误诊为房间隔缺损的慢性阻塞性肺疾病原因分析及超声心动图特征OA

Objective To investigate the causes of chronic obstructive pulmonary disease(COPD)misdiagnosed as atrial septal defect(ASD),and to summarize the echocardiographic characteristics and differential points of misdiagnosed cases.Methods The clinical data of 2 patients with COPD misdiagnosed as ASD from March 2022 to May 2024 were retrospectively analyzed.Results One male patient presented with exertional dyspnea for 4 years,which was worsened in the past week.Echocardiography revealed right heart enlargement and tricuspid regurgitation,leading to a misdiagnosis of secundum ASD with a planned interventional occlusion procedure.Further pulmonary function tests demonstrated severe obstructive ventilatory impairment[forced expiratory volume in one second/forced vital capacity ratio(FEV1/FVC)52％].Chest CT showed diffuse emphysema and centrilobular bullae.A right-heart contrast echocardiogram excluded an intracardiac shunt.The final diagnosis was"acute exacerbation of COPD,chronic pulmonary heart disease combined with type Ⅱ respiratory failure."The duration of misdiagnosis was 4 years.After prompt adjustment of the treatment plan to standardized COPD management,the patient's dyspnea significantly improved,and coughing decreased within 3 days.Upon discharge on the 10th day of hospitalization,pulmonary function FEV1/FVC had improved to 56％.During the 6-month follow-up,the patient adhered to inhaled bronchodilator therapy and home oxygen therapy,with no recurrence of acute exacerbations.One female patient was admitted with"recurrent palpitations and lower limb edema for 2 years."Echocardiography showed right ventricular hypertrophy,pulmonary hypertension,and an interrupted atrial septal echo,leading to a misdiagnosis of secundum ASD with right heart overload and chronic right heart failure.Intensive diuretic therapy was initiated.After 3 days of treatment,the patient's resting dyspnea showed no significant improvement.Further right-heart contrast echocardiography revealed no intracardiac shunt.Blood gas analysis indicated hypoxemia and hypercapnia.Combined with a long-term smoking history,pulmonary function(FEV1/FVC 65％),and CT findings of emphysema,the final diagnosis was Global Initiative for Chronic Obstructive Lung Disease(GOLD)grade 3 COPD,chronic pulmonary heart disease combined with type Ⅱ respiratory failure.The duration of misdiagnosis was 2 years.The ASD-related treatment plan was immediately discontinued and switched to comprehensive management for COPD and pulmonary heart disease.At 5 d after treatment,lower limb edema subsided to the ankle level,and palpitations were relieved.The patient was discharged at 14 d after hospitalization,with a discharge pulmonary function FEV1/FVC of 67％.During the 1-year follow-up,the patient adhered to inhaled bronchodilator therapy and home oxygen therapy and was not re-hospitalized for heart failure.Conclusion In COPD patients with abnormal right heart function,the ultrasonographic manifestations are easily confused with ASD.Clinical analysis should be combined with pulmonary function,chest CT and right heart echocardiography to avoid misdiagnosis caused by cardiac ultrasound alone.