of error diagnoses were analyzed preliminarily.Results(1) Surgery:337 cases were included. According to the surgical results, the type in which both great arteries deriving from the right ventricle in their entirety was the most common one (46.6%), the proportions of the aortic overriding, pulmonary overriding and both overriding types were 42.1%,10.7% and 0.6% (only two cases), respectively. (2) Echocardiography vs. Surgery: 316 cases were included. Compared with the surgical results, the total coincidence rate of echocardiography was 72%. The rates of the aortic overriding type, pulmonary overriding type and the type in which both great arteries deriving from the right ventricle in their entirety were76%,69% and 71%, respectively. However, echocardiography missed detecting 2 cases with two great arteries overriding. (3) Cardioangiography vs. Surgery:161 cases were included. Compared with the surgical results, the total coincidence rate of cardioangiography was 66%. The rates of the aortic overriding type, pulmonary overriding type and the type in which both great arteries deriving from the right ventricle in their entirety were65%,50% and 73%, respectively. However, cardioangiography missed detecting 2 cases with two great arteries overriding. (4) Echocardiography vs. Cardioangiography: 157 cases were included. As for the aortic and double overriding types, the coincidences of echocardiography and cardioangiography diagnosis were the same, respectively. However, there was no significant difference between echocardiography and cardioangiography diagnosis of the type in which both great arteries deriving from the right ventricle in their entirety and the pulmonary type. The complete coincidence rate of echocardiography, cardioangiography and surgical diagnosis were 56%.ConclusionThe accuracy rate of echocardiography and cardioangiography observing of the aortic and double overriding types were the same. Whereas as for the other two types, there was no significant difference between echocardiography and cardioangiography diagnosis. |
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