Imaging Diagnosis Of 277 Cases Of Anomalous Pulmonary Venous Connection

Objective:This essay aims to evaluate the ues of Trans-thoracic Echocardiography(TTE)in the diagnosis of different types of Anomalous Pulmonary Venous Connection(APVC)and to compare the diagnosis of APVC by TTE and Computed Tomographic Angiography(CTA)before surgery.Methods:A review-based analysis of 277 APVC cases determined by the echocardiography laboratory of Fujian Medical University Union Hospital from January 2012 to December 2018 was conducted and out of which 36 cases were found to be general CTA examinations.They were then being categorised under total abnormal pulmonary venous drainage(TAPVC),total abnormal pulmonary venous drainage(TAPVC),partial anomalous pulmonary venous connection(PAPVC)and no APVC depending on the results of the operation.The following TTE data was analysed of each category : left and right diameter,upper and lower atrial diameter,area of Left and right atria,TTE and CTA diagnosis of ectopic drainage pulmonary vein and location.The selected clinical data were tested by ?2 test to evaluate the diagnostic accuracy of different examination methods for APVC classification and ectopic drainage of pulmonary veins.Spearman correlation analysis was used to analyze the RA/LA and area ratio and the maximum ASD diameter ratio to produce the ROC curve in order to assess the usefulness and accuracy of APVC cases using TTE.Results:(1)The TTE diagnostic accuracy rate of 277 patients was 66.4%,out of which 125 cases were TAPVC,including 63 cases of supracentric type,50 cases of intracardiac type,6 cases of subcardiac type,6 cases of mixed type,135 cases were PAPVC.The diagnostic accuracy rate of TAPVC was 87.2%.The diagnostic accuracy rate of TTE was higher than that of PAPVC(P < 0.05);(2)The diagnostic accuracy rate of each type of TAPVC was 92.1% for supracentric type,88.0% for intracardiac type,50.0% for subcardiac type and 66.7% for mixed type.The diagnostic accuracy rates of TTE for supracardiac and intracardiac type were higher than those for subcardiac and mixed type(P < 0.05).(3)135 cases were PAPVC.The diagnostic accuracy rate was 66.4%.The diagnostic accuracy rate of TTE for four pulmonary veins was 77.5% for right superior pulmonary vein,68.6% for right inferior pulmonary vein,41.1% for left superior pulmonary vein,60.0% for left inferior pulmonary vein.The accuracy rate of right superior pulmonary vein was higher than that of left superior pulmonary vein(P < 0.05),and that of right inferior pulmonary vein was higher than that of left superior pulmonary vein(P < 0.05).There were no statistically significant differences between the other groups.(4)There were significant differences between ASD and PAPVC in the ratio of left to right diameters,the ratio of upper to lower diameters,the ratio of area to upper and lower diameters,the ratio of area divide ASD and the ratio of area divide ASD(P < 0.05).The area under the ROC curve of RA/LA upper to lower diameters was the largest,and the cut-off point was 1.12.There were significant differences in the ratio of left and right diameters,upper and lower diameters,area ratios and those divide ASD between TAPVC and PAPVC patients(P < 0.05).The area under the RA/LA area ratio/ASD ROC curve was the largest with a cut-off point of 1.78.(5)The diagnostic accuracy rate Of 36 patients who underwent CTA examination was 94.4%,PAPVC and no APVC was 90.4%.There were significant differences between CTA and TTE(P < 0.05).TAPVC was 100%,There was no significant difference between CTA and TTE(P > 0.05).There was no significant difference between CTA and TTE in the diagnosis of four pulmonary veins(P > 0.05).Conclusion: 1.TTE is the first option for testing APVC as it is able to make a clear diagnosis of the type and position of APVC which can then be used as an important reference for how the operation should be conducted.2.CTA can make up for the deficiency of TTE and improve the accuracy rate.3.If ASD cannot determine whether APVC exists or not,and the upper and lower diameters of RA/LA can be used as a reference index to tell the difference.If APVC is found but is not sure of whether it is a complete or partial type,the area ratio of RA/LA can be used as a reference index to distinguish.