肺动脉高压的解剖M型超声心动图检测及其影响因素分析

目的 应用解剖M型超声心动图(AMM)检测肺动脉高压并探讨其影响因素.方法 160例合并有三尖瓣反流的肺动脉高压患者以及160例相匹配的正常肺动脉压对照组,常规测定肺动脉干内径、右心房内径、三尖瓣反流峰值流速,同时应用AMM观测肺动脉干运动曲线并测定肺动脉干前侧壁搏动幅度(PAWPA).结果 肺动脉高压组PAWPA值[(5.24±1.37) mm]低于肺动脉压正常组[(8.71±0.90) mm],同时伴有肺动脉干增宽、右心房内径增大(P均<0.001).肺动脉高压组PAWPA与肺动脉收缩压(β=-0.90,P<0.001)、年龄(β=-0.17,P<0.01)、肺动脉瓣关闭不全(β=-0.15,P<0.05)及右房压(β=-0.23,P<0.05)成负相关.其中,肺动脉压力与右房压(r'=0.78,P<0.001)、肺动脉瓣反流(r'=0.39,P<0.01)成正相关.结论 肺动脉高压患者PAWPA显著低于正常肺动脉压力者.除肺动脉压力外,年龄、右房压和肺动脉瓣关闭不全均是影响肺动脉高压患者PAWPA测值的重要因素.     

解剖M型超声心动图观测肺动脉高压患者肺动脉主干前侧壁运动曲线

目的　探讨解剖M型超声心动图在观测肺动脉高压患者的肺动脉主干运动曲线中的作用。方法　 2 1例合并有三尖瓣反流的肺动脉高压患者以及 2 1例年龄和性别与病变组配对的正常人 ,常规超声心动图测定肺动脉干内径、右心房内径、肺动脉瓣血流频谱上升支加速时间 (ACTpv)、三尖瓣反流峰值流速 ,并根据后者推算肺动脉收缩压 (PASP)。采用解剖M型超声后处理系统 ,观测肺动脉干运动曲线并测定肺动脉干前侧壁搏动幅度 (PAWPA)。结果　肺动脉高压组的PAWPA低于正常组 ,同时伴有肺动脉干增宽、右心房内径增大、ACTpv缩短 (均P <0 .0 5)。肺动脉高压组PAWPA与PASP呈中度负相关 (r =-0 .549)、与ACTpv呈中度正相关 (r =0 .40 2 )。结论　解剖M型超声心动图可用于观测PAWPA ,该参数有可能作为一个新的简便易行评估肺动脉高压的定性或半定量指标     

肺动脉瓣M型频谱形态评价肺动脉高压与根据三尖瓣口反流束压差估测肺动脉高压之间的相关性分析

目的分析肺动脉瓣M型频谱形态评价肺动脉高压与根据三尖瓣口反流束压差估测肺动脉高压之间的相关性。方法选取2016年12月至2018年8月间我院收治的50例肺动脉高压患者及50例精神科躯体健康患者作为研究对象,对患者采用扫查肺动脉瓣M型频谱形态与三尖瓣口反流束压差检查并分析指标间相关性。结果肺高压组患者肺动脉内径、右心房左右径及ACTpv均明显高于健康对照组(P<0.05);肺高压组患者PAWPA明显低于健康对照组,且差异存统计学意义(P<0.05),且肺动脉高压患者与健康者M型频谱形态存明显差异;肺动脉瓣M型频谱形态与ACTpv呈显著正相关关系(P<0.05),与PASP呈显著负相关关系(P<0.05)。结论肺动脉瓣M型频谱形态与三尖瓣口反流束压差的ACTpv呈显著正相关关系,与PASP呈明显负相关关系。     

超声心动图对特发性肺动脉高压的评估

目的探讨超声心动图对特发性肺动脉高压(IPAH)的评估价值。方法 2013年8月至2014年8月在我院经右心导管检查确诊的58例IPAH患者,应用超声心动图诊断仪测量右心房左右径(RAT)、主肺动脉内径(MPA),右、左心室舒张末期前后径(RVD、LVD)及左右径(RVT、LVT),计算右、左心室前后径及左右径的比值(RVD/LVD、RVT/LVT);运用多普勒超声测量三尖瓣反流最大压差、肺动脉瓣舒张早期反流压差、肺动脉瓣舒张末期反流压差,将超声心动图的检测指标与心导管测值进行相关性分析。结果 58例患者均存在不同程度三尖瓣反流或肺动脉瓣反流,其中存在三尖瓣反流患者56例,肺动脉瓣反流患者48例,同时存在肺动脉瓣反流和三尖瓣反流患者46例;超声心动图估测肺动脉收缩压(PASPe)与右心导管检测肺动脉收缩压(PASPc)呈显著正相关(r=0.668,P<0.001),超声心动图估测肺动脉平均压(PAMPe)、肺动脉舒张压(PADPe)与右心导管检测肺动脉平均压PAMPc、舒张压PADPc相关性良好(r=0.637,P<0.001;r=0.640,P<0.001),RVD/LVD、RAT、RVT/LVT与PASPc呈明显相关(r值分别为0.598、0.47、0.491,均P<0.001),MPA与PASPc相关性较差(r=0.281、P<0.05)。结论超声心动图与右心导管测量的PASP、PAMP、PADP具有高度相关性,超声心动图通过三尖瓣反流及肺动脉瓣反流来评估特发性肺动脉压是临床上首选、无创准确测量肺动脉压力的方法之一。     

胎心容积辅助诊断工具对孕中晚期单胎胎儿心脏流出道病变筛查的可行性

目的 分析胎心容积辅助诊断工具对孕中晚期单胎胎儿心脏流出道病变筛查的可行性。方法 选择2019年7月～10月在我院行超声检查的孕中晚期单胎孕妇190例,所有胎儿除了行常规二维超声心动图检查外,还对其胎儿心脏容积数据进行采集、储存;然后使用胎心容积辅助诊断工具对成像进行后处理;分析两种方法测量获得的主动脉和肺动脉内径之间的相关性,两种方法的一致性,以及观察者内和观察者间的重复性。结果 176例(92.63%)孕妇采用胎心容积辅助诊断工具获得了胎儿心脏左、右室流出道切面的清晰图像,能够测量主动脉和肺动脉内径;Pearson相关性分析结果提示,两种不同超声检查方法测得的主动脉和肺动脉内径值呈正相关(P均＜0.05);Bland-Altman 图检验结果提示,两种不同超声检查方法测得主动脉、肺动脉内径的一致性较好,95%一致性界限分别在(-1.18～1.01)、(-1.81～1.03);此外,胎心容积辅助诊断工具测量主动脉内径、肺动脉内径观察者间及观察者内的ICC值均＞0.85。结论 胎心容积辅助诊断工具在孕中晚期单胎胎儿心脏流出道病变筛查中具有较好的应用价值。     

超声心动图在右肺动脉异常起源于主动脉中的诊断价值

目的探讨超声心动图在右肺动脉异常起源于主动脉(anomalous origin of the right pulmonary artery from ascending aorta,AORPA)中的诊断价值。方法回顾性分析经超声心动图诊断的25例AORPA患者临床和超声心动图资料。结果 24例患者超声心动图诊断结果与手术诊断结果相符,1例患者漏诊动脉导管未闭;近端型18例,右肺动脉内径为(13.6±3.4)mm,肺动脉收缩压为(112.3±16.5)mm Hg;远端型7例,右肺动脉内径为(14.1±3.0)mm,肺动脉收缩压为(112.1±20.0)mm Hg;24例行手术治疗,1例放弃手术治疗;25例均合并重度肺动脉高压、右心增大及不同程度三尖瓣关闭不全;合并动脉导管未闭者21例,室间隔缺损者5例,房间隔缺损/卵圆孔未闭者5例,法洛四联症者1例,二尖瓣关闭不全者1例,重度三尖瓣关闭不全者3例;超声心动图表现为主肺动脉分叉结构消失,肺动脉主干仅与左肺动脉延续,右肺动脉起源于主动脉。结论超声心动图在AORPA中诊断率较高,有助于早期临床确诊和尽早手术治疗,可作为诊断AORPA的首选方法。     

超声心动图在吸入伊洛前列素急性血管反应试验中的应用价值

目的 在吸入伊洛前列素急性血管反应试验中应用超声心动图监测肺动脉高压患者血流动力学参数,探讨这一无创检查方法的临床应用价值.方法 2007年9月至2008年12月北京朝阳医院住院确诊肺动脉高压患者43例,男20例,女23例,年龄25～75岁,平均(50±14)岁,其中40例行右心导管检查,3例漂浮导管失败改为超声心动图监测.超声心动图测量指标包括:三尖瓣反流压差、肺动脉瓣舒张期最大反流压差、肺动脉瓣舒张末期反流压差、下腔静脉最大内径、下腔静脉最小内径,计算肺动脉收缩压(SPAP)、肺动脉舒张压(DPAP)、肺动脉平均压(MPAP)、右心输出量(RCO)并与右心导管作比较.结果 吸药前超声心动图测量肺动脉压力SPAP、DPAP及MPAP与右心导管测值之间有良好相关性(r分别为0.904、0.823及0.861,均P＜0.001);2种方法测得的右心输出量之间有相关性(r=0.946,P＜0.001).急性血管反应试验阳性患者7例.结论 超声心动图作为一种无创性评价肺动脉压力的检测方法应用于临床,尤其对于不能进行右心导管检查的患者,可以考虑作为替代检查,为临床医师提供诊疗依据.     

超声心动图测量肺动脉高压患者血流动力学参数与右心导管测值的相关性

目的 通过与右心导管测值比较,评价超声心动图测量肺动脉高压血流动力学参数的临床价值。 方法 对肺动脉高压患者60例测量超声心动图指标,包括三尖瓣反流压差、肺动脉瓣舒张期最大反流压差、肺动脉瓣舒张末期反流压差、下腔静脉最大内径、下腔静脉最小内径,计算肺动脉收缩压(SPAP)、肺动脉舒张压(DPAP)、肺动脉平均压(MPAP)、右心输出量(RCO),并与右心导管的测值比较。 结果 超声心动图测量肺动脉压力与右心导管测值之间有良好相关性(P＜0.001);两种方法测得的右心输出量存在相关性(P＜0.001)。 结论 超声心动图测量肺动脉压力与右心导管测值有良好相关性,为临床无创测量及研究肺循环疾病血流动力学提供了可能。     

分析经胸超声心动图对肺动脉栓塞诊断的应用价值

目的:分析经胸超声心动图对肺动脉栓塞诊断中应用价值。方法:以我院机选取的48例肺动脉栓塞患者(实验组)与50例健康体检者(参照组)为研究对象,所有受检者均开展经胸超声心动图检查。结果:实验组右心房左右径、右心室左右径、右心房上下径、右肺动脉内径、主肺动脉内径经胸超声心动图检出结果明显大于参照组(P<0.05)。经胸超声心动图诊断肺动脉栓塞的准确率为97.92%。重度肺动脉栓塞患者反流速度、肺动脉收缩压明显高于轻中度患者(P<0.05)。结论:经胸超声心动图在肺动脉栓塞诊断中的应用价值较为突出,值得广泛推广。     

胎心容积辅助诊断技术筛查孕中晚期胎儿心脏流出道病变的可行性

目的分析胎心容积辅助诊断技术筛查孕中晚期胎儿心脏流出道病变的可行性。方法选取在我院行超声检查的孕中晚期单胎孕妇190例,常规行二维超声心动图检查,采集、储存胎儿心脏容积数据,然后应用胎心容积辅助诊断技术对成像进行后处理,并进行图像质量评分,比较处理前后图像质量评分的差异。应用Pearson相关分析法分析两种方法测得的主动脉和肺动脉内径之间的相关性;应用Bland-Altman检验分析两种方法的一致性,并分析观察者内和观察者间的重复性。结果 176例(92.63%)孕妇采用胎心容积辅助诊断技术获得了胎儿心脏左、右室流出道切面的清晰图像,测得主动脉和肺动脉内径;软件处理前后左室流出道和右室流出道切面图像质量评分比较差异均有统计学意义(Z=-6.958、-8.521,均P=0.000)。Pearson相关分析显示,二维超声心动图和胎心容积辅助诊断技术测得的主动脉和肺动脉内径均呈正相关(r=0.83、0.79,均P0.05);Bland-Altman检验显示,两种方法测得主动脉和肺动脉内径的一致性较好,95%一致性界限分别为-1.18～1.01、-1.81～1.03;胎心容积辅助诊断技术测量主动脉、肺动脉内径观察者间和观察者内的组内相关系数均0.85。结论胎心容积辅助诊断技术在孕中晚期单胎胎儿心脏流出道病变筛查中具有一定可行性,临床应用价值较好。     

计算机辅助彩色M型超声心动图无创估测肺血管阻力的研究

目的 评价自行设计的计算机软件辅助彩色M型超声心动图无创估测肺血管阻力(PVR)的可行性及准确性.方法 20例先天性心脏病患者和20例正常儿童为研究对象,应用彩色M型超声心动图检测肺动脉血流传播速度(VPE)并进行比较;应用自行设计的计算机软件测量先心病患者的肺动脉血流传播速度(VPC),并与右心导管技术所测的PVR对比.结果 先天性心脏病患者彩色M型超声测得的VPE明显低于正常儿童[(38.38±18.89)cm/s对(80.34±15.65)cm/s,P＜0.01],且与心导管所测的PVR值显著相关(r=-0.69,P＜0.01).计算机软件测得VPC与PVR高度相关(r=-0.78,P＜001),且重复性较好.VPC＜35.910预测PVR＞16 kPa·S·L-1的灵敏性为92.9%,特异性为100%.结论 应用计算机辅助彩色M型超声心动图技术测量肺动脉血流传播速度可以比较准确地无创估测肺血管阻力.     

A rabbit model with acute thrombo-embolic pulmonary hypertension created with echocardiography guidance

A rabbit model of acute thrombo-embolic pulmonary hypertension was developed by infusing self-thrombi into the right femoral vein and simultaneously measuring the pulmonary artery pressure via a right heart catheter and echocardiography. The model was used to explore the usefulness of an ultrasound-guided protocol. In the present study, acute thrombo-embolic pulmonary hypertension was produced in 25 of 30 healthy New Zealand rabbits; the success rate was 83%. A significant and positive correlation between the right ventricle-right atrial pressure gradient, an estimate of the pulmonary artery systolic pressure derived from tricuspid regurgitation and the pulmonary artery systolic pressure measured using the right heart catheter (r=0.765, P=0.002) was noted. During the process of establishing a rabbit model of acute thrombo-embolic pulmonary hypertension, it was demonstrated that echocardiography can be used to guide the right heart catheter to obtain pulmonary artery systolic pressure measurements, to quantify the tricuspid regurgitation jet to assess the pulmonary artery systolic pressure and to observe cardiac morphologic changes so as to evaluate cardiac function. Based on the present study, it is clear that echocardiography is valuable in improving the success rate of producing the animal model of acute thrombo-embolic pulmonary hypertension. This could ultimately facilitate preclinical research and clinical research in humans.     

Congenital pulmonary sling, aorto–pulmonary window and pulmonary vein obstruction as a diagnostic and therapeutic challenge in an infant with VACTERL association

Summary In a newborn with anal atresia and urethral valves an incomplete VACTERL association, was diagnosed and a colon anus praeter was placed. Sweating and heart murmur led to cardiac diagnostics. By 2D colour Doppler echocardiography a huge atrial septal defect and pulmonary venous stenoses were diagnosed. Additionally, a pulmonary sling combined with an aortopulmonary window (AoPAw) was suspected and later confirmed by angiography. Heart failure developed and closure of the AoPAw, transplantation of the left pulmonary artery and closure of the atrial septal defect was performed at the age of 4 weeks. But the patient did not improve. Pulmonary hypertension with suprasystemic pressure in the right ventricle originating from a stenosis of the new orifice of the left pulmonary artery and obstruction of the right pulmonary veins was diagnosed by echocardiography and confirmed by angiography. At the age of 8 months the orifice of the left pulmonary artery was enlarged by a patch, the obstruction of left sided pulmonary veins was opened, and the rightsided pulmonary veins were newly implanted into the left atrium. Finally the inter–atrial communication was closed by a patch plastic. Again, postoperatively the patient improved only slightly. At the age of 10 months trans–septal catheterisation was performed. Angiography revealed a successful balloon dilatation of the long obstruction of the right pulmonary veins. Later on, an absorbable magnesium stent was implanted into the right upper pulmonary vein and medication with an endothelin antagonist was started. Temporarily the patient improved significantly. Within 6 weeks, right ventricular systolic pressure was again suprasystemic due to extreme inflow obstruction of the right pulmonary vein diagnosed by echocardiography. Severe heart failure developed and at the age of 1 year the patient died.     

Diagnosis of left-ventricular diastolic dysfunction in patients with predialysis chronic renal failure

AIM: To specify effectiveness of different methods for assessment of diastolic function in patients with pre-dialysis chronic renal failure (CRF). MATERIAL AND METHODS: Forty non-diabetic pre-dialysis CRF patients (20 males and 20 females, mean age 51 +/- 11 years) were studied. Serum creatinine was 209.3 +/- 117.4 mcmol/l. 19 patients had chronic heart failure (CHF) of NYHA class I-III. M-mode echocardiography and Doppler echocardiography were performed. Transmitral and pulmonary venous flows were assessed by Doppler echocardiography and the flow propagation velocity (Vp) was estimated by color M-mode Doppler echocardiography. The ratio of peak E-wave velocity of transmitral flow to Vp (E/Vp) was calculated. All the patients had preserved systolic function (ejection fraction > 45%). RESULTS: Interpretation of transmitral flow was difficult in 16 (40.0%) patients. During Valsalva's manoeuvre the E-wave peak velocities, the A-wave velocities and the ratio E/A were decreasing. However, we did not reveal any correlation between E/A and NYHA class of heart failure (r = 0.18; p = 0.32). Interpretation of pulmonary venous flow was possible only in 24 (60.0%) patients. Vp estimation by color M-mode Doppler echocardiography improved evaluation of diastolic function in 15 of 16 patients with problems of transmitral flow assessment. A negative correlation was revealed between NYHA class and Vp (r = -0.39; p = 0.013) and a positive correlation was between NYHA class and E/Vp (r = 0.45; p = 0.004). CONCLUSION: Vp assessed by color M-mode Doppler echocardiography improves the diagnosis of diastolic dysfunction in patients with chronic renal insufficiency. This method has an advantage over pulmonary venous flow investigation. The Valsalva's manoeuvre is low-effective for differential diagnosis of transmitral flow types.     

经胸超声心动图对房间隔缺损封堵术患者肺动脉顺应性的研究

目的探讨经胸超声心动图测算肺动脉顺应性指数（PACI）评价房间隔缺损封堵术患者肺动脉顺应性的价值,以及PACI与年龄及术后肺动脉压力变化的关系。方法74例继发孔型房间隔缺损并成功进行封堵治疗患者,根据术后肺动脉收缩压分为3组,≥40mmHg（1mmHg=0.133kPa）组11例,30～40mmHg组23例,≤30mmHg组40例。术前超声心动图测量肺动脉收缩压,计算房间隔缺损面积指数（ASD—AI）、PACI,术后3个月再次测量肺动脉收缩压,并进行对比。结果与≥40岁组比较,20-40岁组和≤20岁组术后肺动脉收缩压降低,PACI增高;与术后肺动脉收缩压≥40mmHg组比较,30～40mmHg组和〈30mmHg组的PACI增高,ASI—AI减低;差异均有统计学意义（P〈0.05）。结论PACI高、年龄小的房间隔缺损患者,手术后肺动脉收缩压的恢复较好,因此推断PACI可作为评价房间隔缺损封堵术患者术后肺动脉收缩压恢复程度的指标之一。     

Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit

OBJECTIVE: To determine whether Doppler transmitral and pulmonary venous flow pattern is related to left ventricular filling pressures in critically ill patients. DESIGN: Prospective clinical investigation. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Fifty-four mechanically ventilated patients (age, 63 +/- 16 yrs) were investigated via transthoracic echocardiography and Doppler. Main diagnoses were pneumonia (31%), acute exacerbation of chronic obstructive pulmonary disease (24%), congestive heart failure (11%), and poisoning (11%). INTERVENTIONS: Doppler examinations were performed simultaneously with measurements of pulmonary artery occlusion pressure via a right heart catheter. MEASUREMENTS AND MAIN RESULTS: Pulmonary artery occlusion pressure correlated with transmitral peak E-wave velocity (r =.46) and E/A ratio (r =.55). Pulmonary artery occlusion pressure inversely correlated with deceleration time of the transmitral E-wave (r = -.52), pulmonary venous peak S-wave velocity (r = -.37), and systolic fraction of the pulmonary forward flow (r = -.56). An E/A ratio >2 predicted a pulmonary artery occlusion pressure >18 mm Hg with a positive predictive value of 100%. A duration of pulmonary venous A-wave reversal flow exceeding the duration of the transmitral A-wave forward flow predicted a pulmonary artery occlusion pressure >15 mm Hg with a positive predictive value of 83%. A systolic fraction of the pulmonary venous forward flow <0.4 predicted a pulmonary artery occlusion pressure >12 mm Hg with a positive predictive value of 100%. CONCLUSION: Transmitral and pulmonary venous flow patterns measured by transthoracic Doppler echocardiography can be used to estimate the left ventricular filling pressure in critically ill patients.     

First-trimester fetal heart block: a marker for cardiac anomaly.

BACKGROUND: Fetal heart block in the second and third trimesters may be caused by transplacental passage of auto-antibodies or cardiac defects. Little is known about the etiology of first-trimester fetal heart block. MATERIALS AND METHODS: Fetal heart block was diagnosed in four patients (negative antibody serology) referred for first-trimester sonographic evaluation of increased fetal nuchal fold thickness with bradycardia. Two-dimensional echocardiography was complemented by color Doppler flow imaging of the fetal heart. Fetal arrhythmia was verified by M-mode, pulsed wave Doppler and/or color M-mode echocardiography. RESULTS: All fetuses had congenital heart disease, atrioventricular valve regurgitation, heart block and edema. Autopsy confirmed heterotaxy in three cases (left atrial isomerism with atrial septal defect; left isomerism with double-outlet right ventricle, great artery malposition and ventricular septal defect. The third case had dextrocardia with atrioventricular canal defect and the fourth case dextrocardia with great artery transposition. CONCLUSION: First-trimester fetal bradycardia may result from heart block of the type associated with complex congenital heart disease. Accelerated edema formation in this setting may be the basis of nuchal edema formation. First-trimester fetal echocardiography offers the potential for early diagnosis and intervention in these cases with poor prognosis.     

肺移植术后早期心脏结构和功能的变化

目的 分析肺移植术后早期心脏结构和功能变化,探讨其与患者术后肺动脉压力降低之间的关系。方法 回顾性分析2002-2010年无锡市人民医院行肺移植手术90例,术前及术后超声心动图资料完整者20例患者的临床资料。对比分析术前及术后超声心动图的变化。应用Pearson直线相关分析判断术后早期心脏结构及功能的变化与肺动脉收缩期压力下降之间的关系。结果 术后肺动脉收缩期压力[(38.30±8.92)mmHg]较术前[(60.05±29.10)mm Hg]明显降低(t=3.120,P=0.006);术后右心室内径较术前明显缩小(t =36.000,P=0.008);三尖瓣及肺动脉瓣返流程度明显减轻(t=57.000、t=66.000,P均＜0.05)。术后左心房内径、左心室舒张末期内径[(35.15±5.73) mm和(43.25±5.56)mm]均较术前[(32.40±7.29)mm和(40.15±6.20) mm]明显扩大(t=-2.384和t=-2.153,P均＜0.05)。虽然术后每搏输出量[(59.54±14.97) ml)]较术前[(44.18±15.85) ml]明显增加(t=-3.918,P=0.004),但术后左心室射血分数(63.10±8.48)％较术前(71.75±8.10)％明显下降(t =3.742,P=0.001)。Pearson直线相关分析可见肺移植术后肺动脉收缩压降低程度越大,术后左心房内径、左心室舒张末期内径增加幅度及术后左心室射血分数降低幅度越大(相关系数分别为0.642、0.737、0.448,P均＜0.05)。结论 肺移植术后早期右心结构正常化,右心功能改善,左心扩大,心搏出量增加,但左心室收缩功能降低,这些变化与肺动脉收缩期压力降低有一定关系。