动脉导管未闭并左肺动脉缺如误诊1例

病人 ,女 ,2 5岁。患者出生后易“感冒” ,发育差 ,无发紫、蹲踞。查体 :心率 12 0次 /ｍｉｎ ,律齐 ;血压 :左上肢10 5 / 5 0ｍｍＨｇ、右上肢 110 / 6 0ｍｍＨｇ、左下肢 180 / 6 0ｍｍＨｇ、右下肢 180 / 5 5ｍｍＨｇ ,胸骨左缘Ⅱ～Ⅲ肋间可触及双期震颤 ,听诊闻及连续性机械样杂音 ,Ｐ2 亢进 ,股动脉闻及枪击音。心电图 :大致正常 ;Ｘ线示 :两肺血多 ,主动脉结宽 ,漏斗征 (+) ,肺动脉段突出 ,左心室增大 ,心胸比例 0 6 1。超声示 :左房、左室及右室内径扩大 ,主肺动脉增宽 ,内径达 2 3ｍｍ ,左肺动脉与降主动脉间可探及一宽约 4ｍｍ ,…     

先天性冠状动脉瘘

先天性冠状动脉瘘较为少见,本院遇及一例左冠状动脉右房瘘,经手术治愈。 女孩,九岁,幼时易感冒,入院前半年体检时发现心脏病。体力与同龄儿相似,可参加体育活动,无外伤史,既往史足月顺产。体检:脉搏90次/分,血压114/78mmHg。左前胸隆起,末触及震颤,胸骨右缘第三、四前肋间可闻双期连续性杂音3/4级,肝脏未触及。心音图证实两期连续性杂音,心电图左室肥厚。心脏平片;肺动脉段明显突出,右室增大,左室段向下后延伸,肺血增多,主动脉结偏小。右心导管:右房、室,主动脉无压差,左心房平均血氧高于腔静脉血氧3.2体积％,示心房水平有     

左冠状动脉起自肺动脉干一例

患者　女 ,16岁。活动后心前区不适及体检发现心脏杂音5年。体检 :于左第 3、4肋间闻及广泛收缩期杂音。心电图示ＳＴ Ｔ改变、异常Ｑ波和电轴左偏。超声心动图疑诊“主动脉窦瘤破入右室”。心脏远达片示心影呈“二尖瓣型” ,左室肥大 ,心胸比率为 0 .5 2 ;左心缘肺动脉段膨隆 ,肺血轻度增多。主动脉根部造影示左冠状窦较右冠状窦小 ,左冠状动脉完全未显。右冠状动脉主干及右心室支明显增粗 (主干直径为0 .8ｃｍ)、纡曲 (图 1)。右冠状动脉右前斜位造影示其右心室支末梢增多、增粗、扭曲呈网状与左冠状动脉交通 ;继之左冠状动脉前降支、左冠…     

左冠状动脉起自肺动脉1例报告

患者　男 ,8岁。自幼因感冒体检发现心脏杂音。查体 :于胸骨左缘 3、4肋间闻及广泛收缩期杂音。无紫绀 ,无咯血 ,活动后轻度乏力 ,心慌、气喘 ,胸痛。心电图 :窦性心律 ,心电图左偏 -10° ,左心室肥厚 ,ST -T缺血改变。超声心动图 :房间隔缺损 ,肺动脉 -冠状动脉瘘。X线示两肺呈多血改变 ,肺动脉段膨隆 ,心胸比率 0 .5。主动脉根部造影见 :主动脉窦形态正常 ,无造影剂返流。右冠状动脉造影见 :右冠状动脉主干及右心室支明显增粗、迂曲。分支末端在心前壁形成毛细血管网 ,造影剂经网状血管到左冠状动脉回流至肺动脉后侧使肺动脉主干及分支…     

特发性肺动脉扩张1例

患者女性,59岁。反复咳嗽、气促5年,劳累加重。查体:口唇无发绀,颈静脉无充盈,双肺肺泡呼吸音清,未闻及干湿性哆音。心界不大,心率72次/min,律齐,胸骨左缘二、三肋间可闻及4/6级收缩期杂音,不传导,P2>A2。腹平软,无压痛及反跳痛,肝脾肋缘下未触及,肠鸣音正常,无血管杂音。胸部X线示:肺动脉段明显突出,肺纹理增加。胸部增强CT:肺动脉主干及左、右主肺动脉及近端分支瘤样扩     

右乏氏窦瘤破入左、右心室流出道1例

正患者男,25岁。因活动后胸闷3月,加重10天入院。查体:神志清醒,口唇无发绀,两肺未闻及干湿啰音。心脏听诊胸骨左缘第3~4肋间可闻及连续性杂音4~6级,向心前区传导。胸部CT示心脏增大。超声心动图示:左心房、室扩大,右心房、室腔大小正常,肺动脉增宽,右乏氏窦囊袋状改变(图1a),基底宽约8mm,基底左侧紧贴左、右冠瓣交界处,右侧距离右冠状动脉开口约6mm,可见两个破口(图1b,     

儿童冠状动脉异常起源肺动脉的16层螺旋CT诊断

目的 评价儿童冠状动脉异常起源肺动脉的多层螺旋CT(MSCT)诊断价值.资料与方法 MSCT应用于8例冠状动脉异常起源肺动脉患儿检查中,平均年龄4.12岁(5个月～10岁),其中4例采用无心电门控CT血管成像,MSCT参数:准直0.625～1.25mm,层厚0.625～1.25mm,螺距为0.562,旋转速度0.5s/r,床进5.62mm/r,0.31～0.625mm重建间隔,4例采用回顾性心电门控.结果 8例冠状动脉起始、右冠状动脉近端、左冠状动脉主干、左前降支及左回旋支近端显示率100%.7例左冠状动脉异常起源于肺动脉瓣窦上的肺动脉总干,1例右冠状动脉异常起源于肺动脉总干右后壁,1例伴右上肺静脉异位引流入上腔静脉,1例伴右冠状动脉高位开口.结论 冠状动脉异常起源肺动脉为少见的先天性心脏病,MSCT可作为一种可靠的,有潜力的无创伤性诊断方法 应用于其诊断中.     

Ⅲ型右位主动脉弓并孤立性左锁骨下动脉一例

病例资料患者,女,10岁。出生后发现心脏杂音,易感冒,轻度发绀,哭闹后加重。体检:发育差,心率125次/分,律齐,胸骨左缘第2、3肋间可闻及吹风样收缩期杂音,肺动脉第2音亢进。心电图:右心室肥厚,心房扩大。胸片示两肺血多,肺动脉段凸出,右心室增大,心胸比率0.55。超声心动图:先天性心脏病,右心室双出口、室间隔缺损、房间隔缺损、永存左上腔静脉。右心导管检查:先天性心脏病右室双出口、室间隔缺损(主动脉瓣下)、肺动脉狭窄;主动脉根部造影:冠状动脉左     

动脉导管未闭合并感染性心内膜炎CT检出肺动脉内赘生物二例

例1 女,10岁.发现心脏杂音10年.5个月前发热2～3天(38℃左右).为诊治心脏病来我院就诊.体检:胸骨左缘第二肋间Ⅲ级双期杂音.血常规:血红蛋白86 g/L.心电图:窦性心动过速,左心室肥厚,T波改变.超声心动图:动脉导管未闭(6 mm),主肺动脉及左肺动脉交界处动脉腔内见44 mm×20 mm中强回声占位性病变.X线平片示两肺血多,肺动脉段突出,左心室增大.考虑为左向右分流先天性心脏病.心脏CT增强扫描示动脉导管未闭(漏斗型),肺动脉端直径6 mm.     

主动脉弓离断三联症一例

患者 女,8岁．5年前发现心脏杂音,3年前出现紫绀、蹲踞现象．未见明显差异性紫绀。体捡：心前区略隆起．心界无明显扩大．心音有力,胸骨左缘3、4肋间可闻及3/6级收缩期吹风样杂音．向胸骨右缘传导．P2亢进,X线平片示：肺血增多．左、右肺动脉明显增宽,主动脉结显示不清,肺动脉压安出,心尖圆钝（图1）。     

Brachial Artery Access for Percutaneous Renal Artery Interventions

Purpose: To evaluate the suitability of transbrachial access for endovascular renal artery interventions. Methods: During 37 consecutive endovascular renal artery interventions, the transbrachial approach was used on nine patients (mean age 63 years; range 41–76 years) for 11 renal artery procedures on native kidneys and one percutaneous transluminal angioplasty (PTA) on a transplanted kidney. The reason for using transbrachial access was a steep aorta-renal angle in five, and severe aorta-iliac atherosclerosis in the remaining patients. In addition to the intervention catheter in the left brachial artery, an additional nonselective catheter for controlling the procedure was inserted transfemorally (six patients) or via the contralateral brachial artery. Results: Eleven interventions (six PTAs, five stents) were successfully completed. The one failure resulted from impenetrable subclavian artery stenosis. The only major complication was a brachial artery pseudoaneurysm requiring surgical treatment. Conclusion: Transbrachial access is an effective and relatively safe technique for renal artery interventions when transfemoral access is not possible. Received: 0/00/00/Accepted: 0/00/00     

Traumatic Axillary Artery Dissection with Radial Artery Embolism

This report describes a case of pathologically proven traumatic arterial dissection, presenting as complete occlusion of the axillary artery with radial artery embolism. Occlusion of the axillary artery by traumatic dissection mimicked transection and radial artery embolism mimicked congenital absence of the radial artery on the initial angiogram, but these were correctly diagnosed with the following sonogram.     

Prostatic Artery Perfusion from the Medial Circumflex Femoral Artery

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Combined Antegrade Femoral Artery and Retrograde Popliteal Artery Recanalization for Chronic Occlusions of the Superficial Femoral Artery

PurposeTo evaluate the efficacy and safety of a dual femoral–popliteal approach in the supine position after failed antegrade recanalization attempts in chronic total occlusion (CTO) of the superficial femoral artery (SFA).Materials and MethodsFrom May 2011 to October 2012, 21 patients underwent dual femoral–popliteal recanalization for CTO of the SFA, with a mean lesion length of 87.4 mm ± 5.8. When contralateral antegrade recanalization of SFA occlusions via the common femoral artery could not be achieved, the occlusions were intrainterventionally accessed by retrograde approach via the popliteal artery, which was punctured anteriorly with gently flexed knee and crus extorsion. When the SFA had been recanalized, further angioplasty and stent placement procedures were completed via the femoral artery.ResultsA technical success rate of 100% (entailing puncture of the popliteal artery and SFA recanalization) was achieved, and no hemorrhage, hematoma, pseudoaneurysm, arteriovenous fistula, or other complications developed. During a mean follow-up of 9.8 months ± 1.5, claudication severity, rest pain, and toe ulcers improved significantly. The pulse of the distal arteries, as well as the filling of the veins, could be distinctly felt. Ankle-brachial index changed from 0.48 ± 0.17 to 0.84 ± 0.11 at 1 year after intervention (P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 80%, and 42%, respectively.ConclusionsA dual femoral–popliteal approach in the supine position is an alternative backup option after failed attempts at the antegrade approach for patients with proximal barriers in CTO or lesions with major extending collateral vessels.     

冠状动脉瘤合并肺动脉瘘1例报告

患者　男 ,66岁。胸闷、气短 ,间断发作 9年 ,症状逐渐加重 ,伴气短及胸前区压榨感 ,按冠心病、心绞痛治疗后症状缓解。彩色多普勒显示左心室功能下降。冠状动脉造影显示左主干管状扩张 ,左前降支发出对角支之后形成囊样改变 (图 1)。SCT三维血管成像显示肺动脉圆锥左前方大小约 18mm的类圆形瘤样扩张影 (图 2 ) ,瘤体与左冠状动脉前降支之间可见大量迂曲成团的动脉血管影 ,紧贴肺动脉干分布 ,并与左前降支相连 (图 3 )。瘤体与冠状动脉根部有一细小血管影 ,该血管末端直径约 1.3mm ,其右 (外 )侧有一较粗大右冠状动脉血管 ,可见与瘤体交…     

左冠状动脉异常起源于肺动脉1例报告

冠状动脉起源于肺动脉是一种较为罕见的先天性心血管异常,约占先天性心脏病的0 .2 6%～0 .5 % [1] 。我院最近遇到1例,资料较完整,报道如下。1　病例报告患者,女,14岁。发现心脏杂音2 0d入院。自幼有活动后心悸、气短,无法完成重体力劳动,偶有头晕。体检发现胸骨左缘第三肋间收     

正常肺动脉和肺动脉高压的磁共振成像研究

目的　确定MRI评价正常肺动脉和肺动脉高压 (PAH)病因及其顺应性变化的价值。材料与方法　在GEVectra 0 .5T超导MR仪上采用肺动脉长轴对正常组 ( 2 3例 ,年龄 10～ 79岁 )和PAH组 ( 2 1例 ,年龄 2～ 66岁 )进行SE和CineMRI检查 ,以测量其管径和顺应性改变 ,并辅以其他成像平面以确定PAH的病因。结果　正常组采用SE测量的管径值为 :肺动脉主干 (MPA) 2 .5 4cm±0 .2 3cm、右肺动脉 (RPA) 1.74cm± 0 .2 3cm、左肺动脉 (LPA) 1.77cm± 0 .2 9cm ,采用CineMRI测得的顺应性为 :MPA 12 %、RPA 16%、LPA13 % ;18例经心导管、造影和 /或手术证实有PAH者MRI均很好显示出其原发病变 ,2例慢性阻塞性肺部疾病 (COPD)和 1例原发PAH者MRI也显示中央肺动脉显著扩张和右室肥厚。经测量PAH组MPA、RPA和LPA管径较正常组增宽明显 ,其顺应性下降显著 ,经t检验 ,两组差异具有非常显著意义 (P <0 .0 0 1)。结论　MRI对确定PAH产生的原因及其顺应性变化具有重要价值