老年高血压状态下左心室构型与左心房和左心室容积

背景：研究表明,左心房容积可反映左心室充盈压、心房结构重塑及神经激素的活动,左心房容积扩大是预测慢性心力衰竭不良预后的一个强有力的标志。目的：观察老年原发性高血压患者在不同左心室构型情况下左心房容积和左心室容积的变化。方法：采用超声心动图对129例老年原发性高血压患者（高血压组）和125名体检血压正常的老年人（对照组）的左心房容积和左心室容积相关指标进行测量,并依据Ganau标准对左心室几何构型进行分型;同时对老年高血压患者进行动态血压监测,依据血压节律进行分组比较。结果与结论：与对照组比较,高血压组左心房容积、左心房容积指数、左心室收缩末期容积、左心室舒张末期容积均明显增大（P〈0.05）;同时,在高血压组内,病程和动态血压昼夜节律对左心室几何构型的分布有影响,且左心室构型异常者上述指标较左心室构型正常者增大更明显（P〈0.05）。提示,老年原发性高血压患者病程和非杓型血压节律对左心室构型存在重要影响,左心房容积和左心室容积的变化与左心室构型的改变相伴随。     

Decreased and abnormal left ventricular filling in acute heart failure: role of pericardial constraint and its mechanism.

Pericardial constraining force is minimal in normal hearts; however, it is considered to be prominent in moderate to severe heart failure. Thus, effects of the pericardium on pulsed Doppler transmitral flow velocity pattern were examined in 17 dogs with acute left ventricular dysfunction. Left ventricular dysfunction with left ventricular end-diastolic pressure > or = 15 mm Hg was produced by injection of microspheres into the left coronary artery. Transmitral flow velocity pattern, left atrial and left ventricular diameters, and high-fidelity left atrial and left ventricular pressures were recorded before and after pericardiectomy. In five of the 17 dogs, mitral regurgitation with giant "v" wave of left atrial pressure occurred with reductions of left ventricular systolic pressure and peak rate of the left ventricular pressure fall (dP/dt) after pericardiectomy. In the other 12 dogs, peak early and late diastolic filling velocities increased with a decrease in left ventricular minimal pressure and increases in left arterial and left ventricular diameters and left atrial and left ventricular compliance after pericardiectomy. In these 12 dogs, left atrial to left ventricular crossover pressure, left ventricular end-diastolic pressure, and references for left ventricular relaxation did not change after pericardiectomy. Thus the release from pericardial constraining force in severe heart failure may increase chamber compliance of the left ventricle and left atrium and, in turn, increase peak early and late diastolic filling velocities through an increment in forward transmitral pressure gradient. Increased pericardial constraining force is a possible cause limiting left ventricular filling and hence cardiac output in heart failure.     

经食管超声对窦性心律左心耳血流频谱的研究

目的　研究窦性心律左心耳血流频谱的类型 ,评价相应的血流动力学。方法　应用经食管超声技术 (TEE)对 83例窦性心律的左心耳血流频谱进行研究。结果　窦性心律左心耳血流频谱的波相可分为 4相、3相、2相三类。从 4相到 2相的演变过程中 ,左心房、左心耳扩大 ,左心房及左心耳功能降低 ,心率和年龄呈增加的趋势 ,左心房内自发性显像 (SEC)程度和血栓发生率均增加 ,风湿性心脏病、二尖瓣重度狭窄所占的比例也增加。多因素相关分析表明 :左心耳收缩期血流速度 (LAA A)与左心房面积 (S LA)、左心房容积 (V LA)呈负相关 ,与左心房面积变化率 (FAC)、左心房容积变化率 (EF LA)、左心耳容积变化率 (EF LAA)呈正相关。结论　窦性心律左心耳的血流频谱能较好地反映左心房、左心耳功能 ,在一定程度上反映了左心室的舒张功能。     

影响扩张性心肌病患者左室血栓形成的相关因素

目的探讨扩张型心肌病患者左室血栓形成的危险因素,为提出预防措施提供依据.方法对2000年1月至2003年6月在我院住院的发现左室血栓形成的33例扩张型心肌病患者进行1:1配对病例对照研究.结果单因素分析显示,血栓组的左室舒张末期内径、收缩末期内径,二尖瓣反流量均比无血栓组明显增大,而血栓组的左室射血分数较无血栓组明显降低.多因素Logist回归分析显示左室射血分数和二尖瓣反流量是左室血栓形成的独立相关因素.结论扩张型心肌病患者左室血栓形成的危险因素是左室射血分数降低.二尖瓣反流可能会防止左室血栓的形成.     

The left inferior phrenic artery arising from left hepatic artery or left gastric artery: radiological and anatomical correlation in clinical cases and cadaver dissection

Background The purpose of this study is to assess angiographic and CT appearance of left inferior phrenic artery (LIPA) arising from left hepatic or left gastric artery and to recognize its specific anatomical location with the help of cadaver dissection. Methods We retrospectively reviewed 761 abdominal angiographies and found 13 patients (1.7%) with LIPA arising from left hepatic or left gastric artery. We classified those origins and assessed radiological features. We also presented a cadaver dissection to identify anatomical location of LIPA arising from left hepatic artery. Results The origin of the LIPA was classified as follows: (a) left hepatic artery: four, (b) accessory left gastric artery: one, (c) accessory left hepatic artery: three, and (d) left gastric artery: five patients. The proximal portion was located in gastrohepatic ligament and its distal portion was located in front of esophageal hiatus. In a cadaver dissection, the proximal portion ascends along ligamentum venosum and distal portion courses along superior aspect of left hemi diaphragm in front of esophagus. Conclusion The LIPA rarely arises from left hepatic or left gastric artery. The proximal portion was located in gastrohepatic ligament and the distal portion runs in front of the esophageal hiatus.     

高血压病患者左心室构型的彩色多普勒超声分析

目的分析高血压病患者左心室的不同构型及其发生机制,方法 高血压病组172例,对照组123例,以超声心动图测定左心室重量指数（LVMI）和室壁相对厚度（RWT）;以彩色多普勒检测有无二尖或主动脉瓣反应及其程度,以肱动脉血压和左心排血量计算体循环血管阻力（SVR）,根据LVMI与RWT分析高血压病患者的左心室不同构型,并分析其彩色多普勒超声表现与SVR特征。结果 高血压病组左室正常型占49．42％,向心性重构型9．30％,向心性肥厚型11．63％,离心性肥厚型29．65％,离心性肥厚组中度二尖瓣反流者较多,SVR最高者为向心性重构组,其次为向心性肥厚组,再次为左室正常组,三者与对照组比较差异的均有显著意义（P＜0．01）,结论 在高血压病中层得中,离心性肥厚较向心性肥厚更为常见,向心性重构也占一定的比例,向心性肥厚及向心性重构主要与压力负荷过重有关,离心性肥厚既有压力负荷过重,又有容量负荷过重,向心性重构还可能与容量低负荷有关。     

非体外循环下左心室重建联合冠状动脉旁路移植术治疗左心室室壁瘤

目的评价在非体外循环下行左心室重建术＋冠状动脉旁路移植术治疗左心室室壁瘤的效果。方法左心室室壁瘤患者103例,在非体外循环下先行冠状动脉旁路移植术,其中乳内动脉与前降支吻合80例,大隐静脉-前降支或其他血管吻合21例,2例未搭桥,然后用2-0聚丙烯线围绕前间壁及心尖部室壁瘤基底部全层荷包缝合室壁瘤及室壁瘤的游离壁以消除死腔。结果术后发生低心排综合征10例,脑卒中2例,开胸止血2例,室性心律失常3例,死亡3例;手术前左心室舒张末内径（66.59±9.76）mm,术后减少到（50.00±5.30）mm（P〈0.05）;左心室舒张末容积由术前（165.20±59.48）mL减少到（85.60±23.70）mL（P〈0.05）;左心室射血分数由术前（35.70±0.05）%增加到（50.00±0.04）%（P〈0.05）。结论非体外循环左心室重建术＋冠状动脉旁路移植术治疗左心室室壁瘤手术操作简单,并发症少,近期疗效良好。     

彩色多普勒超声对急性心肌梗塞病人左房功能的分析

应用二维彩色多普勒超声技术评价急性心肌梗塞病人的左房功能。结果显示，急性心肌梗塞组与正常对照组比较其各指标均有显著性差异（Ｐ＜０．００１或Ｐ＜０．０５）。左房内径（ＬＡＤｄ）、左房容积（ＬＡＶ）、左房压力（ＬＡＰ）、左房张力（ＬＡＴ）、左房射血期（ＬＡＥＴ）、左房每搏量（ＬＡＳＶ）、左房射血分数（ＬＡＥＦ）和Ａ峰均增加，而Ｅ峰、Ｅ／Ａ比值、射血前期（ＬＡＰＥＰ）和ＬＡＰＥＰ／ＬＡＥＴ比值降低。结论：急性心肌梗塞后，左房代偿性收缩功能增强，维持一定的左房与左室间的压差（ＡＶＰＧ），对增加左室充盈量起重要作用，符合Ｆｒａｎｋ—ｓｔａｒｌｉｎｇ定律。     

基于超声四维左房定量分析技术评价原发性高血压左心室肥厚患者的左房功能

目的  基于超声四维左房定量分析（4DLAQ）技术评价原发性高血压（EH）左心室肥厚（LVH）患者的左房功能。 方法  选择EH患者80例,根据LVH的新标准将患者分为LVH组无LVH（NLVH）组,同时选取36例健康体检者作为对照组,3组均采用二维超声心动图测量得到二维超声数据,采用4DLAQ技术测量及分析得到左房容积参数包括左房最小容积（LAV_min）、左房最大容积（LAV_max）、左房收缩前容积（LAV_preA）、左房整体射血分数（LAEF）;左房应变参数包括左房储备期长轴应变、左房管道期长轴应变、左房收缩期长轴应变、左房储备期环形应变、左房管道期环形应变、左房收缩期环形应变,比较3组二维和四维技术所得数据的差异。 结果  3组收缩压及舒张压的差异有统计学意义（P < 0.05）。3组左心房内径、双平面左室射血分数、室间隔厚度、左心室舒张末期内径、左心室后壁厚度、E/e’的差异均有统计学意义（P < 0.05）。3组LAV_min、LAV_preA、LAEF、左心房被动射血分数、左心房主动射血分数的差异有统计学意义（P < 0.05）,而LVA_max的差异无统计学意义（P > 0.05）。3组左房应变参数的差异均有统计学意义（P < 0.05）。观察者间和观察者内的一致性较好（组内相关系数 > 0.90）。 结论  EH患者左房内径增大早于左室收缩功能受损,随着疾病进展左房容积升高,储存功能、管道功能受损,泵血功能处于NLVH时增加,随着LVH程度加重,左房泵血功能减低。4DLAQ能发现EH患者左房功能细微的改变,其应变参数评价左房功能更敏感,其中环形应变在表达左房管道功能上比纵向应变更具优势。     

慢性房颤患者射频消融术后左心房和左心室远期结构变化简

目的探讨慢性房颤患者射频消融术后左心房、左心室远期结构变化。方法50例经射频消融治疗的房颤患者根据复发情况分为复发组（n=18）与未复发组（n=32）,对比两组患者术前、术后12个月左房前后径、左右径、上下径,左心房最大容积、左心室舒张末期内径、左心室收缩末期内径、左室射血分数。结果术前、术后随访12个月比较左房前后径、左右径、上下径,左心房最大容积、左心室舒张末期内径、左心室收缩末期内径、左室射血分数比较,复发组差异无统计学意义（P〉0．05）,未复发组差异具有统计学意义（P〈0．05）。结论射频消融术治疗房颤具有显著疗效,复律并维持窦性心律对于逆转左心房、左心室重构,提高左室功能均具有重要意义。     

非瓣膜性心房颤动患者左心房血栓或自发性显影影响因素分析

目的 探讨非瓣膜性心房颤动(房颤)患者左心房血栓或自发性显影的影响因素。方法 连续入选非瓣 膜性房颤患者130例,进行CHA2DS2-VASc评分,并记录性别、年龄、伴发疾病、化验指标、超声心动图结果等基线资 料。根据食管超声结果分为左心房血栓或自发性显影阳性组和阴性组,比较两组各项指标的差异。Logistic多因素 分析确定左心房血栓或自发性显影的独立危险因素。通过受试者工作特征性曲线(ROC)判断CHA2DS2-VASc评 分、左心房内径(LAD)、左心耳排空速率及左心耳充盈速率对左心房血栓或自发性显影的预测价值。结果 LAD、左 心室舒张末内径(LVEDD)、左心室射血分数(LVEF)、持续性房颤、既往脑卒中或短暂性脑缺血发作(TIA)史、体质量 指数(BMI)、CHA2DS2-VASc评分、左心耳排空速率、左心耳充盈速率在两组间差异有统计学意义(P <0.05)。多因 素回归显示,LAD>40.0mm(P <0.01)、左心耳排空速率<54.15cm/s(P <0.01)、BMI≥25(P <0.01)与非瓣膜 性房颤患者左心房血栓或自发性显影独立相关。LAD 的ROC 曲线下面积为0.845(95%CI=0.776~0.913,P < 0.01);左心耳排空速率的ROC曲线下面积分别为0.851(95%CI =0.781~0.921,P <0.01)。结论 左心房内径> 40.0mm、左心耳排空速率<54.15cm/s是非瓣膜性房颤患者左心房血栓或自发性显影的独立危险因素。     

Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit

OBJECTIVES: When extracorporeal membrane oxygenation (ECMO) is used in the setting of severe myocardial dysfunction, left ventricular end-diastolic and left atrial pressure can rise to extremely high levels. Decompression of the left atrium in this setting is essential for resolution of pulmonary edema and recovery of left ventricular function. We sought to evaluate whether adequate left atrial decompression can be achieved via percutaneous placement of a transseptal left atrial drain incorporated in the ECMO venous circuit. DESIGN: Retrospective case series. SETTING: Tertiary care center pediatric intensive care unit and cardiac catheterization laboratory. PATIENTS: Seven patients (age 8 months to 28 yrs) with cardiac failure on venoarterial ECMO with left atrial hypertension. INTERVENTIONS: All patients underwent left atrial decompression with transseptal puncture and placement of a drain (8- to 15-Fr) incorporated into the ECMO venous circuit. Catheterization and ECMO records and echocardiograms were reviewed, as were the clinical course and outcome for each patient. MEASUREMENTS AND MAIN RESULTS: The median time from ECMO cannulation to left atrial decompression was 11 hrs. Average initial left atrial pressure was 31 mm Hg. Successful drain placement was achieved in seven patients with no major procedural complications. Echocardiographic improvement in left atrial dilation was achieved in five patients (71%). Inability to decompress the left atrium was fatal in two patients. Four patients were decannulated (57%), and three survived to hospital discharge (43%). Larger sheath size and higher flow rate correlated with a greater likelihood of success. CONCLUSIONS: Adequate decompression of the left atrium can be achieved by transseptal placement of a left atrial drain incorporated into the ECMO circuit. This technique represents a reasonable alternative to blade or balloon atrial septostomy for patients requiring left atrial decompression.     

维吾尔语和汉语动词产生相关脑区的功能性磁共振成像研究

目的通过功能性磁共振成像（fMRI）观察母语为维吾尔语（简称维语）和汉语正常人执行动词产生任务时的脑激活区及其脑激活差异区,探讨语言理解和产生的神经机制,以及脑损伤后语言障碍及其康复机制。 方法以维语和汉语名词为基本实验材料,通过血氧水平依赖功能性磁共振成像（BOLD-fMRI）扫描31例维吾尔族（语组）和28例汉族（汉语组）正常志愿者执行动词产生任务时的脑激活区,采集fMRI数据,并进行组内及组间比较。 结果汉语组的主要脑激活区为左侧尾状核、左侧枕下回、左侧梭状回、双侧辅助运动区（BA8/6区）、左侧BA32区、左侧楔前叶、左侧顶上、下小叶（BA7区）、左侧角回、右侧中央前回（BA9区）、左侧三角部额下回、右侧岛盖部额下回和双侧小脑。维语组的主要脑激活区为左侧中央前回（BA9区）、左侧岛盖部额下回、左侧三角部额下回和左侧小脑。维语组和汉语组组间比较发现,汉语组在左侧尾状核体、左侧眶部额中回、右侧尾状核头和双侧扣带回前部（BA32区）有明显激活,与维语组比较,差异有统计学意义（P<0.05）;而维语组未见比汉语组更明显激活的脑区。 结论维语和汉语正常人动词产生激活脑区不完全相同;维语文字的加工处理主要集中在左侧大脑半球;汉字加工处理比维语文字加工处理需要更多右侧大脑半球的参与。     

经食道超声心动图评估非瓣膜性房颤患者左心耳容积和功能的临床意义

目的  探究经食道超声心动图（TEE）评估非瓣膜性房颤患者左心耳容积和功能的临床价值及意义。方法  选取2016年8月~2020年8月于成都市新都区人民医院行TEE检查且确诊为非瓣膜性房颤的患者138例为房颤组,另选取同期因怀疑为其他心血管疾病而接受TEE检查的对象47例作为对照组。TEE多切面观察两组患者的左心耳超声图像,应用Simpson双平面法获取左心耳容积参数,所有对象均通过经胸超声心动图采集左房三维容积图像,并导入Qlab9.0分析软件,获取左房的容积及变化参数。比较两组患者的左心房、左心耳容积参数和血流动力学参数,分析不同左心耳功能患者的血栓形成及自发显影情况。结果  房颤组患者的左房射血分数、左心耳射血分数、心耳容积变化率、左心耳最大排空速度和体表面积标化的左心耳排空指数均小于对照组（P < 0.05）,左房最大容积、左房最小容积、左心耳最大容积和左心耳最小容积均大于对照组（P < 0.05）。房颤组中,左心耳功能正常89例（64.49%）,左心耳功能轻度下降31例（22.46%）,左心耳功能中重度下降18例（13.04%）,不同左心耳功能状态患者的血栓形成和自发显影情况比较,差异有统计学意义（P < 0.05）,且功能中重度下降患者的血栓形成率高于轻度下降和正常患者（P < 0.05）;功能中重度下降患者的自发显影严重程度高于正常患者（P < 0.05）。结论  TEE在评估非瓣膜性房颤患者左心耳容积和功能中具有良好的临床价值,患者左心耳功能下降水平越高,发生血栓形成和自发显影风险越大。     

超声对高血压致不同左室构型左房功能改变的研究

目的 联合应用二维、M-型超声心动图与脉冲多普勒技术评价高血压左心室不同构型左房功能改变。方法 采用M-型和二维超声技术测量高血压患左室几何构型，测量各组左房功能及二尖瓣血流频谱指标。结果 与对照组相比，高血压各组左房功能均有不同程度改变，高血压早期即可出现左房功能异常，表现为左房灌注分数(LAF)的增高。结论 左房灌注分数(LAF)可以比二尖瓣血流频谱更早的体现左室舒张功能的异常改变。     

多普勒,2—DE,左房收缩时间间期评价陈旧性心肌梗塞病人的左房功能

本文应用脉冲多普勒方法测量左房收缩时间间期,结合M、二维超声心动图定量评价24例陈旧性心肌梗塞病人的左房功能。结果显示:陈旧性心梗组左房收缩时间间期各指标与对照组相比有明显差异。左房每搏量、左房射血分数、左房每搏量与左室每搏量之比比对照组明显增加。这些结果提示:心肌梗塞后,左房收缩功能增强,对维持左室充盈量起重要作用,其代偿机理符合Frank·Starling定律。     

Angiocardiographic estimation of left ventricular mass in normal infants and children

Left ventricular mass data were obtained from biplane cineangiocardiograms in 37 normal infants and children. Left ventricular mass calculated by using thickness of anterior wall (left ventricular mass-anterior) and posterior wall (left ventricular mass-posterior) of the free left ventricular wall were studied in relation to body surface area and left ventricular end-diastolic volume. Both of left ventricular mass-anterior and mass-posterior were expressed as a function of body surface area with exponential relationship; left ventricular mass-anterior = 68.5 (body surface area) g (r = 0.98, p less than 0.01), left ventricular mass-posterior = 84.6 (body surface area) g (r = 0.97, p less than 0.01). Left ventricular mass-anterior/left ventricular end-diastolic volume averaged 0.73 +/- 0.01 g/ml, and left ventricular mass-posterior/left ventricular end-diastolic volume 0.89 +/- 0.02 g/ml, respectively. Thus, left ventricular mass can be predicted from body surface area by using the exponential equations. In addition, normal values for left ventricular mass-posterior must be discriminated from those for left ventricular mass-anterior.     

Left ventricular apicoaortic valved conduit for treating obstruction of the left ventricular outflow tract

The left ventricular-aortic conduit provides one solution to the problem of a congenital obstruction of the left ventricular outflow tract, which may result from a wide variety of conditions. The creation of a double-outlet left ventricle successfully relieves left ventricular hypertension and its sequelae. This case demonstrates one long-term complication of the left ventricular-aortic conduit--stenosis at the point of origin of the graft in the left ventricle due to endothelial proliferation, which necessitated replacement of the graft.     

不同类型左无名静脉异常产前超声心动图特征及其临床意义

目的 观察胎儿不同类型左无名静脉异常的超声心动图特征及其临床意义.方法 回顾性分析67胎左无名静脉异常胎儿的临床资料、超声心动图特征及预后.结果 ①67胎中,47胎左无名静脉走行异常,12胎主动脉弓上方左无名静脉缺如,8胎左无名静脉内径异常或异常血流.②47胎左无名静脉走行异常中,左无名静脉主动脉弓下走行40胎、食管后...     

运用左心房排空率评价高血压患者左心房功能的初步研究

目的 探讨左心房(左房)排空率(dV/dt)评价高血压患者左房功能的可行性及临床价值.方法 运用左房追踪技术(LA-tracking),分别获取31例健康志愿者(正常对照组)和21例高血压患者(病例组)的左房排空率曲线、左房容积曲线和长径曲线,测量左房排空率、左房容积和长径在左房充盈期、左室舒张早期及舒张晚期的峰值,分析左房充盈期的排空率峰值与左房最大容积的相关性.结果 与正常对照组比较,高血压组左室舒张早期的左房排空率峰值(dV/dt_E)明显降低,左室舒张晚期的左房排空率峰值(dV/dt_A)明显增大,差异具有统计学意义(P<0.05).左房充盈期的左房排空率峰值(dV/dt_S),左房容积(LAV)和长径(LAL)峰值在高血压组略高于对照组,但差异无统计学意义(P>0.05).两组dV/dtS与左房最大容积(LAV_S)均有良好的相关性(r_1=0.86,r_2=0.80).结论 左房排空率是从整体上定量评价左房功能的一种新参数.