二尖瓣返流程度的超声脉冲多普勒肺静脉血流探测与评价

目的探讨脉冲多普勒肺静脉血流评价二尖瓣返流的程度。方法对37例二尖瓣关闭不全患者行超声脉冲多普勒检测左、右上肺静脉血流，将收缩期负向频谱，峰值减低频谱分为Ⅱ-Ⅳ度。结果2l例Ⅳ度返流者检出20例，敏感性为95％，特异性为100％；右上肺静脉常显示血流负向频谐，左上肺静脉常显示峰值减低频谱。结论脉冲多普勒探测肺静脉血流可用于评价二尖瓣返流程度。     

经皮冠状动脉内多普勒超声技术对冠状动脉血液动力学的研究

目的 :评价冠状动脉 (冠脉 )内多普勒血流钢丝测量冠脉血流速度和血流储备 (CFR)的应用价值。　　方法 :在 2 1例冠脉狭窄患者 (冠脉狭窄组 )和 12例正常冠脉者 (对照组 )中 ,利用冠脉内多普勒血流钢丝和冠脉内注射罂粟碱测量了冠脉的血流速度和 CFR。　　结果 :左前降支冠脉狭窄远端的平均最大血流速度、舒张期最大血流速度、舒张期与收缩期流速比值和 CFR均显著低于对照组测值。　　结论 :应用冠脉内多普勒超声技术可准确测量正常和冠脉狭窄患者的冠脉血流速度和 CFR,冠脉内注射罂粟碱安全、可靠 ,这一方法的临床应用对冠心病患者冠脉血液动力学的评价提供了可靠的方法。     

多普勒超声技术定量分析二尖瓣返流

本文综述多普勒超声技术定量分析二尖瓣返流严重性的研究近况，并对各种定量技术的局限性进行评述，以便临床合理应用。     

多普勒超声评价老年心梗病人的二尖瓣返流

二尖瓣返流（ＭＲ）是冠心病的常见并发症之一，随着缺血性心脏病发病率的增长，缺血性ＭＲ已占ＭＲ病因的２５％左右。我们分析了近年来１１５例有明确心肌梗塞（ＭＩ）病史老年病人的临床资料、多普勒超声相应参数，以了解一些老年心梗病人ＭＲ的特点。１　资料与方法１．１　研究对象　１１５例老年陈旧性ＭＩ病人分为以下３组。Ｉ组：５９例，男４６例，女１３例，年龄６０～８０岁；前壁ＭＩ２８例，下壁ＭＩ３１例，合并高血压２１例；左室舒张末径（ＥＤＤ）＜５－５０ｃｍ，左室射血分数（ＬＶＥＦ）＞０－５０，所有患者均无ＭＲ。…     

彩色多普勒血流成像对生理性三尖瓣返流机理的探讨

本文以彩色多普勒血流成像观察了50例生理性三尖瓣返流,发现90%的返流有穿瓣现象,认为生理性三尖瓣返流是健康人三尖瓣关闭不够严密而造成的收缩早期的轻微返流.     

高血压合并单纯主动脉瓣返流

高血压合并单纯主动脉瓣返流(AR)在临床上一直被视为“无害性”而被忽视.本文应用超声多普勒对高血压合并 AR 的发病情况进行调查,结果表明:AR 在高血压患者中并非少见,不能完全用增龄退变和动脉硬化来解释。主动脉回流作为高血压患者的合并症而应受到临床重视.     

冠状动脉造影血流TIMI分级及其计帧值与血管内多普勒血流速度相关性

目的 :应用血管内多普勒导丝测量血流速度评价冠状动脉造影血流TIMI分级 (TIMI FG)及其计帧值 (TIMI FC)准确性。方法 :在 11只猪右冠状动脉狭窄动物模型和 36例冠状动脉造影及 17例行血管介入治疗患者中 ,比较TIMI FG和TIMI FC与血流速度相关性。结果 :①随动物模型充盈球囊造成血管狭窄程度加重 ,血流速度减慢、TIMI FG下降、TIMI FC变大。② 17例患者 2 5支血管介入治疗后 ,血流速度增加 ,TIMI FG上升、TIMI FC变小。③TIMI FC与血流速度呈中度负相关 ;而TIMI FG和TIMI FC变化值与血流速度变化值相关性提高。结论 :冠状动脉造影TIMI FC判断血流速度具有一定准确性 ,尤其对血流速度变化更佳     

彩色多普勒超声心动图在诊断二尖瓣返流中的应用

彩色多普勒超声心动图在诊断二尖瓣返流中的应用湖南医科大学湘雅医院刘跃飞综述王振华审校彩色多普勒超声心动图（ＣｏｌｏｒＤｏｐｐｌｅｒＥｃｈｏｃａｒｄｉｏｇｒａｐｈｙ，ＣＤＥ）或彩色多普勒血流图（ＣｏｌｏｒＤｏｐｐｌｅｒＦｌｏｗＩｍａｇｉｎｇ）自本世纪８...     

冠状动脉内支架术对冠状动脉血流储备的远期影响

目的　采用经胸多普勒超声心动图冠状动脉 (冠脉 )血流显像技术观察冠脉支架置入术对冠脉血流储备 (CFR)的远期影响。方法　对 34例冠心病患者分别于支架术术前、术后 72h内及随访期 [( 6 .7± 1.5 )个月 ]记录病变血管远端静息舒张期血流峰速 (r Vd)、注射潘生丁及等长握力实验时最大舒张期血流峰速 (d Vd)及CFR。每例患者于随访期复查冠脉造影。结果　随访期造影无再狭窄 2 8例。据术后 72h内CFR分为CFR受损组 ( 10例 ,CFR≤ 2 .5 )及CFR未受损组( 18例 ,CFR >2 .5 )。术后近期CFR受损组r Vd较CFR未受损组明显增高 (P <0 .0 1) ;随访期时CFR受损组CFR升高至CFR未受损组水平 (P >0 .0 5 )。随访期出现再狭窄 6例 ,CFR均 <2 .0 ,降至术前水平。结论　 ( 1)成功的支架术后部分患者存在暂时性CFR降低 ,CFR的降低及其恢复与r Vd的一过性增高及恢复有关 ;( 2 )再狭窄患者冠脉血流储备于随访期显著降低 ,达到术前水平。经胸冠脉血流显像技术可作为冠脉介入治疗后一种简便、安全、无创的随访方法。     

多普勒导丝评价猪急性冠状动脉闭塞侧支循环状态及硝酸甘油的影响

目的应用冠状动脉内多普勒导丝评价猪冠状动脉急性闭塞后侧支循环状况及硝酸甘油对其的影响.方法使用冠状动脉内多普勒导丝测定14头小型家猪正常状态及左回旋支急性闭塞后远端血管的血流频谱,并观察冠状动脉内应用硝酸甘油对其的影响.结果急性闭塞左回旋支远端的平均峰值流速(APV)明显低于正常[(0.97±1.05)cm/svs.(25.78±4.36)cm/s,P<0.01];应用硝酸甘油后梗死相关血管(IRA)血流呈现逆向或双向,APV绝对值较用药前明显增加[(0.97±1.05)cm/svs.(8.32±1.53)cm/s,P<0.01];闭塞后90 min基础及重复用药后APV分别为(0.99±1.14)cm/s和(9.02±1.47)cm/s,较闭塞即刻差异均无统计学意义.结论多普勒导丝可用来评价冠状动脉侧支循环,猪急性冠状动脉闭塞时侧支循环自身建立不足,硝酸甘油可明显增加冠状动脉侧支循环血流.     

906例患者中冠状动脉内多普勒检查的安全性

目的是评价采用冠脉内多普勒导丝FloWire进行冠脉内血流速度测定的安全性.方法从1993年到1998年,共有906例病人(男性704例,平均年龄56.8±10.8岁)行冠脉内多普勒血流速度测定,血流描计仪采用Cardiometrics FloMap,多普勒导丝为0.014英寸或0.018英寸的FloWire,为测定冠脉血流储备,采用冠脉内注射罂粟碱(90例病人,右冠状动脉8 mg,左冠状动脉12 mg)或腺苷(右冠状动脉12 μg,左冠状动脉18 μg)诱发冠状动脉的最大扩张.结果在所有研究病人中,829例为非心脏移植病人,其中617例为诊断性冠状动脉造影(Ⅰ组),212例为冠脉内介入治疗病人(Ⅱ组),77例为心脏移植术后病人(C组).906例病人中共有27例(2.98%)发生与多普勒血流测定有关的心血管并发症.在冠脉内注射腺苷后,15例病人(1.66%)发生较严重的短暂的心动过缓(心脏停搏或Ⅱ度到Ⅲ度的房室传导阻滞),其中14例发生在右冠状动脉,1例在左前降支.在多普勒导丝的送入过程中,9例(0.99%)发生冠脉痉挛(5例在右冠状动脉,4例在左冠状动脉).两例(0.22%)检查过程中发生室颤(其中一例为冠脉内注射罂粟碱后,另一例为急性下壁心梗右冠状动脉急症球囊成形术后),低血压伴随心动过缓1例,室性早搏1例,心脏移植病人中并发症的发生率明显高于非心脏移植病人,右冠状动脉行多普勒检查时的并发症尤其是心动过缓明显高于左冠状动脉(右冠状动脉5.87%,左前降支1.05%,左回旋支0.17%,P<0.001).所有的并发症均得到妥善处理,没有死亡发生.结论用多普勒导丝及冠脉内注射腺苷行冠脉内多普勒血流测定是相当安全的,但是,也可产生如心动过缓及冠脉痉挛等并发症,在行右冠状动脉和心脏移植病人的检查时尤其应谨慎.     

Assessment of severity of aortic regurgitation by M-mode colour Doppler flow imaging

To assess the value of measuring the aortic regurgitant jet diameter at its origin by M-mode colour Doppler imaging, 82 patients with aortic regurgitation underwent, within 72 h of each other, colour Doppler examination and angiography. After excluding one patient without colour Doppler aortic regurgitation and five with a highly eccentric regurgitant jet, we found a close relationship between the jet diameter at its origin measured by M-mode colour Doppler and the angiographic grade of aortic regurgitation (r = 0.88). A jet diameter greater than or equal to 12 mm identified severe aortic regurgitation (grade III or IV) with a sensitivity of 86.4% and a specificity of 94.4%. In 38 patients, the jet diameter correlated well with the regurgitant fraction measured by a combined haemodynamic-angiographic method (r = 0.88). A jet diameter greater than or equal to 12 mm identified a regurgitant fraction greater than or equal to 40% with a sensitivity of 88.2% and a specificity of 95.2%. This study indicates that the size of the regurgitant jet diameter at its origin measured by M-mode colour Doppler provides a simple and useful measure of the severity of aortic regurgitation. It may allow differentiation between mild or moderate and severe aortic regurgitation and evaluation of regurgitant fraction.     

冠状动脉造影与冠状动脉内超声检查对钙化斑块检出的比较

目的 探讨冠状动脉造影（CAG）检查结合临床资料分析能否正确检出患者在拟行介入治疗的冠状动脉狭窄段有无钙化,并与冠状动脉内超声（ICUS）检查结果进行比较分析,进一步评价在冠状动脉介入治疗前应用ICUS确定钙化的范围和严重程度的价值作进一步的评价。方法 对150例拟行冠状动脉介入治疗的患者行CAG同时行ICUS检查,评价靶血管狭窄处的钙化情况。结果有113例（75.3％）靶血管狭窄处被ICUS检出钙化。而CAG检出52例有钙化。两种方法的检查结果有75例相符,75例不相符合。CAG对钙化检出的敏感性为38.9％,特异性为86.5％。在靶血管狭窄段CAG检出钙化的平均弧度（n=52）较ICUS检出的（n=113）要大。CAG判定表浅型钙化的敏感性和特异性分别为35.3％和95.2％。在98例靶血管狭窄处CAG判定为无钙化的患者中,68例患者ICUS检出有不同程度的钙化。而CAG在非靶血管狭窄段检出钙化是ICUS在98例患者中检出钙化惟一的预期值（P=0.003,OR=1.16,95％可信区间为1.1～1.3）。有73例CAG在冠状动脉丛任何处均未见钙化,而ICUS检出44例（60.3％）有钙化,其中>90弧度的表浅型钙化仅9例（12.3％）。结论CAG检出靶血管狭窄段有钙化存在提示可能为弧度较大的表浅型钙化。在CAG检不出靶血管狭窄处钙化的病例中,若患者的年龄较大,旦发     

Evaluation of mitral regurgitation by Doppler echocardiography

The diagnosis and assessment of mitral regurgitation has been one of the main challenges for cardiac ultrasound. Imaging techniques (M-mode and two-dimensional echocardiography) provide direct morphologic and etiologic information of the evaluation of patients with suspected mitral regurgitation. The advent of cardiac Doppler increased tremendously the ability to evaluate mitral regurgitation noninvasively. Continuous-wave and pulsed Doppler have been found to be sensitive and specific in the detection of mitral regurgitation. The introduction of color flow Doppler simplified enormously the assessment of patients with suspected mitral regurgitation. The maximal regurgitant area and maximal regurgitant area corrected for left atrial size have become the most commonly used parameters to evaluate mitral regurgitation by color flow Doppler in the clinical setting. However, the color regurgitant jet area is highly dependent on anatomical, hemodynamic, and equipment factors. A new method, based on the proximal isovelocity surface area, is being evaluated and appears to be relatively independent of equipment factors. Transesophageal echocardiography has been shown to be exquisitely sensitive in the detection of mitral regurgitation. Quantitation of mitral regurgitation by transesophageal echocardiography is currently based on the maximal regurgitant area and this parameter appears to correlate closely with the angiographic degree of mitral regurgitation. Pulmonary venous flow analysis had been used in conjunction with color flow mapping for the evaluation of mitral regurgitation by transesophageal echocardiography. The presence of reversed systolic flow has been shown to be sensitive and specific for the diagnosis of severe mitral regurgitation. Patients with clinically difficult surface studies, flail mitral valve leaflets, and prosthetic mitral valve are best evaluated by the transesophageal approach with interrogation of pulmonary venous flow.     

彩色多普勒超声诊断主动脉瘤的观察与分析

目的 探讨超声诊断主动脉瘤的可靠性和准确性,评价其临床价值。方法 应用HP2500及TOSHIBA SSA-380A超声诊断仪,检查36例主动脉瘤患者,并将其部分超声检查结果与CT、核磁(MRI)、数字减影血管造影(DSA)及手术结果进行比较。结果 夹层动脉瘤与CT、MRI、DSA检查结果的符合率分别为86%、80%、89%;腹主动脉瘤与MRI、DSA及手术结果的符合率为100%。结论 彩色多普勒超声检查可发现有无主动脉瘤、动脉瘤的大小、范围、搏动和血流状态,对于夹层动脉瘤破裂口的观察、指导临床手术方案的选择有重要意义。     

Quantitative assessment of aortic regurgitation by combined two-dimensional, continuous-wave and colour flow Doppler measurements.

The width of the regurgitant jet at the aortic valve plane, i.e. the core flow diameter, the ratio of the jet width to the left ventricular outflow diameter, the regurgitant volume and regurgitant fraction were determined using two-dimensional, continuous wave and colour flow Doppler echocardiography. The relationship between the non-invasive measurements and semiquantitative angiographic grading of the regurgitant flow (1 + to 4+) was examined in a primary group of 20 patients with chronic aortic regurgitation. Cut-off points for the non-invasive measurements were selected so as to separate patients with mild or moderate regurgitation (1+ or 2+) from patients with moderately severe or severe regurgitation (3+ or 4+). These cut-off points were prospectively applied in a new group of 35 patients with aortic regurgitation to predict the angiographic grading. Jet width correctly predicted the angiographic grading in 86% of cases, the ratio of the jet width to the outflow diameter in 83% of cases, the regurgitant volume in 86% of cases and the regurgitant fraction in 91% of cases. We conclude that the severity of aortic regurgitation as determined by angiographic grading can be estimated with reasonable accuracy by non-invasive techniques based on colour flow imaging.     

Diagnosis of tricuspid regurgitation. Sensitivity of Doppler ultrasound compared with contrast echocardiography

Fifty-one patients underwent Doppler studies of tricuspid flowand 2-D derived M-mode studies of the inferior vena cava (IVC)during upper extremity contrast injections. Tricuspid regurgitation(TR) was diagnosed with Doppler when reverse flow in systolewas recorded at and behind the closure level of the tricuspidvalve. TR was diagnosed with contrast ehocardiography (CE) whencontrast appeared in the IVC between the onset of the QRS complexand the end of the T-wave of the ECG. Of the 49 patients whohad TR diagnosed with Doppler, contrast was recorded in theIVC in 46, but only 18 (37%) fulfilled the criterion for a positiveCE study. When the severity of the TR was semiquantitated withDoppler, CE diagnosed 1 of 25 mild, 5 of 11 moderate, and 12of 13 severe regurgitations. When systolic contrast appearancein the IVC after the peak of the R-wave was used as the criterionfor a positive contrast study, CE missed 2 of 13 severe regurgitations.In the 24 catheterized patients the CE study was positive onlywhen an abnormal V-wave in the right atrial pressure curve waspresent. Doppler is a more sensitive method than CE for diagnosingTR and is more readily applied.     

Quantification of acute aortic regurgitation by color Doppler flow in an experimental animal model

Color Doppler flow studies were performed on ten anesthetized open-chest dogs. Acute aortic regurgitation was created in the dogs by a special valve-spreading catheter. The magnitude of valvular regurgitation was determined by aortic electromagnetic flow recordings of regurgitant fraction. Arbitrarily-designated grades of aortic regurgitation: mild (4%-10%), moderate (11%-30%), and severe ( greater than 30%) were assigned on the basis of electromagnetic flow. We attempted to obtain studies of varying degrees of AR in each animal. Mean regurgitant fraction for the three grades were 6.8 +/- 0.6% (n = 11), 22.0 +/- 2.4% (n = 7), and 40.4 +/- 2.5 (n = 20), respectively (each P less than 0.05). By color Doppler flow assessment, the ratio of regurgitant jet height to the left ventricular dimension at the junction of the left ventricular outflow tract and the aortic annulus (JH/LVOH) was measured in each study. AR was classified by Doppler as grade I (mild), 1%-24%; II (moderate), 25%-64%; and III (severe), greater than or equal to 65% jet height/left ventricular outflow tract height. Color Doppler flow correlated well with flowmeter assessment of regurgitant fraction. Color Doppler flow tests had a calculated sensitivity of 88%, specificity of 83%, and predictive value of 85% for significant (moderate + severe) aortic regurgitation. Our data support the concept that this method of color Doppler flow assessment provides a quantitative noninvasive evaluation of aortic regurgitation.