超声心动图诊断左上腔静脉合并先天性心脏病

目的：探讨超声心动图方法诊断左上腔静脉合并先天性心脏病的诊断价值。方法：17例临床诊断或怀疑先天性心脏病的患进行超声心动图检查，冠状静脉窦有扩张的患同时进行超声声学造影检查，以明确有否存在左上腔静脉异位引流。结果：本组17例患存在左上腔静脉合并先天性心脏病，13例患冠状静脉窦扩张，经超声心动图及超声声学造影确诊，4例先天性心脏病患漏诊左上腔静脉。13例患进行了手术治疗。结论：超声心动图的检查发现冠状静脉窦有扩张时，超声声学造影进一步检查可确诊有否存在左上腔静脉异位引流。     

胎儿冠状静脉窦扩张合并心内外畸形的超声表现

目的探讨胎儿冠状静脉窦扩张及其合并心内外畸形的产前超声诊断特点。方法回顾性分析我院经超声诊断的202例冠状静脉窦扩张胎儿,并与出生后随访或引产后病理解剖结果进行对照分析。结果 202例冠状静脉窦扩张胎儿中,合并永存左上腔静脉194例(96.0%),肺静脉异位引流4例,无顶冠状静脉窦1例,同时合并永存左上腔静脉及肺静脉异位引流1例,余2例为单纯冠状静脉窦扩张。其中合并其他畸形78例(38.6%),包括永存左上腔静脉合并其他心内畸形52例,合并心外畸形17例,合并心内外畸形7例;肺静脉异位引流合并其他心内畸形1例;无顶冠状静脉窦合并其他心内畸形1例。结论永存左上腔静脉是胎儿冠状静脉窦扩张的主要原因,其中室间隔缺损、肺动脉狭窄及法洛四联症是其最常见的并发心内畸形。产前超声在胎儿冠状静脉窦扩张及合并心内外畸形鉴别诊断中具有重要意义。     

胎儿超声心动图在诊断永存左上腔静脉中的应用

目的 总结永存左上腔静脉胎儿超声心动图特征及临床意义.方法 对2008年5月至2011年1月在我院诊断为永存左上腔静脉的33例胎儿超声心动图表现进行总结分析,并与引产后病理或产后超声心动图诊断结果进行对照分析,总结永存左上腔静脉胎儿超声心动图特征及临床价值.结果 33例永存左上腔静脉胎儿中引产后病理或产后超声心动图证实32例,超声表现为:四腔观可见扩张的冠状静脉窦,三血管观在肺动脉左侧可见一圆形血管回声,为永存左上腔静脉,同时可见右上腔静脉变细,追踪走行可见其与冠状静脉窦相连续.其中18例为单发畸形(18/32,56.25%),14例合并其他畸形(7例合并心内畸形,2例合并心外畸形,5例同时合并心内和心外畸形).胎儿超声心动图将内脏反位综合征合并完全型房室间隔缺损误诊为同时合并永存左上腔静脉1例.结论 胎儿超声心动图是诊断永存左上腔静脉的可靠方法.永存左上腔静脉常合并其他畸形,产前超声发现永存左上腔静脉需进一步检查以排除其他合并畸形.     

超声心动图在诊断新生儿期永存左上腔静脉中的价值

目的探讨超声心动图对新生儿期永存左上腔静脉的诊断价值。方法我院产前胎儿超声心动图检查时明确诊断或疑为永存左上腔静脉胎儿共11例,出生后再行超声心动图检查,总结永存左上腔静脉的声像图特征。结果 11例胎儿产后均明确诊断为永存左上腔静脉。超声图像表现为永存左上腔静脉全程可显示,位于主动脉弓左侧,由左颈内静脉与左锁骨下静脉交汇形成,呈"Y"形,近心端与冠状静脉窦相连;永存左上腔静脉血流频谱与右侧上腔静脉相一致。结论超声心动图对新生儿期引流入冠状静脉窦到右心房的永存左上腔静脉有较好的诊断价值。     

胎儿冠状静脉窦扩张合并心内外畸形的的超声诊断特点

【】 目的：探讨胎儿冠状静脉窦扩张及其合并心内外畸形的产前超声诊断特点。 方法：回顾性分析2011年7月~2015年4月于广州市妇女儿童医疗中心诊断胎儿冠状静脉窦扩张病例,并与出生后随访或引产后病理解剖结果进行对照分析。 结果：共有202例胎儿冠状静脉窦扩张,其中合并永存左上腔静脉194例(194/202, 96%),合并肺静脉异位引流4例,合并无顶冠状静脉窦1例,同时合并永存左上腔静脉及肺静脉异位引流1例,余2例为单纯冠状静脉窦扩张。其中合并其他畸形78例(78/202, 38.6%)。其中永存左上腔静脉合并其他心内畸形52例,合并心外畸形17例,合并心内外畸形7例;肺静脉异位引流合并其他心内畸形1例;无顶冠状静脉窦合并其他心内畸形1例。室间隔缺损、肺动脉狭窄、法洛氏四联症是最常见的并发心内畸形,单脐动脉是最常见的并发心外异常。 结论：永存左上腔静脉是胎儿冠状静脉窦扩张的主要原因,其中室间隔缺损、肺动脉狭窄、法洛氏四联症是最常见的并发心内畸形。产前超声对胎儿冠状静脉窦扩张及合并心内外畸形进行鉴别诊断具有重要诊断意义。     

产前超声诊断胎儿永存左上腔静脉

目的 探讨产前超声诊断胎儿永存左上腔静脉的临床价值.方法 回顾性分析21例经胎儿超声检查诊断为永存左上腔静脉的超声资料与随访结果,分析总结胎儿永存左上腔静脉各切面异常声像图特点.结果 12例胎儿经尸体解剖证实为永存左上腔静脉,胎儿永存左上腔静脉的主要声像图特征是胎儿心脏三血管切面观,肺动脉左侧多一条血管.冠状静脉窦扩张有助于诊断.结论 产前超声检查是诊断永存左上腔静脉的首选方法,有重要临床意义.     

彩色多普勒加心脏声学造影诊断冠状静脉窦隔缺损并左上腔静脉永存1例

彩色多普勒加心脏声学造影诊断冠状静脉窦隔缺损并左上腔静脉永存１例江西医学院第二附属医院李泉水，李沿江，张蒂荣，皮小兰江西省丰城市人民医院孙贵才患者咳嗽３０余年，近半个月气促、心慌。体格检查：ＢＰ２０／１２ＫＰａ，心率１０８次，心律绝对不齐。Ｘ线检查：...     

超声心动图对冠状静脉窦扩张病因的诊断价值

目的　探讨各种病因所致冠状静脉窦扩张的诊断及鉴别诊断。方法　２９ 例三组冠状静脉窦（ＣＳ） 扩张患者（Ｂ组;左上腔静脉引流入ＣＳ组;Ｃ组：肺静脉畸形引流入ＣＳ组;Ｄ 组：冠状动脉瘘入ＣＳ组及２０ 例正常对照组（Ａ组）ＣＳ进行形态学、血流动力学及右心声学造影分析。结果　正常对照组常规超声常难以显示ＣＳ,而三组ＣＳ扩张组ＣＳ则显示清晰,内径分别为１１４ ±４６ 、１２１ ±３９ 、１４２ ±１１ｍ ｍ ,ＣＳ下角观测流速分别为５４ ±１８９ 、１２１ ±４５７ 、２８０±５０ｃｍ／ｓ,左上肢右心声学造影仅永存左上腔静脉组ＣＳ内即刻见造影剂反射,其余各组ＣＳ内均未见造影剂反射。结论　正确分析扩张冠状静脉窦形态学及血流动力学特征对于三组疾病的诊断与鉴别诊断有着极为重要的意义。     

产前超声诊断胎儿永存左上腔静脉并右上腔静脉缺如畸形

目的 探讨永存左上腔静脉并右上腔静脉缺如胎儿的产前超声特点及其诊断价值。方法 回顾性分析产前诊断为永存左上腔静脉并右上腔静脉缺如的8胎胎儿的超声资料,观察其超声表现及合并畸形,并随访其结局。结果 胎儿永存左上腔静脉并右上腔静脉缺如的超声特征为三血管-气管切面于肺动脉左侧见一血管回声,追踪走行见其汇入增宽的冠状静脉窦,同时主动脉右侧未见右上腔静脉显示。时间-空间关联成像（STIC）联合高分辨血流显像（HDF）可立体显示左上腔静脉与主动脉、肺动脉的空间位置关系。8胎均伴冠状静脉窦增宽,5胎合并其他心内畸形,1胎合并心外畸形。结论 超声可在产前准确诊断永存左上腔静脉并右上腔静脉缺如及合并畸形。冠状静脉窦扩张是产前超声诊断的重要线索。     

超声心动图诊断胎儿冠状静脉窦扩张

目的 探讨超声心动图诊断胎儿冠状静脉窦扩张及其相关疾病的临床意义.方法 2010年1月-2012年4月19 914名孕妇于我院接受产前超声心动图检查.回顾性分析其中冠状静脉窦扩张胎儿的超声心动图表现及其合并相关疾病的特点.结果 共检出54胎冠状静脉窦扩张胎儿,均合并永存左上腔静脉;其中12胎合并其他心内畸形,3胎合并心外异常,6胎同时合并心内、心外异常.结论 产前超声对冠状静脉窦扩张及其相关疾病具有重要诊断价值和临床意义.     

Transesophageal echocardiography in the diagnosis of the persistent left superior vena cava.

Three patients with suspected persistent left superior vena cava (PLSVC) diagnosed by transthoracic echocardiography underwent single-plane transesophageal echocardiography. In all three patients transverse cuts through right atrium and coronary sinus demonstrated the presence of PLSVC. Agitated contrast injection into the left antecubital vein opacified PLSVC and coronary sinus in all cases. Transesophageal echocardiography is superior to transthoracic echo in the diagnosis of PLSVC and associated cardiac anomalies.     

Successful surgical repair of a giant left main coronary artery aneurysm with arteriovenous fistula draining into a persistent left superior vena cava and coronary sinus: role of intraoperative transesophageal echocardiography

We report the case of a 74-year-old woman with a history of hypertension, hypercholesterolemia, and pacemaker who presented to the hospital with new onset New York Heart Association class IV congestive heart failure. Transthoracic echocardiography revealed a markedly dilated right ventricle with normal right ventricular systolic function. There was moderate pulmonary hypertension with an estimated pulmonary artery systolic pressure of 60 mm Hg. Her echocardiogram 1 year earlier had demonstrated normal right ventricular size and systolic function, and no pulmonary hypertension. Additional transthoracic imaging with saline contrast study through a left peripheral vein demonstrated the presence of a dilated coronary sinus with a persistent left superior vena cava. Color Doppler demonstrated turbulent flow within the coronary sinus with evidence of significant left-to-right shunting. Cardiac catheterization revealed a massively dilated left main coronary artery aneurysm with an arteriovenous fistula into the left superior vena cava and coronary sinus. The calculated Qp/Qs was 2:1. The patient underwent 2 unsuccessful attempts at percutaneous intervention to occlude the arteriovenous fistula. She then underwent successful surgical closure of the coronary arteriovenous fistula. The important role of intraoperative transesophageal echocardiography in guiding this technically challenging surgical case is discussed.     

Side matters: An intriguing case of persistent left superior vena-cava

Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram (TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient’s potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the right atrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.     

Implantation of a biventricular pacing system in a patient with a coronary sinus not communicating with the right atrium

Intubation of the coronary sinus failed during implantation of a biventricular pacing system. An angiogram of the left coronary artery showed in the venous phase a coronary sinus not communicating with the right atrium. The coronary sinus was draining into a persistent left superior vena cava communicating with the left subclavian vein. The coronary sinus lead was successfully implanted through the persistent left superior vena cava, whereas the atrial and ventricular leads were implanted through the right superior vena cava in a conventional way.     

成人永存左上腔静脉的MSCT诊断价值

目的 评价MSCT诊断永存左上腔静脉（PLSVC）的价值.方法 回顾性分析4例经临床证实PLSVC的成人患者MSCT图像特征.结果 4例成人PLSVC全部为Ⅰ型,颈静脉与锁骨下静脉汇合成垂直静脉后向下走行汇入右心房冠状静脉窦.4例患者冠状静脉窦增宽,平均为17.72mm.4例患者右侧上腔静脉均存在,与PLSVC间无交通支.结论 MSCT检查准确性高,能详细显示PLSVC走行等细节情况,是一种无创、方便、实用的检查手段,对于PLSVC的诊断具有特殊意义.     

The coronary sinus in the fetus.

INTRODUCTION: The normal coronary sinus drains venous blood from the cardiac veins to the right atrium. In some instances, the coronary sinus may be dilated due to volume or more rarely pressure overload. AIMS: To assess the feasibility of detecting the coronary sinus in the fetus and to establish the normal values of the coronary sinus dimensions throughout gestation. SUBJECTS AND METHODS: Fetal echocardiography was performed in 78 normal fetuses from the 16th to the 40th week of gestation (median 25 week). The coronary sinus was measured in four-chamber view (87% of cases) or in parasternal short axis view equivalent (13%). A second group of nine fetuses with a dilated coronary sinus was compared to the normal group. RESULTS: Adequate imaging of coronary sinus was obtained in 97.4% of the normal fetuses. The diameter of the coronary sinus ranged from 1 to 3.2 mm (2 mm +/- 0.13 mm, mean +/- 5% confidence interval) and correlated well with the age of pregnancy (r = 0.86). The length-to-diameter ratio of 24% (+/- 6%) did not vary throughout pregnancy. All nine fetuses with a dilated coronary sinus had a persistent left superior vena cava which drained into it. The diameter of the coronary sinus was approximately three times larger in the abnormal group with a diameter-to-length ratio of approximately 83% (P < 0.0001). CONCLUSION: The coronary sinus is readily identified in the fetus. It gradually increases during pregnancy. An abnormal coronary sinus is easily diagnosed and should prompt the sonographer to look for a persistent left superior vena cava.     

Implantation of a biventricular pacing system in a patient with a persistent left superior vena cava

The presence of a persistent left superior vena cava was encountered in a 64-year-old man undergoing implantation of a biventricular pacing system. Leads with active fixation were positioned in the right atrium and right ventricle, through the persistent left superior vena cava and the proximal segment of the coronary sinus. For left ventricular pacing, a standard bipolar lead was positioned directly in the posterior branch of the coronary sinus without the use of special guiding catheters.     

Two- and three-dimensional echocardiographic unroofed coronary sinus.

We present the 2-dimensional findings and 3-dimensional reconstruction of images from an 18-year-old patient with unroofed coronary sinus, persistent left superior vena cava, a common atrium with levoisomerism, ventricular septal defect, and double-outlet right ventricle. The left superior vena cava showed continuity with the floor of the coronary sinus. Diagnosis of the constellation of anomalies established by transesophageal reconstruction clarified the continuity of the coronary sinus with left superior vena cava and atrial wall.