经食管超声心动图对房颤时左右心耳血流频谱的对比研究

目的　探讨房颤时左、右心耳血流频谱的形态特点能否反映左、右心房的激动模式。方法　选取2 6例房颤患者,常规经胸超声资料的留取后,采用经食管超声心动图技术,充分清楚显示左、右心耳图像并采集血流频谱和其它相应指标。结果　房颤时,左右心耳血流频谱类型表现不一致。结论　经食管超声心动图对左右心耳血流频谱的研究为房颤时左右心房激动模式提供信息     

经食管超声心动图对心房颤动患者右心耳自发显影回声和血栓发生的研究

目的探讨经食管超声心动图(TEE)观察慢性心房颤动(房颤)时右心房、右心耳自发显影(SEC)和血栓发生情况。方法选取26例房颤患者和13例窦性心律患者，常规经胸超声心动图资料留取后，采用TEE充分清楚显示左、右心耳图像并采集血流流速曲线和其他相应指标。结果26例房颤患者左心耳内均可测及SEC，共测及血栓形成者10例；房颤患者右心耳内有SEC者共17例，共测及右心耳血栓形成者1例。结论房颤时右心耳内可有血栓发生，TEE检查在房颤抗凝治疗中和复律前后具有重要意义。     

经食管超声心动图对心房颤动时右心耳血流动力学的研究

目的　应用经食管超声心动图(TEE)技术观察慢性心房颤动(房颤)时右心耳结构、功能和血流流速曲线的改变。方法　选取 26例房颤患者和 13例窦性心律患者,采用TEE充分清楚显示右心耳图像并采集血流流速曲线和其他相应指标。结果　与对照组相比,房颤组右心房射血分数 (RAEF)和右心耳射血分数(RAAEF)均显著降低(P<0. 05~0. 01);房颤时右心耳血流流速曲线峰值排空、充盈流速和流速积分均显著下降(P<0. 05~0. 01)。右心耳峰值排空、充盈流速与右室射血分数 (RVEF)、RAAEF、RAEF、右心房最大面积(Smax RA)等指标具有显著的相关性。结论　TEE可以安全、准确地评价右心耳血流动力学情况;房颤时右心耳血流流速曲线是反映右心房、右心耳功能的良好指标。     

经食管超声心动图组织多普勒评价左心耳功能

目的观察窦性心律和心房纤颤（房颤）患者经食管超声心动图左心耳脉冲组织多普勒的图像特点,结合脉冲多普勒初步研究使用组织多普勒技术评价左心耳功能的价值。 方法窦性心律和房颤患者各15例均经食管超声心动图检查,房颤患者根据有无心房血栓或心房血流浓密自显影分为2组,并将经食管超声心动图的指标进行比较。 结果窦性心律患者的左心耳血流频谱和脉冲组织多普勒图像为可测量的三相波;房颤患者则表现为无规律的可测量的多相波。左心耳血流速度在各组间均有显著性差异;脉冲组织多普勒指标在窦性心律和房颤患者中有显著性差异,在有血栓和心房血流自显影的房颤患者中进一步降低或有进一步降低的趋势。 结论经食管超声心动图检查能获得可测量的左心耳（包括房颤患者）组织多普勒图像,可作为分析左心耳功能的重要补充。     

经食管超声对窦性心律左心耳血流频谱的研究

目的　研究窦性心律左心耳血流频谱的类型 ,评价相应的血流动力学。方法　应用经食管超声技术 (TEE)对 83例窦性心律的左心耳血流频谱进行研究。结果　窦性心律左心耳血流频谱的波相可分为 4相、3相、2相三类。从 4相到 2相的演变过程中 ,左心房、左心耳扩大 ,左心房及左心耳功能降低 ,心率和年龄呈增加的趋势 ,左心房内自发性显像 (SEC)程度和血栓发生率均增加 ,风湿性心脏病、二尖瓣重度狭窄所占的比例也增加。多因素相关分析表明 :左心耳收缩期血流速度 (LAA A)与左心房面积 (S LA)、左心房容积 (V LA)呈负相关 ,与左心房面积变化率 (FAC)、左心房容积变化率 (EF LA)、左心耳容积变化率 (EF LAA)呈正相关。结论　窦性心律左心耳的血流频谱能较好地反映左心房、左心耳功能 ,在一定程度上反映了左心室的舒张功能。     

经胸及经食管超声在房颤射频消融术前检测左右心耳血栓的临床意义

目的 探讨经胸及经食管超声在心房纤维性颤动(房颤)射频消融术前检测左、右心耳血栓的临床意义.方法 应用经胸(TTE)及经食管(TEE)超声心动图对分为阵发性房颤组(A组)及持续性房颤组(B组)的140例受检者进行研究.结果 A组中, TTE技术没有检测到左心耳血栓,TEE技术在90例中检测出6例左心耳血栓,占6.6%;B组中,TTE技术在50例中发现4例左心耳血栓,占8%; TEE中发现20例左心耳血栓,占40%;右心耳血栓3例,占6%;在左心耳血栓中有15%的患者TEE检查发现2块左心耳的附壁血栓.左、右心耳同时发现血栓者占3%. 结论TTE及TEE在房颤射频消融术前检测左、右心耳血栓具有重要的临床意义.     

经食管超声心动图对非风湿性心房颤动转复前后左心耳血流频谱曲线的研究

目的　探讨非风湿性心房颤动 (简称房颤 )转复前后左心耳血流频谱曲线的类型及其相应的血流动力学特点。方法　应用经食管超声心动图 (TEE)对 60例非风湿性房颤患者转复前后的左心耳血流频谱曲线进行研究。结果　非风湿性房颤左心耳血流频谱曲线分 3种类型 :①持续整个心动周期的明确且不规则的充盈及排空波 ;②不连续的低小充盈及排空波 ;③持续的低流速波。从第一到第三种类型的演变过程中 ,左心房、左心耳内径逐渐扩大 ,功能逐渐减低 ,自发显像 (SEC)程度和血栓发生率逐渐增加。转复窦性心律后左心耳血流频谱曲线为规则收缩与舒张的窦性心律血流频谱曲线 ,但转复后的左心耳峰值血流速度 (LAA PEV )为 (2 3± 10 )cm /s ,低于转复前的 (3 0± 12 )cm /s (P <0 .0 0 1) ;左心房及左心耳新出现SEC者 8例 ,SEC密度增加者 11例。结论　非风湿性房颤左心耳的血流频谱曲线较好地反映左心房及左心耳功能 ,在一定程度上反映了左心室的舒张功能。房颤转复窦性心律后 ,左心耳血流频谱曲线恢复窦性 ,但左心耳功能出现“顿抑”。     

TEE 对非瓣膜性房颤复律后左心耳功能“顿抑”的观察

目的　对非瓣膜性房颤复律后左心耳功能“顿抑”超声表现的观察。方法　应用多平面经食管超声心动图 (TEE)对 17例非瓣膜性房颤病人复律后左心耳血流频谱及复律前与复律后 2 4小时、1周左心耳最大排空速度(LAA PEV) ,以及复律前、后左房自发显影 (SEC)的检测。结果　①房颤病人转复窦性心律后左心耳血流频谱呈现窦性心律模式。②电转复前LAA PEV为 30 8± 10 3cm/s ,转复后 2 4小时为 2 3 3± 10 2cm/s(P <0 0 0 1)。③转复后 1周LAA PEV为 6 6 4± 12 5cm/s ,与我们曾报道的正常组LAA PEV70 4± 10 9cm/s基本相近。④转复前左房显示SEC7例 ,其中有 5例转复后密度增加。转复前无SEC的 10例 ,转复后 3例出现SEC。结论　本文初步阐述了房颤复律后左心耳功能“顿抑”的超声表现。并据本组观察复律 1周后左心耳功能恢复正常     

M—型彩色多普勒成像评价冠心病左室舒张功能

Ｍ型超声在新技术 (如食管超声、三维超声等 )推广应用时 ,作用相对减弱。本文应用Ｍ型多普勒超声对冠心病和正常病人二尖瓣血流速度测定并与常规超声心动图检查对照分析 ,意在探讨Ｍ型多普勒超声评价冠心病左室舒张功能的临床应用价值。资料与方法研究对象正常对照组 30例 ,男 2 3例 ,女 7例 ,年龄 ( 5 1±10 .65 )岁。病例组为我院 1999年 10月～ 2 0 0 0年 8月经临床与心电图确诊为冠心病者 (心肌梗塞 19例 ,心胶痛 7例 ,缺血性心肌病 4例 ) ,男 2 4例 ,女 6例 ,年龄 ( 5 4± 12 .5 )岁 ,均为窦性心律 ,二尖瓣及主动脉病变者除外。超声仪…     

经胸及经食管超声在正常成年人肺静脉形态及血流动力学方面的对比研究

目的 探讨经胸超声(TTE)和经食管超声(TEE)在正常人肺静脉形态及血流动力学中的应用价值.方法 50例窦性心律患者.均行TTE和TEE检查,利用二维、脉冲多普勒及彩色多普勒观察4条肺静脉的内径及血流频谱.结果 TTE对4条肺静脉的显示率分别为:左上肺静脉90%,右上肺静脉86%,左下肺静脉40%,右下肺静脉2%;TEE为:左、右上肺静脉均为100%,左下肺静脉83%,右下肺静脉85%.TTE和TEE 2种方法在测量肺静脉形态及血流速度方面没有显著差异,但TEE比TTE所检测的频谱质量要好,而且有良好的信噪比.左、右上肺静脉的血流束与声束间的角度小于20°,可测量到较理想的血流频谱.取样容积的深度在一定范围内对收缩期血流速度及频谱质量没有影响,但随着取样容积位置的加深,舒张期血流速度逐渐减低.结论 在肺静脉的研究方面经食管超声比经胸超声能够获得质量更好、更多的血流动力学信息.     

Left atrial appendage dysfunction: a cause of thrombosis? Evidence by transesophageal echocardiography-Doppler studies.

The blood flow velocity patterns within the left atrial appendage were studied by transesophageal color flow imaging and pulsed Doppler in 84 patients. At the time of the study, 57 of the patients were in sinus rhythm, 25 were in atrial fibrillation, and two were in atrial flutter. The relationships between atrial rhythm, blood flow pattern and the presence/absence of spontaneous echocardiographic contrast or thrombus within the appendage were investigated. Transesophageal echocardiography allowed recording of blood flow velocities in 81 of the 84 patients studied. In 51 of the 55 patients in sinus rhythm the pulsed Doppler study showed a biphasic blood flow pattern, whereas a multiphasic pattern was found in the two patients with atrial flutter and in 14 patients with atrial fibrillation. In four patients with sinus rhythm and 10 patients with atrial fibrillation, no significant blood flow velocity could be detected. Thrombus or spontaneous echocardiographic contrast were found within the left atrial appendage in 20 patients, and in all these patients blood flow was either absent or significantly reduced. Our findings indicate that an absent or low blood flow velocity within the left atrial appendage represents a predisposing factor for thrombosis. Isolated left atrial appendage dysfunction has been documented in four patients during sinus rhythm, which may lead to thrombosis. This observation may offer an explanation for cardioembolic events that occur occasionally in patients without apparent heart disease and sinus rhythm.     

Electric dissociation within left atrial appendage diagnosed by Doppler echocardiography.

We describe a patient who presented with a transient ischemic event in whom transesophageal echocardiography showed presence of an accessory lobe within the left atrial appendage that was in atrial fibrillation by pulsed wave Doppler when the left and right atrial appendages, pulmonary vein, and right atria were in sinus rhythm.     

Alternate site atrial pacing in the young: conventional echocardiography and tissue Doppler analysis of the effects on atrial function and ventricular filling

BACKGROUND: Although the right atrial appendage (RAA) is typically used for atrial pacing lead implant, recent studies have shown benefits of alternate site atrial pacing (ASAP) in the elderly. However, comparable studies in the young are lacking. METHODS: To investigate effects of ASAP on cardiac function and atrioventricular mechanical interactions in the young, 26 subjects (ages 10 to 23 years) with normal cardiac anatomy, function, and atrioventricular node conduction underwent echocardiography during electrophysiology studies while in sinus rhythm (NSR), and with temporary pacing from high right atrium (HRA), RAA, mid septal right atrium approximating Bachmann's bundle (BB), and left atrium (LA) via the distal coronary sinus (CS). After a paced steady state of 10 minutes, left atrial total and systolic ejection fractions, color-guided mitral inflow, and annular tissue Doppler indices were obtained. Left ventricular ejection fraction and myocardial performance indexes (MPI) were calculated. RESULTS: The total and systolic LA ejection fractions were higher during the NSR compared to all ASAP. Mitral inflow velocities changed significantly with ASAP. The passive/active ventricular filling ratio (E/A) deteriorated from NSR to HRA to BB to CS. There were significant changes in late diastolic tissue Doppler velocities during ASAP compared to NSR. The MPI during ASAP differed from those during the NSR. HRA and Bachmann bundle pacing provided better MPIs than RAA or CS pacing. CONCLUSION: The location of atrial pacing leads has an acute impact on cardiac function and atrioventricular mechanical interaction. Pacing close to sinus node location may be beneficial in the young.     

Dual-site right atrial pacing increases left atrial appendage flow in patients with sick sinus syndrome and paroxysmal atrial fibrillation

BACKGROUND: Dual-site right atrial pacing has been proposed as a promising concept for prevention of paroxysmal atrial fibrillation (PAF). Effects of this pacing configuration on left atrial appendage (LAA) flow and transmitral flow may be of prognostic and hemodynamic relevance. This study aims to characterize acute changes in left atrial flow depending on dual-site right atrial pacing. METHODS: In 12 patients (66 +/- 8.8 years, 4 women) with PAF and sinus bradycardia a pacemaker with a right atrial dual-site lead configuration (right atrial lateral and coronary sinus ostium) was implanted. Flow velocities in the left pulmonary vein (LPV), LAA, and across the mitral valve were assessed by transesophageal echocardiography and compared during sinus rhythm (SR) and dual-site (DS) pacing. RESULTS: Dual-site pacing resulted in higher maximum (SR: 0.57 m/s; pacing: 0.77 m/s; P < 0.02) and mean (SR: 0.33 m/s; DS: 0.47 m/s; P < 0.01) LAA emptying flow when compared with SR. The passive transmitral flow component (maximum E-wave velocity) was lower during dual-site pacing (SR: 0.53 m/s vs DS: 0.44 m/s, P < 0.02). The E/A ratio tended to be lower during dual-site pacing (SR: 1.21 vs DS: 1.01, P = 0,10). LPV flow velocities during SR and DS pacing did not differ. CONCLUSION: DS right atrial stimulation in patients with PAF increases the LAA emptying flow velocity and shifts the transmitral flow pattern towards a lower passive component when compared with sinus rhythm. The change in LAA flow may contribute to a lower incidence of thromboembolism and merits further investigation.     

When the body and appendage of the left atrium disagree: "Focal" atrial fibrillation-implications for atrial thrombus formation and risk of thromboembolism.

A case is presented of a man who had 5 hours of atrial fibrillation followed by spontaneous conversion and maintained sinus rhythm that persisted as shown by surface electrocardiography. Transesophageal echocardiography performed 24 hours after electrocardiographic conversion documented an atrial fibrillation pattern within the left atrial appendage, with a normal sinus Doppler pattern in the body of the left atrium. This apparent regional discrepancy in atrial function may partially explain the increased risk for "late" thromboembolism among patients with atrial fibrillation who appear to be successfully converted with sustained sinus rhythm.