新生儿先天性心脏病的根治与围手术期治疗

[目的]分析本院外科手术治疗的36例新生儿先天性心脏病婴儿的临床资料,总结新生儿先心病的围手术期处理经验.[方法]全组患儿均在体外循环下行一期根治术,术前给予控制感染、纠正心衰、增加心功能储备等处理,术后给予呼吸、循环管理,治疗并发症等处理.[结果]①21例未出现并发症,术后(11.91±3.65)d痊愈出院.12人出现并发症,共32例次,均痊愈出院.死亡3例,病死率8.33%.均为复杂性先心病患儿,死于重度低心排综合征.②比较患儿入院、出院时呼吸频率、心率、肝脏大小,结果均有显著统计学意义(P＜0.05).③分析患儿术前、术后10 d所做心脏彩超数据,结果表明:射血分数、舒张末期左室内径、每分钟心输出量、舒张末期左室容积均无明显差异(P＞0.05),合并肺动脉高压患儿出院时平均肺动脉压、肺动脉内径较术前明显下降(P＜0.05).[结论]先天性心脏病手术宜早期进行.合理的围手术期治疗,是提高新生儿先心病手术成功率的关键.     

磁共振在常见左向右分流先天性心脏病中的 诊断价值探讨

目的　探讨磁共振 (MRI)在小儿常见左向右分流先天性心脏病 (先心病 )中的诊断价值。方法　 82例均行超声心动图及MRI检查 ,其中 6例作心血管造影 (ACG) ,5 7例行手术。结果　 82例中单纯室间隔缺损 (VSD) 6 0例 ,VSD合并房间隔缺损 (ASD) 11例 ,VSD合并动脉导管未闭 (PDA) 2例 ,ASD合并PDA 1例 ,VSD合并ASD、PDA 3例 ,ASD 2例 ,PDA 3例。MRI检查出超声心动图漏诊的伴有主动脉弓病变 18例。结论　小儿常见左向右分流先心病的MRI诊断结果与超声相符 ,能显示心外大血管异常是MRI的优势。     

新生儿及婴儿先天性心脏病多层螺旋CT心血管成像

目的探讨新生儿及婴儿多层螺旋CT(MSCT)心血管成像技术及其对先天性心脏病的诊断价值.方法 MSCT对比增强心脏检查83例,所有病例均作心脏超声(US)对照,并经手术或X线心血管造影证实.结果 MSCT对先心病畸形的诊断敏感性96.99%、特异性99.57%、准确率95.71%.其中,心脏部分畸形80处,MSCT与 US诊断准确率差异无显著性意义(χ2=0.879,P=0.352);心外部分畸形153处, MSCT诊断准确率明显高于US(χ2=36.6,P=0.000).MSCT与US联合诊断准确率99.14%.结论 MSCT对新生儿及婴儿先心病畸形的检出优于US,MSCT与US联合可提高对新生儿及婴儿先心病诊断的准确率.     

彩色多普勒超声心动图联合心脏超声检查在新生儿先天性心脏病筛查中的应用价值分析

目的:研究筛选先天性心脏病新生而使用彩色多普勒超声心动图和心脏超声的效果并对其可行性进行分析。方法:对2018年6月～2019年6月于我院分娩的135例疑似先天性心脏病患儿的临床诊断资料进行回顾分析,所有患儿均顺利接受彩色多普勒超声心动图和心脏超声检查,分析其临床诊断结果。结果:临床手术及病理检测共有59例患儿存在先天性心脏病,超声检出57例,在所有患儿中,肺动脉瓣狭窄漏诊1例、误诊1例,大血管错误的漏诊有1例,诊断与超声进行联合应用后,有效率、特异度与敏感度均达到96.30%,对患儿心脏结构是否正常以及血流状况、连接状况等均能清晰检测。从两组患儿心脏检测指标差异来看,患有先心病的患儿,肺动脉瓣血流要更快一些,且收缩期、舒张期的左室后壁后壁也要变得更大,数据进行分析后差异粗在奶意义(P0.05)。结论:将心脏超声与彩色多普勒超声两种检查方式联合应用可以准确的筛选出存在先天性心脏病的患儿,排除非先天性心脏病患儿,能够较为有效的检出患儿心脏异常状况,检查无创、安全,临床应用价值高,但是临床诊断中仍然应该根据患儿具体情况结合诊断提升诊断准确性。     

胎儿先天性心脏病MRI诊断的初步探讨

目的探讨MRI在胎儿先天性心脏病(CHD)诊断中的应用价值。方法 60例孕妇,孕龄21～36周。产前常规行超声(US)检查后24～48h内行超声心动图(Echo)或MR检查。MR采用快速平衡稳态采集(FIESTA)序列或平衡稳态梯度回波(B-FFE)序列、单次激发快速自旋回波(SSFSE/SSTSE)序列和非门控动态FIESTA电影序列或实时B-FFE序列,行胎儿颅脑胸腹部常规及胸部横断、冠状及斜矢状面扫描,胎儿心脏四腔及短轴扫描,将产前MRI、Echo表现与出生后影像表现、手术或尸解结果对照。采用四格表的Fish-er确切检验统计分析。结果 60例CHD中43例(71.7%)产前Echo和MRI诊断均准确,2例(3.3%)产前Echo和MRI诊断均不正确,8例(13.3%)产前Echo诊断准确而MRI诊断不准确,7例(11.7%)产前MRI诊断准确而Echo诊断不准确。结论 MRI对胎儿CHD有一定诊断价值,在心脾综合征、多脏器复杂畸形、大血管异常方面具有一定诊断优势,能发挥Echo一定的补充作用。     

超声二维斑点跟踪技术测量三尖瓣环位移评价右心室收缩功能

目的 探讨彩色多普勒超声心动图对完全性肺静脉异位连接(TAPVC)的诊断价值。方法 回顾分析19例经手术证实的TAPVC患者的超声心动图诊断情况。结果 首次彩色多普勒超声心动图检查诊断TAPVC与手术诊断的符合率为89.47%(17/19),其中心上型11例,心内型5例,心下型1例。首次超声检查漏诊2例(10.53%),其中包含1例心下型TAPVC以及将1例混合型TAPVC(心上型+心内型)诊断为部分性肺静脉异位连接心内型。这2例患者术前再次复查超声心动图,均正确诊断。19例TAPVC均伴继发孔房间隔缺损及中至重度肺动脉高压。19例TAPVC超声心动图表现共同特点:右心系统扩大,以右心房为主,肺动脉增宽,右心房和(或)左心房增大,左心系统缩小,以左心房缩小显著;彩色多普勒血流显示均为房水平右向左蓝色分流束;不同分型的特征性改变:左心房内不能探及肺静脉的入口部位,左心房缩小,左心房后方可探及一管状无回声结构,即共同静脉干。心上型TAPVC者胸骨上窝主动脉弓长轴切面可显示于主动脉弓前方并环绕主动脉弓的异常“静脉弓”,即共同静脉干经垂直静脉、无名静脉汇入上腔静脉;心内型TAPVC者大多数经冠状静脉窦汇入右心房,此时,在胸骨旁左心室长轴及四腔心切面可显示扩张的冠状静脉窦及其与共同静脉干沟通;心下型TAPVC者剑下主动脉短轴切面显示三条大血管,异常连接的共同静脉干位于下腔静脉左前、腹主动脉的前方,血流呈红色与腹主动脉相同,长轴追踪该共同静脉干于肝右叶后方汇入门静脉。混合型TAPVC(心上型合并心内型)者,胸骨上窝主动脉弓长轴切面显示左上肺静脉与垂直静脉(相对较细)相连,在胸骨旁左心室长轴及四腔心切面可显示右肺静脉及左下肺静脉经冠状静脉窦汇入右心房。合并心内畸形:19例TAPVC患儿中,2例合并心内膜垫缺损,1例合并大动脉转位,1例合并肺动脉瓣狭窄,2例合并动脉导管未闭。结论 二维彩色多普勒超声心动图经多部位、多切面、多方向的探查,对TAPVC能明确诊断及分型,为外科治疗方案提供重要依据,且检查简便易行、无创、可重复,是诊断TAPVC的首选方法。     

心脾综合征中肺静脉回流的影像学诊断

目的:分析76例心脾综合征中肺静脉回流特点对手术的影响,并评价其影像学诊断方法。方法:76例均做了心血管造影。其中38例做了MRI检查。结果:56例无脾综合征中33例伴肺静脉异位引流(APVC),28例为完全性肺静脉异位引流(TAPVC),12例为心上型,3例为心下型。20例多脾综合征中,5例伴APVC。结论:心脾综合征肺静脉回流特点多样,完全性肺静脉异位引流发生率高,术前正确诊断对先天性心脏病的手术治疗很重要。心血管造影仍有很高的诊断价值,造影增强磁共振血管成像(CE-MRA)是最好的辅助诊断方法。     

彩色多普勒超声心动图对完全性肺静脉异位连接的诊断价值

目的探讨彩色多普勒超声心动图对完全性肺静脉异位连接(TAPVC)的诊断价值。方法回顾分析19例经手术证实的完全性肺静脉异位连接患者的超声心动图诊断情况。结果 19例TAPVC患儿首次彩色多普勒超声心动图检查诊断与手术诊断的符合率为89.5%(17/19),其中心上型11例,心内型5例,心下型1例。首次超声检查漏诊2例(2/19),其中包含1例心下型TAPVC以及将1例混合型TAPVC(心上型+心内型)诊断为部分性肺静脉异位连接(心内型)。这两例患者术前再次复查超声心动图检查均做出了正确诊断。19例TAPVC均伴有继发孔房间隔缺损及中至重度肺动脉高压。结论彩色多普勒超声心动图对TAPVC能明确诊断及分型,为制定外科治疗方案提供重要依据。     

新生儿复杂先天性心脏病围术期护理

2000年1月~2005年5月,我们行新生儿复杂先天性心脏病手术46例,现将围手术期护理体会报告如下。1临床资料本组46例,男29例,女17例。23h~28d,平均14.8±6.9d,其中23~72h者6例,3~10d者15例,10~28d者25例;术时体重2.2~4.3kg,平均3.1±0.4kg,其中2.2~3kg者9例,3.2~4kg者31例,>4kg者6例。患儿术前经心电图、胸部X线摄片、二维或三维超声心动图检查确诊。术前诊断包括大动脉转位(TGA)21例,主动脉弓中断7例;法洛四联症(TOF)2例,TOF合并肺动脉闭锁(FA)7例;永存动脉干(TAPVC)4例。术前有紫绀者38例,重度低氧血症11例;合并肺炎、心功能不全者15…     

超声心动图评估梗阻性与非梗阻性完全型肺静脉异位引流的应用价值

目的探讨超声心动图评估梗阻性与非梗阻性完全型肺静脉异位(TAPVC)引流的临床应用价值。方法选取TAPVC患儿112例,分为梗阻组34例和非梗阻组78例,分别于术前、术后1个月及6个月行超声心动图检查,评价其心内结构、功能及肺静脉引流情况。应用M型超声测量左、右室舒张末期内径(LVD、RVD),脉冲多普勒测量肺静脉流速,连续多普勒测量三尖瓣反流峰值压差(PTR)。分析并比较两组患儿术前、术后心室内径和PTR的变化,以及两组术后死亡率和肺静脉梗阻(PVO)发生率。结果超声心动图对TAPVC的检出率为100%,诊断符合率为89.3%(100/112)。手术前梗阻组患儿手术月龄、体质量及LVD均明显低于非梗阻组,差异均有统计学意义(均P0.01);梗阻组PTR明显高于非梗阻组,差异有统计学意义(t=4.328,P0.01)。术后1个月两组患儿LVD和LVD/RVD均明显增大,RVD和PRT明显减小,与手术前比较差异均有统计学意义(均P0.01)。手术后1个月和6个月两组患儿间PTR和LVD/RVD比较差异均无统计学意义。梗阻组术后死亡率与非梗阻组比较差异有统计学意义(P0.01),而术后PVO发生率比较差异无统计学意义。结论超声心动图是早期诊断TAPVC的首选检查方法,可有效评价术后患儿心室容量的恢复及肺循环压力的变化情况,并能及时发现术后PVO的存在,具有较高的临床应用价值。     

儿童先天性心脏病磁共振成像

先天性心脏病(先心病)相当常见,在每1000个新生儿中就有7人左右.儿童先心病通常首选超声心动图枪查,如明确诊断,即行治疗,如不能明确诊断,则做心脏磁共振或多层螺旋CT.CT的主要问题是有大量射线.磁共振对手术前后的儿童先心病人可成为解剖和功能的一站式检查手段.本文介绍磁共振对儿童先心病人的扫描技术和临床应用.自旋同波...     

Diagnosis of congenital obstructive aortic arch anomalies in Chinese children by contrast-enhanced magnetic resonance angiography.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of contrast-enhanced magnetic resonance angiography for the diagnosis of congenital obstructive aortic arch anomalies in children and compare it with transthoracic echocardiography and other MR imaging techniques (ECG gated T1-weighted spin-echo imaging and gradient-echo cine imaging). MATERIALS AND METHODS: Contrast-enhanced magnetic resonance angiography, ECG gated T1-weighted spin-echo imaging, and gradient-echo cine imaging were performed for the diagnosis of congenital obstructive aortic arch anomalies in 416 patients from April 1999 to March 2005 (age range, 3 days to 12 years; mean age, 2.4 years) using a GE 1.5T MR scanner. Transthoracic echocardiography was performed in all patients prior to MR examination. Surgery and/or conventional X-ray angiocardiography were done in all patients to determine the final diagnosis. RESULTS: The population consisted of 416 patients. Congenital obstructive aortic arch anomalies were diagnosed in 213 patients and ruled out in 203 patients by operation and/or conventional X-ray angiocardiography. Among the 213 patients with anomalies, coarctation of aorta was diagnosed in 174, interruption of aortic arch was diagnosed in 35, and persistent fifth aortic arch with fourth aortic arch interruption was diagnosed in 4 patients. Among the 35 patients with interruption of aortic arch, 21 were of type A, and 14 were of type B. The diagnostic sensitivity, specificity and accuracy of contrast-enhanced magnetic resonance angiography for congenital obstructive aortic arch anomalies were 98% (208/213), 99% (201/203) and 98% (409/416), respectively. The diagnostic sensitivity, specificity and accuracy of transthoracic echocardiography were 88% (187/213), 92% (186/203) and 90% (373/416), respectively. The diagnostic sensitivity, specificity and accuracy of other MR imaging techniques (ECG gated T1-weighted spin-echo imaging and gradient-echo cine imaging) were 89% (189/213), 84% (170/203) and 86% (359/416), respectively. CONCLUSION: Contrast-enhanced magnetic resonance angiography is a reliable, noninvasive imaging technique for the diagnosis of congenital obstructive aortic arch anomalies in children. Occasionally, even more information can be obtained from this technique than from conventional X-ray angiocardiography. Contrast-enhanced magnetic resonance angiography is superior to transthoracic echocardiography and other MR imaging techniques (ECG gated T1-weighted spin-echo imaging and gradient-echo cine imaging) for diagnosis of congenital obstructive aortic arch anomalies in children.     

应用超声心动图对先天性主动脉弓畸形病例的分析

目的应用超声心动图观察分析先天性主动脉弓畸形的类型。方法回顾分析以往病例检查中31例先天性主动脉弓畸形患者的超声心动图表现。所选病例均经手术或心血管造影(CAG)证实。结果31例先天性主动脉弓畸形患者中,右位主动脉弓(RAA)18例(2例伴有椎动脉自主动脉弓发出),主动脉缩窄(COA)5例,主动脉弓部曲折畸形3例,单纯头臂干(无名动脉)发出异常2例,肺动脉单发于主动脉弓2例(1例伴有头臂干发出异常),主动脉弓离断(IAA)1例,其中27例合并其他心内畸形。结论超声心动图对于诊断先天性主动脉弓畸形是一种有效、无创、经济的检查手段,可作为诊断的首选方法。     

Magnetic resonance imaging is the diagnostic tool of choice in the preoperative evaluation of patients with partial anomalous pulmonary venous return

Background Diagnosis of partial anomalous pulmonary venous return is usually suspected by echocardiography and often confirmed by cardiac catheterization. Magnetic resonance imaging is a powerful non-invasive diagnostic tool that can give accurate insight on systemic and pulmonary veins, cardiac anatomy and physiopathology.Aim To test the diagnostic accuracy of magnetic resonance in patient with suspected partial anomalous pulmonary venous return.Case presentation Twenty consecutive patients (10 male, mean age: 27±20 years) with suspected partial anomalous pulmonary venous return underwent a magnetic resonance study comprehensive of Gadolinium-enhanced three-dimensional magnetic resonance angiography and phase-velocity-contrast in order to evaluate pulmonary and systemic venous anatomy and QP/QS. In 14 of them a cardiac catheterization was also performed. Anatomy findings and QP/QS result of both exams were compared. Sixteen patients underwent surgical correction. In the other four patients with QP/QS<1.5, surgical correction was not indicated according to the literature (1).Among patient which performed both magnetic resonance and cardiac catheterization (14 patients) anatomy findings were concordant in 12 of them. In all operated patients, surgical findings were concordant with MRI report. There was a good correlation between magnetic resonance and cardiac catheterization QP/QS evaluation (mean value 2.23 and 2.4, respectively).Conclusion In patients with suspected anomalous pulmonary venous return, magnetic resonance provides a comprehensive evaluation of pulmonary venous return and the amount of shunt, overcoming most of the limitations of echocardiography. Therefore magnetic resonance is a powerful diagnostic tool for indicating therapeutic management and surgical strategies for this group of patients, and can be considered a non-invasive alternative to cardiac catheterization.     

儿童主动脉弓中断的影像诊断与病理分类

目的：报道23例先天性主动脉弓中断（IAA）,评价磁共振对儿童主动脉弓中断的实际诊断价值并讨论主动脉弓中断的病理分类。材料与方法：在23例中,14例经心血管造影诊断,2例经造影增强磁共振血管成像术（CE－MRA）诊断,7例同时做了两种检查。结果：23例中,21例伴有动脉导管未闭,19例伴有室间隔缺损,A型主动脉弓中断19例,B型4例,14例经手术证实。在7例同时做了心血管造影和CE－MRA的病例中,CE－MRA优于心血管造影4例。结论：CE－MRA能相当准确地诊断儿童先天性主动脉弓中断。     

Congenital cardiac defects and MR-guided planning of surgery

In neonates and infants with congenital heart disease (CHD), cardiovascular magnetic resonance (CMR) is an established imaging modality in all patients in whom echocardiography does not provide sufficient information and definitive diagnosis. CMR is noninvasive, and does not involve vascular catheterization or ionizing radiation. Therefore the use of CMR obviates the potential risks of cardiac catheterization in critically ill infants. This article discusses the use of CMR in newborns with CHD before cardiac surgery, focusing on conotruncal anomalies, pulmonary venous anomalies, complex CHD in visceroatrial heterotaxy, borderline hypoplastic left heart syndrome, and the use of contrast medium in newborns.     

Aortography by radial artery injection in infants with anomalies of the aortic arch

Aortography by radial artery injection was performed in 22 infants and one child with congenital heart disease. The left radial artery was used in 20 cases and the right radial artery was used in 3 cases. This method visualized the following aortic arch anomalies: coarctation of the aorta in 4 patients, interrupted aortic arch in one, patent ductus arteriosus in 10, patency of the left Blalock-Taussig shunt in one and anomalous origin of the right subclavian artery in one. An injection of the contrast material into the right radial artery in one case failed to visualize coarctation of the aorta, which was confirmed by retrograde catheterization. Retrograde aortography has been necessary for diagnosis of aortic arch anomalies, but it is not so easy to perform and carries a risk of arterial thrombosis. Aortography by radial artery injection is relatively easy to perform, less invasive and has no severe complications. It is concluded that aortography by radial artery injection is a useful method for diagnosis of anomalies of the aortic arch in neonates and children.     

Accuracy of fetal echocardiography: a cardiac segment-specific analysis.

OBJECTIVE: In patients with congenital heart disease, comprehensive, segment-specific analysis of cardiac anatomy has become 'the standard of care', largely as a result of improvements in cardiac imaging technology. Our aim was to apply segment-specific standards to assess the accuracy of fetal echocardiography. METHODS: This was a retrospective review of all fetal echocardiograms (n = 915) performed at our center between August 1998 and June 2003. Of these, 100 studies had congenital heart disease findings and corresponding postnatal studies on the same patients for comparison. An expert independent pediatric echocardiologist, using the standards of accuracy expected of postnatal echocardiography, assessed the studies for the following cardiac segments: abdominal situs, systemic venous return (VR), pulmonary VR, atria, atrioventricular valves, ventricular septum, ventricular hypoplasia, ventricular morphology, semilunar valves, great arterial relation and aortic arch. Sensitivity, specificity, and positive and negative predictive values were calculated for each segment. RESULTS: Specificity and negative predictive value were high for all cardiac segments (range, 82-100%). Sensitivity and positive predictive value were similarly high (range, 83-100%) for most cardiac segments, but were only 50-88% for systemic VR, pulmonary VR and aortic arch segments. CONCLUSIONS: Fetal echocardiography has excellent diagnostic accuracy in describing intracardiac anatomy. However, despite both technological advances and improved physician awareness, assessment of systemic VR, pulmonary VR, and aortic arch anatomy remain challenging.     

Magnetic resonance imaging of benign uterine pathology

Magnetic resonance imaging is commonly used for the identification and characterization of many pelvic abnormalities. Magnetic resonance provides the most comprehensive and detailed view of the uterus of any imaging modality. This article focuses on the magnetic resonance imaging features used to recognize and describe congenital uterine anomalies and benign conditions of the uterus.