双源CT测量主动脉瓣环直径的方法及其相关性分析

目的探讨双源CT测量主动脉瓣环直径在经导管主动脉瓣植入术术前评估中的临床应用价值。方法通过双源CT对主动脉瓣环长短径、周长及面积的测量,分别换算成直径,比较所得各径值之间的差异有无统计学意义。依据瓣环钙化与否分为A、B两组,A组瓣环有钙化24例,B组瓣环无钙化56例,取面积测量值换算成直径,比较两组之间差异有无统计学意义。结果双源CT测得主动脉瓣环长短径均值为(2.63±0.11)cm,周长换算所得直径为(2.64±0.10)cm,面积换算所得直径为(2.63±0.11)cm,三种测量数值之间差异无统计学意义;钙化组与无钙化组面积测量所得直径分别为(2.62±0.09)cm、(2.64±0.11)cm,两组之间差异无统计学差异。结论双源CT可以通过对主动脉瓣环长短径、周长及面积的测量为经导管主动脉瓣植入术术前提供准确的瓣环测量数据,瓣环的钙化与否不影响测量结果。     

超声心动图对不同主动脉瓣病变患者主动脉瓣置换前后左室功能变化评估价值研究

目的 探讨超声心动图对不同主动脉瓣病变患者主动脉瓣置换(AVR)前后左室功能变化的评估价值。方法 选取北部战区总医院2019年1—12月收治的行单独AVR的主动脉瓣疾病患者61例为研究对象,其中,主动脉瓣狭窄(AS)28例(AS组),主动脉瓣关闭不全(AI)33例(AI组)。比较AS组和AI组术前、术后1周、术后1年的超声心动图指标,包括左房前后径、室间隔厚度、左室舒张末期内径、左室后壁厚度、二尖瓣舒张早期峰速(E)/二尖瓣瓣环侧壁舒张早期峰速(e’)、左室射血分数及肺动脉收缩压。结果 (1)AS组：与术前比较,术后1周的室间隔厚度、左室舒张末期内径、左室后壁厚度、肺动脉收缩压降低,术后1年的左房前后径、室间隔厚度、左室舒张末期内径、左室后壁厚度、E/e’、肺动脉收缩压降低且左室射血分数升高,差异有统计学意义(P<0.05);与术后1周比较,术后1年的左房前后径、左室后壁厚度、肺动脉收缩压降低且左室射血分数升高,差异有统计学意义(P<0.05)。(2)AI组：与术前比较,术后1周、术后1年的左房前后径、室间隔厚度、左室舒张末期内径、左室后壁厚度、E/e’、肺动脉收缩压降低且...     

超声心动图诊断老年主动脉瓣退行性变及其临床价值

目的：通过二维及彩色多普勒超声观察主动脉瓣二维图象及血流变化，探讨主动脉瓣退行性病变发生、发展的声像图特点，为临床诊断和鉴别诊断提供依据。方法：患者左侧卧位，常规探察心脏左室长轴及心底大动脉短轴切面观察主动脉瓣二维征象。心尖五腔心观察主动脉瓣反流，测量反流束的长度和宽度；同时取反流柬的频谱观察。对瓣膜改变进行分度和分级。结果：本组病例中，主动脉瓣瓣缘增厚、回声增强，或仅见小的斑块者458例，且瓣膜活动良好，有132例伴有主动脉瓣轻度返流；其余79例钙化较明显、呈团块状和片状强回声，瓣膜活动度差，均伴有不同程度的返流，其中重度返流者2例，同时伴有左室增大；52例伴有二尖瓣的回声增强及轻度返流；主动脉瓣钙化改变中，左冠瓣108例，右冠瓣122例，无冠瓣249例，联合瓣58例。结论：超声检查主动脉瓣钙化性改变直接而敏感。超声心动图可以分别从二维、彩色及频谱多谱勒上观察主动脉瓣的钙化回声、发生部位、主动脉瓣形态、返流柬走行、色彩亮度、发生时相以及血流的速度、时间和压差等为临床提供诸多诊断和鉴别诊断线索。     

闭式或直视切开术?还是瓣膜替换术?

作者根据23例单纯二尖瓣狭窄(MS)或伴有轻度关闭不全(M(■)患者分析了超声检查的哪些指标可以预示手术的方式——闭式或直视切开或换瓣。术前均做了 M 型、双维、脉冲多普勒超声检查和左、右心导管,左室及冠状动脉造影。实时双维超声对显示整个二尖瓣结构有明显的优越性,能清楚显示瓣叶、交界粘连区域、结节状钙化区的部位和大小,瓣环和瓣下结构。左室长轴和短轴切面能分开重迭部分,测量瓣叶和交界区的增厚。多普勒技术采用心尖四腔位切面,以左房内返流血流的距离估计 MI 的严重度。血液动力学测定用于证实狭窄     

大鼠颈部异位心脏移植模型的建立与超声心动图观察

目的:探讨高频超声心动图观察大鼠颈部异位心脏移植模型的可行性及观察方法。方法:23例大鼠建立颈部异位心脏移植模型,其中同系移植6例,同种移植17例。术前对原位心脏行超声心动图观察,常规记录原位心左室长轴切面、乳头肌水平左室短轴切面、心底短轴切面及心尖四腔切面,测量舒张末期、收缩末期左室内径、舒张末期左室壁厚度、左室射血分数。术后立即对移植心脏行超声心动图观察,并显示上述切面,测量相应超声指标,所测指标与术前原位心比较。结果:23只实验鼠原位心可显示乳头肌水平短轴、心底短轴、左室长轴和心尖四腔切面各为19例、11例、10例和9例;异位移植心与原位心比较,移植心左室短轴内径明显减小;左室射血分数明显减低。结论:大鼠颈部异位心脏移植模型与原位心和腹腔异位移植心脏相比较乳头肌水平左室短轴切面是评价移植心脏形态、大小与心肌功能改变较为理想的切面。     

组织运动二尖瓣环位移技术评价2型糖尿病患者左室长轴收缩功能及其与心外膜脂肪厚度相关性

目的探讨应用组织运动瓣环位移(TMAD)技术评价2型糖尿病(T2DM)患者左室长轴收缩功能的价值及其与心外膜脂肪组织(EAT)厚度的相关性。方法选取T2DM患者60例为T2DM组,健康志愿者60名为对照组。采用Philips iu22彩色超声诊断仪,存储心尖四腔、三腔和两腔心切面连续3个心动周期动态二维超声图像,用Qlab 7.0软件脱机分析,测量二尖瓣环6个位点的收缩期最大位移(Ds)、各切面二尖瓣环两个位点连线中点的最大位移(midpt)和各切面二尖瓣环两个位点连线中点的最大位移占左室长轴百分比(midpt%),分别计算平均值,并与二维超声测量的EAT厚度做相关性分析。结果 T2DM组EAT厚度(5.87±1.30)mm较对照组的(4.85±0.93)mm明显增加(t=4.943,P<0.05),T2DM组二尖瓣环6个位点Ds、3个切面的midpt、midpt%及其均值较对照组均明显降低(P<0.05),两组Ds均值、midpt均值与midpt%均值与EAT均显著负相关。对照组r值分别为-0.628、-0.697和-0.761(P<0.05);T2DM组r值分别为-0.537、-0.636和-0.768,(P<0.05)。结论 T2DM患者EAT厚度较正常人增厚,TMAD技术可以定量评估T2DM患者左室长轴收缩功能的减低,EAT厚度与左室长轴收缩功能密切相关。     

组织运动二尖瓣环位移技术评价2型糖尿病患者左室长轴收缩功能及其与心外膜脂肪厚度的相关性

目的探讨组织运动瓣环位移(TMAD)技术评价2型糖尿病(T2DM)患者左室长轴收缩功能的价值及其与心外膜脂肪组织(EAT)厚度的相关性。方法选取T2DM患者60例为T2DM组,健康志愿者60例为对照组。采用Philips iu 22彩色超声诊断仪,存储心尖四腔、三腔和两腔心切面连续3个心动周期动态二维超声图像,用Qlab7.0软件脱机分析,测量二尖瓣环6个位点的收缩期最大位(Ds)、各切面二尖瓣环两个位点连线中点的最大位移(midpt)和各切面二尖瓣环两个位点连线中点的最大位移占左室长轴百分比(midpt%),分别计算平均值,并与二维超声测量的EAT厚度做相关性分析。结果 T2DM组EAT厚度较对照组明显增加分别为(5.87±1.30)mm与(4.85±0.93)mm(t=4.943,P<0.01),T2DM组二尖瓣环6个位点Ds、三个切面的midpt、midpt%及其均值较对照组均明显降低(P<0.05),两组Ds均值、midpt均值与midpt%均值与EAT均显著负相关。对照组r值分别为-0.628、-0.697和-0.761(P<0.05);T2DM组r值分别为-0.537、-0.636和-0.768,(P<0.05)。结论 T2DM患者EAT厚度较正常人增厚,TMAD技术可以定量评估T2DM患者左室长轴收缩功能的减低,EAT厚度与左室长轴收缩功能密切相关。     

超声心动图在二尖瓣置换术后远期心功能不全病因诊断中的应用

 目的探索超声心动图在二尖瓣置换(MVR)术后远期心功能不全病因诊断中的作用。方法超声随访44例MVR患者术后3个月～13.5a,并根据手术的远期效果,分为心功能不全组(A组)和康复组(B组)。除注意人工瓣和自然瓣的病变外,还分析了这2组手术前后左房、左室内径及左室射血分数(EF)的差异。结果超声显示A组二尖瓣位单组或伴主动脉瓣位双组人工瓣异常5例,其它自然瓣明显病变11例。术后A组的左室内径明显大于B组(P＜0.05),EF值明显小于B组(P＜0.01)。超声心动图提供的信息为36.4％心功能不全代偿期和66.7％失代偿期患者诊断出了导致心功能障碍的主要原因。结论MVR手术前后超声检查对术后远期心功能不全的诊断具有实用价值。     

人工心脏瓣膜血液动力学的MRI初步研究

目的应用MRI测量人工心脏瓣膜远端血流野及三维图像的描绘,来评价人工心脏瓣膜功能,并为长期随访瓣膜血栓等并发症的出现和发展提供原始资料.方法27例人工主动脉瓣膜置换患者进行MR血流速度测量检查,置换双叶机械瓣20例,单叶机械瓣7例.于升主动脉内距主动脉瓣环0.5、1.0及2.0个人工瓣环直径处进行血流速度测量.应用血流分析及Matlab 6.5软件进行二维及三维血流图形重组.结果16例置换Sorin双叶机械主动脉瓣患者,三维血流图人工心脏瓣膜的形状特点为近似对应于2个瓣孔及2个瓣叶之间缝隙的3个喷射峰;4例置换Sorin双叶机械主动脉瓣患者,出现对应于2个瓣孔的双喷射峰.20例置换双叶机械主动脉瓣患者,血流速度在加速射血相及最大射血相血流速度图变成倾斜.7例置换单叶机械主动脉瓣患者在收缩加速相见对应单叶瓣口的1个主喷射峰.26例反向血流出现在人工瓣膜侧孔的位置.MR血流速度三维图反映了人工心脏机械瓣膜的设计形状.距主动脉瓣环1.0人工瓣环直径处的轴向血流速度图较远端（2.0人工瓣环直径处）及近端（0.5人工瓣环直径处）的轴向血流速度图能更详细反映人工瓣膜的设计形状.结论MR可以无创、直观、在体地了解瓣膜功能,为发现术后并发症奠定基础.     

骨盆高度法与模板测量法术前测量髋臼杯大小的差别

目的 探讨初次全髋关节置换术前骨盆高度法和传统胶片模板法测量髋臼杯大小的差别.方法 2014-07至2014-12在解放军总医院关节外科连续行初次全髋关节置换术患者200例(288髋),随机分为A组(100例)和B组(100例),术前分别应用传统胶片模板法和骨盆高度法测量髋臼杯大小,并与术中实际选择髋臼大小进行对比,比较其实际吻合度.结果 以术中实际所用髋臼杯大小为准,A组尺寸一致或者相差一个型号者57例(47.5％),相差两个型号者49例(40.8％),相差三个型号者14例(11.7％);B组尺寸一致或者相差一个型号者145例(86.3％),相差两个型号者20例(11.9％),相差三个型号者3例(1.80％).A组与术中实际差值(2.58 ±0.89)mm、B组较术中实际差值(1.38±1.22)mm,两组差值行独立样本t检验(P=0.0000),差异具有统计学意义.结论 B组实际吻合度明显高于A组,可以作为一种初次全髋置换术前测量髋臼大小的方法.     

Progressive thoracic aortic dilatation after aortic valve replacement

Aneurysms of the ascending aorta developed after aortic valve replacement for chronic aortic insufficiency in four cases. Two of the aneurysms were complicated by dissection; one patient died. Rheumatic disease has become a less common cause of pure aortic regurgitation, and a number of etiologies primarily involving the wall of the aorta are now recognized. Although appropriately timed aortic valve replacement can prevent the irreversible left ventricular depression associated with chronic aortic insufficiency, careful evaluation of the thoracic aorta on serial postoperative chest radiographs is warranted, because the underlying pathologic process may proceed in the aortic wall with eventual aneurysm formation.     

Annular versus supra-annular sizing for transcatheter aortic valve replacement in bicuspid aortic valve disease

BackgroundCT measurement of supra-annular area (SA) has been proposed as an alternative to annular area (AA) for sizing of trancatheter valves in biscuspid aortic valves (BAV). This study examines the reproducibility of SA and AA measurements and their potential impact on downstream transcatheter heart valve sizing and clinical outcomes.Methods44 consecutive patients (mean age: 73 ± 15 years, 57% male) undergoing CTA with subsequent SAPIEN 3 valve insertion for severe bicuspid aortic stenosis (AS) were included. AA was measured at the basal ring. SA was measured by generating a circle defined by the intercommisural distance. AA and SA were measured by 2 independent observers. Baseline characteristics, TAVR procedural data, and discharge echocardiography data were collected.ResultsThe SA was significantly larger than the AA (562 ± 146mm2 vs. 518 ± 112mm2,p = 0.013). Interobserver agreement was high using both techniques (ICC AA = 0.98,p < 0.001; SA = 0.80,p < 0.001), but with narrower limits of agreement with AA measurements (mean difference (limits of agreement): AA = −3mm2 (22; 19), SA = −16mm2 (−92; 76)). AA-based device sizing demonstrated substantial agreement with final valve inserted (κ = 0.72,p < 0.001), while SA demonstrated fair agreement (κ = 0.40,p < 0.001). There was no difference in post TAVR gradients, paravalvular leakage or valve success between patients with concordant sizing between AA and SA, and those in whom SA would have suggested an alternate valve size.ConclusionsSupra-annular sizing is less reproducible than annular sizing, with no difference in procedural complication rates in patients in whom supra-annular sizing would have altered the device size used. These results suggest no role for supra-annular sizing in current clinical practice.     

Paravalvular aortic rupture causing angina following aortic valve replacement

We report the first encounter of a paravalvular rupture of the aorta 5 years after aortic valve replacement with a #25 Omniscience tilting disc. The rupture involved the circumflex coronary artery causing angina.     

Aortic valve and aortic root features in CT angiography in patients considered for aortic valve repair

BackgroundThe underlying mechanism of aortic regurgitation and aortic valve and root characteristics are associated with the durability of surgical repair.ObjectiveWe investigated whether multidetector CT (MDCT) identifies the characteristics of the aortic valve and root that may be associated with the ability to perform successful surgical repair.MethodsSixty-one patients with aortic regurgitation and/or aortic root pathology who were evaluated for aortic valve or root repair and underwent clinically indicated gated or nongated MDCT of the aortic valve and aortic root were included in the present analysis. Patients with endocarditis were excluded. MDCT data of aortic valve anatomy and calcification and thoracic aorta dimensions were analyzed.ResultsThe aortic valve and root was successfully repaired in 36 patients (55 ± 13 years; 61% male; median EuroSCORE II, 3.8%) whereas in 25 patients (56 ± 15 years; 52% male; median EuroSCORE II, 2.5%) repair was not attempted (n = 20) or valve repair was converted to aortic valve replacement during surgery (n = 5). In patients in whom repair was considered not possible or failed, there was a higher percentage of bicuspid aortic valves (48% vs 17%; P = .019), more severe commissural calcification, and more severe annular calcification.ConclusionThe degree of commissural and annular calcification of the aortic valve determined by MDCT is inversely related to the ability to perform surgical valve repair instead of replacement. Similarly, bicuspid valve anatomy predicts failure to perform repair.     

经导管主动脉瓣置换术治疗主动脉瓣狭窄应用进展

【摘要】 主动脉瓣狭窄（AS）是在解剖层面导致心脏射血受阻、心脏负荷增加以及冠状动脉、脑血管和全身脏器供血受限的疾病,对患者产生重要影响。随着我国老龄化进程加快,老年主动脉瓣钙化、退变导致AS患者越来越多,针对这类患者采取合适的治疗方案非常重要。AS根本治疗是瓣膜置换。外科主动脉瓣置换术（SAVR）对年轻AS患者耐受性良好,但仍存在创伤大等缺陷,对老年患者风险很高,并发症发生率也很高。微创经导管主动脉瓣置换术（TAVR）是老年AS患者的重要选择。该文就AS,TAVR手术患者、手术入路、人工瓣膜类型选择,术后抗栓策略,术后并发症及其处理及术后康复治疗等应用进展作一综述。