主动脉夹层114例临床分析

目的　分析主动脉夹层的临床特点、影像学诊断方法 ,以探讨主动脉夹层的早期诊断和治疗。方法　回顾性分析 114例主动脉夹层的临床资料 ,分析其临床特点、影像学诊断结果。结果　 114例主动脉夹层病人均表现胸、腹及腰背疼痛 ,并伴有不同系统损害 ,以心、脑血管系统损害最常见 ;MRI、CT、UCG等影像学诊断方法对主动脉夹层有极大临床价值。结论　主动脉夹层病人均以疼痛为表现 ,可伴有各个系统损害 ;MRI、CT、UCG等影像学检查对主动脉夹层有极大临床价值 ,是主动脉夹层早期诊断的主要方法。     

数字减影血管造影的应用

本文分析120例主动脉夹层的影像学所见,着重讨论数字减影血管造影(DSA)应用及其诊断价值,动脉(ⅠA)和静脉数字减影血管造影(ⅣDSA)方法对主动脉夹层主要征象的显示和诊断效果:显示内膜破口和主动脉分支病变,ⅠA法优于Ⅳ法,显示假腔全貌和内膜片负影,Ⅳ法略优于ⅠA法。对Ⅰ或Ⅱ型夹层的诊断ⅠA法明显优于Ⅳ法,Ⅲ型夹层一般Ⅳ法可满足诊断,按手术适应证和治疗的需要可选择应用ⅠA法。结合本组DSA和MRI对主动脉夹层的诊断效用,本文简要讨论了主动脉夹层影像学综合诊断及优选应用问题。     

主动脉夹层动脉瘤的螺旋CT诊断

为评价主动脉夹层动脉瘤的螺旋CT表现及诊断价值 ,选择 2 3例主动脉夹层动脉瘤患者共进行了 2 5人次螺旋CT检查 ,层厚 10mm、螺距为 1.5。CT影像表现按特异性和非特异性征象进行分析。结果发现 ,特异性征象显示 :主动脉真假双腔 2 2例 (95 .7% ) ,分离移位的内膜瓣 2 2例 (95 .7% ) ;非特异性征象显示 :主动脉不规则扩张 2 3例 (10 0 % ) ,主动脉壁增厚钙化 2 1例 (91.3% ) ,附壁血栓 4例 (17.4% ) ,诊断准确率 95 .7%。提示螺旋CT是评价和诊断主动脉夹层动脉瘤有效的影像学检查方法。     

提高对主动脉夹层的认识和诊治水平

主动脉夹层( Aortic Dissection,AD)是一种发病凶险的严重心血管急症.国外资料显示,主动脉夹层的发生率约为每年2.9 ～4.3/10万人[1].早在1761年Morgagni就对主动脉夹层的临床表现进行了描述,然而直到现在,仍以高死亡率为其特点.随着对主动脉夹层病理和病理生理的深入研究,尤其是影像学技术的快速发展、诊疗手段的进步和医师诊断意识的提高,主动脉夹层的诊断和治疗获得了长足的进步.笔者认为可以从以下几个方面提高对主动脉夹层进行认识.     

主动脉夹层23例临床分析

目的分析主动脉夹层(AD)的临床、影像学特点及治疗转归,探讨AD的早期诊断和治疗。方法对23例本院收治的AD患者的临床特点、影像学结果进行回顾性分析。结果23例AD病人中大多表现胸腹及腰背部疼痛,常伴有其他系统损害,均通过影像学方法而确诊。结论AD以疼痛为主要表现,可伴有其他系统损害,计算机断层扫描(CT)、磁共振成象(MRI)、X线平片等检查具有极大诊断价值。总结AD的诊断要点,提高AD的诊断意识是早期诊断的关键。     

主动脉夹层90例临床分析

目的 :回顾性分析主动脉夹层临床表现、诊断和治疗。方法 :总结分析本院 11年来主动脉夹层 90例。结果 :72例 (80 % )有明确高血压 ,10例 (11.1% )为马凡氏综合征。Daily分型 :A型 4 6例 (5 1.1% ) ,B型 4 4例 (4 8.9% )。X线胸片、超声、CT和磁共振诊断的敏感性分别为34.2 %、6 2 .5 %、92 .6 %和 98.2 %。经治疗后存活 71例 (78.9% ) ,死亡 19例 (2 1.1% )。结论 :主动脉夹层病因主要为高血压 ,影像学技术是其主要诊断方法 ,其中磁共振诊断的准确性最高     

成人先天性主动脉闭锁的影像学检查

本文报告一例经较全面的影像学检查明确诊断的先天性主动脉闭锁病例,属Roberts分型中的IB型。讨论了X线平片、心血管造影、二维超声心动图和磁共振成像(MRI)等对本畸形的诊断价值和限度。     

主动脉夹层CTA的诊断及介入治疗

目的对主动脉夹层CTA的诊断及介入治疗进行探讨与分析。方法本研究共纳入研究对象60例,均为2012年6月到2014年1月我院收治的主动脉夹层患者,所有患者均经DSA抑或MR T1-FS确诊。对患者的内膜瓣、管壁增厚、夹层动脉瘤和双腔征等影像学征象进行回顾性分析。结果 60例患者中出现主动脉夹层病变的70处,其中30例前循环,40例后循环。在70处主动脉夹层病变当中,有27处内膜瓣,7处双腔征,36处血管狭窄。相比DSA诊断,通过CTA可以把23处内膜瓣显示出来,占85.2%(23/27),可把5处双腔征显示出来,占71.4%(5/7),可把34处血管狭窄显示出来,占94.4%(34/36)。而在显示主动脉夹层脉瘤和血管闭塞上差异不显著。CTA比MR T1-FS更容易把血管内膜增厚给显示出来。结论通过CTA诊断主动脉夹层,能够把多种影像学征象给清晰显示出来,包括管壁和血管腔在内的主动脉夹层,是一种有效的影像学方式,对临床上运用适当的介入治疗有着重要的指导作用。     

主动脉夹层的早期诊断与治疗

目的 :探讨主动脉夹层的早期诊断线索 ,以便早期正确处理 ,降低病死率。方法 :对 31例住院患者经临床严密观察和影像学检查 ,确诊为主动脉夹层的患者进行系统研究分析。结果 :突发胸背疼痛 ,心电图及心肌酶学检查不支持急性心肌梗死 ;患者呈休克样表现 ,但血压反而增高或正常 ;四肢血压脉搏不对称 ;新出现主动脉瓣返流杂音以及主动脉分支受累致相应脏器 (脑、心、肾等 )缺血和功能改变 ,是该病的重要表现和诊断线索。CT、B超、MRI可提供主动脉夹层诊断的可靠证据。结论 :提高对主动脉夹层的认识和警惕 ,早期诊断和及时处理 ,是降低病死率的关键     

主动脉夹层13例诊治体会

目的探讨主动脉夹层的临床特征,总结其诊治体会。方法回顾分析13例主动脉夹层患者的临床诊治经验与误诊误治原因。结果 12例主动脉夹层患者根据临床表现、影像学检查确诊,1例通过尸检确诊。经治疗存活9例,死亡4例（30.7%）。结论主动脉夹层患者基层医院可通过其临床特征、影像学资料可明确诊断,早期诊断,合理治疗可降低其病死率。     

Quadricuspid aortic valves

Quadricuspid aortic valves (QAV) are a rare but well recognized cause of significant aortic regurgitation. The first case was found reported in 1862. Since then there have been 110 reported cases of QAV and we report 4 more. Previously, these were diagnosed at the time of surgery or postmortem examination. With advances in echocardiography, including harmonic imaging, and also the advent of transesophageal echocardiography, more cases are being diagnosed prior to surgery. We describe four more cases, three diagnosed preoperatively and one at the time of surgery, and then review the previously reported cases. Of the 114 cases reported, 46 had the aortic valve replaced, most commonly in the 5th and 6th decade of life. Hurwitz and Roberts classified quadricuspid valves according to the size of the leaflets. It has previously been believed that QAVs with four equal sized leaflets were less likely to develop significant aortic regurgitation; however, on review of the available cases, this would not appear to be the case. The preoperative diagnosis of QAVs is important as they can be associated with abnormally placed coronary ostium. Of the 114 cases reported, there are 10 reports of abnormally placed ostia. There has been at least one reported case of death occurring because of obstruction of an abnormally placed right coronary ostium by a prosthetic aortic valve.     

Biomarkers in acute aortic dissection and other aortic syndromes

Acute aortic syndromes have an incidence of >30 per million per annum and a high mortality without definitive treatment. Survival may relate to the speed of diagnosis. Although pain is the most common symptom, there is a large fraction of patients in whom the diagnosis may be mistaken or overlooked. Currently, a high index of clinical suspicion is the chief prompt that diverts a patient into a definitive algorithm of imaging investigations. Although there is no point-of-care biochemical test that can be reliably used to positively identify dissection, biomarkers are available that could accelerate the diagnostic pathway and thereby expedite treatment.     

主动脉夹层伴血栓形成患者的磁共振诊断

目的探讨主动脉夹层伴血栓形成患者的MRI影像特点。方法12例确诊为主动脉夹层伴血栓形成的患者,行快速小角度梯度回波T1WI、快速自旋回波T2WI、三维增强磁共振血管成像、心电门控真稳态进动快速成像及半傅立叶转换单次激发快速自旋回波扫描,观察主动脉夹层伴血栓形成在各序列的信号特点。结果急性期血栓在各序列为低信号或等信号;亚急性期血栓在各序列均为高信号;慢性期血栓在各序列为低信号或等信号。结论主动脉夹层伴血栓形成是主动脉夹层的一种特殊类型,应用MRI的多种序列组合可以增强我们对主动脉夹层伴血栓形成作出正确的诊断。     

Abdominal aortic aneurysm and renovascular disease

Recent technological advances in the diagnosis and therapy of abdominal aortic aneurysm and renovascular disease are continuing to bring about changes in the way patients suffering from these conditions are treated. The prevalence of both these conditions is increasing. This is due to greater life-expectancy in patients with arteriosclerosis, a pathogenetic factor underlying both conditions. The application of diagnostic imaging techniques to non-vascular conditions has led to the early diagnosis of abdominal aortic aneurysm. Clinical suspicion of reno-vascular disease can be confirmed easily using high-resolution diagnostic imaging modalities such as CT angiography and magnetic resonance angiography. Endovascular intervention is successfully replacing conventional surgical repair techniques, with the result that it may be possible to improve outcome in both conditions using effective and minimally invasive approaches. Future technological developments will enable these endovascular techniques to be applied in the large majority of patients with abdominal aortic aneurysm or renovascular disease.     

Unicuspid aortic valve: Case series and review

A unicuspid aortic valve is a very rare valvular lesion. Its physical manifestations vary and are associated with other cardiovascular abnormalities such as aortic stenosis/insufficiency and aortopathy. Echocardiography remains the modality of choice, with computerized tomography or cardiac magnetic resonance used as adjunctive imaging. Herein, we present a case series of three patients with unicuspid aortic valves treated at our institution, with a focus on 2D and 3D echocardiographic imaging.     

脉搏门控非增强快速MR成像在不同分型主动脉夹层动脉瘤中的诊断敏感性对比

目的：对比脉搏门控非增强快速 MR 成像在不同分型主动脉夹层动脉瘤中的诊断敏感性。方法：采用回顾性研究方法，2010年1月到2017年4月选择在我院进行诊治的主动脉夹层动脉瘤24例作为研究对象，术中病理诊断为A型14例、B型20例，记录所有患者的脉搏门控非增强快速 MR 成像质量与特征，判断鉴别诊断敏感性。结果：A型与B型主动脉夹层动脉瘤患者的快速MR成像图像都能够满足医生的临床诊断要求，冠状动脉开口、瓣膜交界以及主动脉窦的图像质量都为2级与1级。脉搏门控非增强快速 MR 成像鉴别诊断不同分型主动脉夹层动脉瘤的敏感性与特异性为100.0%与95.0%；脉搏门控非增强快速 MR 成像对瓣膜交界、主动脉窦、冠状动脉开口的评价准确性分别为91.7%、87.5%和87.5%。结论：脉搏门控非增强快速 MR 成像在不同分型主动脉夹层动脉瘤中的诊断图像优良，具有很高的敏感性与可行性，能有效显示形态学信息，从而指导临床鉴别诊断。     

Echocardiography in the diagnosis of thoracic aortic pathology

Transthoracic two-dimensional and Doppler echocardiography has been well established as a useful technique for evaluating many pathologic processes affecting the thoracic aorta. However, the distance of the aortic arch and descending thoracic aorta from the chest wall and the interposition of highly attenuating lung and highly reflective mediastinal structures between the transducer and the aorta present unavoidable limitations. Transesophageal echocardiography is a relatively new technology that overcomes many of the inherent limitations with transthoracic imaging. Complete echocardiographic evaluation of the entire thoracic aorta can now be achieved in nearly all patients. This article will review the continually expanding role of echocardiography in the evaluation of thoracic aortic pathology, including the dramatic impact of transesophageal imaging on the diagnosis of life-threatening disorders such as aortic dissection.     

Spontaneous thrombosis of a transcatheter aortic valve replacement-induced aortic root pseudoaneurysm

Aortic annulus rupture or aortic root perforation is a rare complication of transcatheter aortic valve replacement (TAVR), requiring emergent cardiac surgery and carrying a high intraoperative mortality. Few cases can be managed conservatively, provided a strict clinical follow-up. This study describes the case of a 78-year-old patient with a degenerated bicuspid aortic valve stenosis who presented with a late aortic root perforation following TAVR, which was successfully managed applying a “watchful waiting” approach. Cardiac computed tomography imaging played a pivotal role in the diagnosis and subsequent decision on treatment and clinical follow-up.     

Quadricuspid aortic valve: a report of 12 cases and a review of the literature

Quadricuspid aortic valve (QAV) is rare and its diagnosis, clinical course, and management are less well defined relative to other aortic valve abnormalities. Advances in diagnostic imaging, notably in ultrasound, have increased clinical awareness of this anomaly and prompted this review of our experience with 12 new patients and a compilation of previously reported patients to further characterize this condition.     

Transesophageal Echocardiography in the Evaluation of Aortic Trauma

Transesophageal echocardiography (TEE) is superior to other imaging techniques for the diagnosis of aortic trauma. It can accurately, rapidly, and safely diagnose life-threatening conditions such as aortic rupture, pseudoaneurysm, traumatic aortic dissection, and intramural hematoma. TEE is useful for the diagnosis and prevention of iatrogenic aortic trauma induced by cardiovascular surgery, intraaortic procedures, and cardiopulmonary resuscitation.