Applications Of Echocardiography And CT Angiography In Diagnosis Of Anomalous Pulmonary Venous Drainage

Objective To compare the value of echocardiography with CTangiography (CTA) in diagnosis of anomalous pulmonary venous drainage(APVD) in childrenand find the cause of misdiagnosis. Methods Theclinical and imaging characteristics of33children cases with APVD wereanalyzed retrospectively admitted from June2009to June2012. Of those，24cases received CTA and23underwent surgical repair. Results Thetypes of APVD among33children were as follows:30with complete APVDincluded15h supra-cardiac type，6intra-cardiac type，7infra-cardiac typeand2mixed type, and3PAPVD. According to the result ofechocardiography， the types included15cases with intra-cardiac,5withsupra-cardiac，5with infra-cardiac，1with mixed type,3PAPVD，and4uncertained. According to the results of the surgery， Echocardiographicdiagnostic accuracy of intra-cardiac type and supra-cardiac type of TAPVDwas90.9%and100%respectively while That of infra-cardiac type was66.7%, significantly lower than above types (P <0.05),.Two cases weremisdiagnosed。24patients received CTA， of which21cases wereconsistent with echocardiography and3cases were different. The first casewas diagnosed as infra-cardiac TAPVD with echocardiography but asmixed (supra-cardiac and infra-cardiac type) with CTA. The second casewith echocardiographic examination was mixed (intra–cardiac andsupra-cardiac type) and supervened with atrial septal defect and pulmonaryhypertension while CTA indicated partial anomalous pulmonary venous drainage and double superior vena cava， and surgery confirmed the resultof ultrasonic diagnosis. The third case was complicatedandechocardiography indicatedcomplete endocardial cushion defect， atrialseptal defect， patent ductus arteriosus and APVD (？) whereas CTAshowed total anomalous pulmonary venous drainage (infra-cardiactype？). Among30cases of patients,28cases were complicated with atrialseptal defect,1with patent foramen ovale,1with patent ductus arteriosus,2with endocardial cushion defect,and20with different degree of pulmonaryhypertension. Conclusions (1) The echocardiography should be taken as thefirst choice diagnostic method in children with APVD. The color Dopplerechocardiography is useful for accurate diagnosis of anomalous pulmonaryvenous drainage， which can provide detailed information for surgicaloperation.(2) For all patients with dilated right heart and small left atriumand complicated atrial septal defect, no matter with pulmonary hypertensionor not, we Should be on high alert to the possibility of APVD. Combiningmore Locus and cross section carefully may decrease the misdiagnosis rateof anomalous pulmonary venous drainage.(3) For patients with infra-cardiac and mixed types of anomalous pulmonary venous drainage.It isnecessary to combine the information of CT angiography for more detailedand accurate diagnosis.