多平面经食管超声心动图对房间隔完整的三房心的诊断价值

目的 评价多平面经食管超声心动图（MTEE）对房间隔完整的三房心的诊断价值。方法 分析9例经手术证实的房间隔完整三房心的经胸超声心动图（TTE）及MTEE声像图表现。结果 9例均系房间隔完整的左房三房心,其8例为完全型（Ⅱa型）,1例为部分型（Ⅰa型）;MTEE对三房心的隔膜位置、开口大小、与肺静脉的关系、房间隔是否完整等的显示较TTE更为直观和逼真。结论 MTEE是诊断三房心畸形更为有效的一种方法。     

Surgical resection of cor triatriatum in a 74-year-old man. Review of echocardiographic findings with emphasis on Doppler and transesophageal echocardiography

A 74-year-old man was admitted to the hospital with congestive heart failure secondary to cor triatriatum. He also had sick sinus syndrome with complete heart block and syncope that had been treated with a permanent pacemaker 20 years earlier. The patient underwent successful surgical resection of the atrial membrane with closure of an atrial septal defect. M-mode, two-dimensional, Doppler, and transesophageal echocardiographic findings are reviewed. A unique "spike and dome" pattern on continuous-wave Doppler echocardiography is described that may suggest diagnosis of cor triatriatum.     

Two-dimensional, spectral Doppler, and color flow imaging in adults with acquired and congenital cor triatriatum

Four adult patients ranging in age from 37 to 72 years with cor triatriatum diagnosed by two-dimensional, spectral Doppler, and color flow imaging are presented, including a previously undescribed "acquired" form after orthotopic heart transplantation and the oldest documented patient with cor triatriatum. The echocardiographic features of cor triatriatum with use of surface and transesophageal imaging are reviewed, with particular emphasis on the color flow findings. Color flow imaging has simplified the diagnosis and assessment of cor triatriatum, including the demonstration of other often-associated congenital cardiac anomalies.     

超声心动图与计算机断层扫描血管成像诊断儿童三房心及其预后分析

目的 探讨超声心动图(Echo)、计算机断层扫描血管成像(CTA)诊断儿童三房心(CT)的临床应用价值并分析其预后.方法 以2009年5月至2019年5月重庆医科大学附属儿童医院手术治疗的49例CT患儿为研究对象,回顾性总结分析其Echo、CTA的影像学特征及患儿预后.结果 本组49例患儿,心脏位置正常者48例(98....     

超声心动图在三房心合并主动脉瓣二叶诊治中的应用

目的探讨超声心动图在三房心或合并其它心血管异常诊断中的应用价值。方法回顾性分析1例三房心合并主动脉瓣二叶患者的病例资料并结合相关文献分析。结果患者高考前体检,超声提示左房内隔膜样回声将左房分隔成二腔形成左房三房心;另外主动脉瓣左、右冠瓣间融合嵴形成,瓣叶呈功能型二叶。结论三房心的隔膜上通常存在交通口,无血流动力学意义者多无症状,可以不需要治疗;交通口小或无交通口者通常需要外科干预矫正。超声心动图是三房心影像诊断中最简便的有力工具。     

MRI misinterpretation of spontaneous echo-contrast as a large left atrial thrombus

A magnetic resonance imaging of the heart was obtained in a patient with history of mitral valve replacement, in whom cor triatriatum dexter was suspected. Dense left atrial echo-contrast, visualized during a previous trans-esophageal echocardiography, was incorrectly interpreted as a large thrombus extending into the pulmonary veins and the patient was referred for cardiac surgical evaluation.     

Value of transesophageal color Doppler echocardiography for detection of different types of atrial septal defect in adults.

In 121 adults, the value of transthoracic and transesophageal color Doppler echocardiography for detection of different types of atrial septal defect (ASD) or of partial anomalous pulmonary venous return was analyzed. The 121 patients had a total of 129 defects with left-to-right atrial shunting (including eight patients with two types of defects). All of six cases with primum-type ASD were diagnosed correctly by both echocardiographic methods. Ninety-seven patients showed a secundum-type ASD during transesophageal echocardiography: by transthoracic echocardiography, only eight (20%) of the 40 small defects (diameter < 5 mm) were detected as compared with 15 (83%) of the 18 defects with a diameter of 5 to 10 mm and all 39 defects with a diameter > 10 mm. A sinus venosus--type ASD was evident by transesophageal echocardiography in 11 patients, of which only one (9%) was demonstrated by the transthoracic approach. Partial anomalous pulmonary venous return was seen by transesophageal echocardiography in 13 patients but missed in two other patients in whom anomalous pulmonary venous return was subsequently identified by surgery (both with anomalous return of the upper right pulmonary vein into the superior vena cava). By use of the transthoracic technique, partial anomalous venous return was detected in only two cases, both of which had "scimitar syndrome." Compared with transthoracic echocardiography, the transesophageal approach is clearly superior in the detection of small secundum-type ASD, sinus venosus--type ASD, and partial anomalous pulmonary venous return.     

Doppler echocardiographic findings in 2 identical variants of a rare cardiac anomaly, "subtotal" cor triatriatum: a critical review of the literature.

Improved diagnostic procedures of echocardiography and better awareness of the anomaly and its possible variants lead the examiner to the right diagnosis of the rare cor triatriatum sinister. We describe two cases of a variant of "subtotal" cor triatriatum sinister. A uniform classification system is desirable to compare cases, treatment, and outcome.     

Prenatal diagnosis of cor triatriatum sinister associated with early pericardial effusion: A case report

BACKGROUNDCor triatriatum sinistrum or cor triatriatum sinister is a rare congenital heart disease that accounts for approximately 0.1% of all cardiac abnormalities. It is defined as the presence of an anomalous septum that divides the left atrium into two cavities, and in most cases, it can be asymptomatic or less frequently very severe.CASE SUMMARYA 37-year-old pregnant woman visited our hospital. In the first trimester scan, we detected signs of fluid in the pericardium (pericardial effusion) that reached the atriums. In the third trimester, an anomalous septum in the left atrium suspicious of cor triatriatum sinister was detected. Expectant management was decided, the pregnancy evolved normally and resulted in uncomplicated delivery of a healthy child. The findings in the prenatal scan were confirmed by echocardiography and the diagnosis of cor triatriatum sinister was confirmed. The newborn was asymptomatic at all times.CONCLUSIONWe show expectant management of cor triatriatum sinister and suggest an association between this entity and early pericardial effusion.     

A cardiovascular cause of hematemesis

Cor triatriatum is a rare congenital heart defect in which a fibromuscular membrane forms an anomalous septum within the left atrium, dividing it into a posterosuperior higher pressure chamber and an anteroinferior anatomically true left atrium. Typically, in cor triatriatum, all four pulmonary veins enter into this accessory chamber, we present an unusual variant of cor triatriatum, in which only the right sided pulmonary veins were involved.     

Doppler assessment of pulmonary venous flow in healthy subjects and in patients with heart disease

Pulmonary venous flow as assessed by Doppler echocardiography is a current topic of investigation. Pulmonary venous flow has been used recently as part of a comprehensive assessment of left ventricular diastolic filling dynamics in restrictive myocardial diseases and constrictive pericarditis. Abnormalities of flow have been described in dilated cardiomyopathy, congenital heart disease, and arrhythmias. With the advent of transesophageal echocardiography, pulmonary venous flow can be readily obtained in all patients by pulsed-wave Doppler echocardiography. Recently, it has been used to assess the severity of mitral regurgitation and to estimate mean left atrial pressure. This article emphasizes the utility, physiology, and technique of measuring pulmonary venous flow with Doppler echocardiography in health and in disease.     

Four-year prospective study of pulmonary venous thrombosis after lung transplantation.

The objective of this study was to prospectively assess pulmonary venous anastomosis by transesophageal echocardiography after lung transplantation. Thrombus formation at the pulmonary venous anastomotic site after lung transplantation may have catastrophic consequences, including allograft failure and stroke. Eighty-seven consecutive adult lung transplant recipients underwent transesophageal echocardiography within 48 hours after surgery. Thrombosis of a pulmonary vein was diagnosed in 13 (15%) of 87 patients in the early postoperative period after lung transplantation. Mean thrombus width was 0.9 +/- 0.4 cm (range, 0.5 to 1.7 cm), with an average peak flow velocity at the site of obstruction of 127 +/- 23 cm/s (range, 90 to 150 cm/s). Five patients with pulmonary vein thrombosis died in the perioperative period, yielding a 90-day mortality rate of 38%. Larger thrombus size and greater acceleration of flow through a narrowed pulmonary vein correlated with poor clinical outcome. During each year of the study, the incidence of pulmonary vein thrombosis declined progressively. Pulmonary vein thrombosis is a potentially ominous complication in the early postoperative period after lung transplantation. Transesophageal echocardiography is a valuable tool for detecting abnormalities of the pulmonary venous anastomosis. Thrombus size and flow velocity at the anastomotic site may guide prognosis and clinical management. Complications of the pulmonary venous anastomosis are in part technical in nature.     

Crossing atrial thrombus in a patient with recurrent pulmonary embolism

OBJECTIVES: To report the detection of a thrombus entrapped in a patent foramen ovale by echocardiography in a patient with recurrent pulmonary embolism. DESIGN: Case report. SETTING: Intensive care unit of a university hospital. PATIENT: A 62-yr-old man with initial deep venous thrombosis and recurrent minor pulmonary embolism followed by a severe embolic event with transitory hemiparesis 10 days after prostatectomy. INTERVENTION: Systemic anticoagulation, surgical removal of a crossing atrial thrombus, closure of a patent foramen ovale, and venous thrombectomy. MEASUREMENTS AND MAIN RESULTS: Transesophageal echocardiography revealed a large thrombus entrapped in a patent foramen ovale with portions in all four heart chambers. Intraoperatively, a 19-cm-long thrombus, shaped like the pelvic veins, was found. The patient was successfully weaned from cardiopulmonary bypass, requiring temporary positive inotropic support because of right ventricular dysfunction. Within 24 hrs of the operation, the patient was discharged to the intermediate care unit. CONCLUSIONS: Recurrent pulmonary embolism can potentially result in paradoxic embolism in patients with a patent foramen ovale. In such patients, it may be crucial to monitor right ventricular function and exclude right-to-left shunts by transesophageal echocardiography, regardless of clinical symptoms. The patent foramen ovale should be closed. This case emphasizes an important indication for transesophageal echocardiography in critically ill patients.     

Transesophageal Doppler echocardiographic assessment of pulmonary venous flow pattern in subjects without cardiovascular disease

This study was designed to assess pulmonary venous flow dynamics using transesophageal Doppler echocardiography. Under general anesthesia, we studied 54 surgical patients with no history or physical evidence of cardiac disorders. In all patients pulmonary venous flow was easily identified by transesophageal color flow mapping. Pulmonary venous flow pattern, which was obtained clearly in 85% (4654) of patients by transesophageal pulsed Doppler echocardiography, was tri- or quadriphasic. The first wave, which was often biphasic in elderly patients, occurred during ventricular systole (S wave). The second wave occurred in diastole during the early ventricular filling phase of mitral flow (D wave). The third wave was reverse flow toward the pulmonary vein during atrial contraction (A wave). The following variables were measured: the peak flow velocities of each wave (PFVs, PFVd, PFVa), and the ratio of PFVs to PFVd (PFV(S/D)). The PFVd correlated with age (r=?0.56, P<0.001), indicating age-related decrease. The PFV(S/D) correlated with age (r=0.61, p<0.001), indicating age-related increase. These results would indicate that the contribution of pulmonary venous flow during diastole to total pulmonary venous flow decreases with age. Our data suggest that age-related diastolic dysfunction of the left ventricle would affect pulmonary venous flow dynamics and that left atrial storage volume during ventricular systole would increase with age.     

Atrial septostomy under transesophageal guidance in a patient with primary pulmonary hypertension and absent right superior vena cava

A patient presenting primary pulmonary hypertension and absent right superior vena cava underwent blade/balloon atrial septostomy as palliative therapy. Due to the anomaly of the venous drainage system, only transesophageal echocardiography allowed the performance of the maneuvre.     

心房颤动患者收缩期肺静脉血流特征的超声研究

目的 探讨心动周期变化对不同病因心房颤动(房颤)患者肺静脉收缩期血流的影响。方法 对照组20例；房颤组74例(非瓣膜病房颤16例，风湿性心脏病二尖瓣轻中度狭窄22例，二尖瓣重度狭窄36例)。应用经食管超声心动图测量肺静脉血流频谱曲线收缩早期逆向R波峰值流速(PVR)和收缩期S波峰值流速(PVS)，分析PVR和PVS与其前心电图R-R间期的关系。结果 所有房颤患者均可检出收缩早期逆向R波，二尖瓣重度狭窄组PVR明显减低，PVR与其前的R-R间期显著负相关；房颤患者的PVS减低，二尖瓣重度狭窄组尤为明显，PVS与其前的RR间期显著正相关。结论 房颤患者的PVR和PVS与其前的RR间期长短密切相关，连续观察PVR和PVS的变化，为动态评价房颤时左心房血流动力学异常提供了重要信息。     

Transesophageal echocardiography for the diagnosis of pulmonary embolism with acute cor pulmonale: a comparison with radiological procedures

Objective: The goal of the study was to assess prospectively the value of transesophageal echocardiography (TEE) for the diagnosis of massive pulmonary embolism complicated by acute cor pulmonale. Design: A prospective study conducted on 44 consecutive patients. Setting: A general intensive care unit (ICU) of a university hospital. Patients and methods: Between May 95 and October 96, 44 consecutive patients with clinically suspected acute pulmonary embolism underwent transthoracic echocardiography (TTE), completed by TEE when acute cor pulmonale was present (30 patients). The results of the echocardiographic studies were compared with radiological investigations by helical CT or contrast angiography. Results: The high sensitivity and specificity of the presence of acute cor pulmonale on TTE for the diagnosis of pulmonary embolism was confirmed. Nineteen patients only underwent TEE. The sensitivity and the specificity of TEE in detecting a proximal pulmonary embolism were 84 % and 84 %, respectively. Its main limitation concerned the left pulmonary artery, in which only one thrombus was visualized by TEE whereas six were present on helical CT, and lobar pulmonary arteries which could not be visualized with TEE. Thus, the overall sensitivity of TEE for the detection of pulmonary embolism with acute cor pulmonale was only 58 %. Conclusion: In comparison with radiological procedures, TEE had limited accuracy for detecting pulmonary embolism with acute cor pulmonale. When the pulmonary embolism was located in the main or right pulmonary artery, TEE could clarify the diagnosis within a few minutes without further invasive diagnostic procedures. However, a negative TEE did not exclude left proximal or lobar pulmonary embolism. Received: 28 April 1997 Accepted: 28 November 1997     

Fenestrated atrial septal aneurysm: diagnosis by transesophageal echocardiography

The diagnosis of atrial septal defect by transthoracic echocardiography remains difficult in a small subset of patients because of either suboptimal acoustic windows or unusual anatomy, for example, fenestrated defects. We report the case of a 55-year-old woman with a fenestrated atrial septal aneurysm that was incompletely visualized by transthoracic echocardiography. Subsequent transesophageal echocardiography demonstrated three defects within the atrial septal aneurysm with left-to-right shunting across each defect. Normal pulmonary venous connections were also defined. All echocardiographic findings were confirmed at surgery. This case demonstrates the additional diagnostic accuracy of transesophageal echocardiography for detecting disease of the atrial septum.     

Cor triatriatum dexter, atrial septal defect, and Ebstein's anomaly in an adult given a diagnosis by transthoracic and transesophageal echocardiography: a case report.

Cor triatriatum dexter is a very rare congenital abnormality in which the right atrium is divided into two chambers by a membrane. In this abnormality, there is a high incidence of associated congenital abnormalities, particularly of the right heart. In this case study, a 67-year-old man with Ebstein's anomaly, atrial septal defect, and cor triatriatum dexter is presented and echocardiography is discussed as a noninvasive diagnostic tool.     

Mechanism and incidence of notched pulmonary venous atrial reversal wave.

In certain patients, pulmonary venous flow pattern obtained by the pulsed wave Doppler during transesophageal echocardiography shows a notching on the atrial reversal (A) wave. However, the incidence or the mechanism of this notched A wave has not been described. After transthoracic echocardiographic evaluation for the chamber sizes, wall thickness, and left-ventricular function, transesophageal echocardiography was performed in 100 patients with in sinus rhythm. Discernible pulmonary venous A wave was observed in 46 patients. Among these 46 patients, notched A wave was observed in 11 (31%). In 4 patients with notched A wave, left-atrial pressure waveforms could be obtained during mitral balloon valvuloplasty. In all these patients, left-atrial pressure waveforms showed prominent c waves. In 2 patients, transesophageal echocardiography was repeated after mitral balloon valvuloplasty. Late peak of the notched A wave decreased with the decrease in the magnitude of rise in left-atrial c wave. Among the transthoracic echocardiographic parameters, patients with notching (n = 11) had significantly larger left atriums than patients without notching (n = 35)(49.3 +/- 6.2 vs 37.3 +/- 4.4 mm, P <.0001). There were no significant differences in left-ventricular dimensions, wall thickness, and ejection fraction. In conclusion, notched pulmonary venous A wave indicates the presence of left-atrial c wave; and presence of left-atrial c wave may represent decreased left-atrial compliance.