哑型主动脉瓣关闭不全的临床和多普勒超声心动图研究

本文报告用脉冲多普勒超声心动图诊断的哑型主动脉瓣关闭不全(SAR)15例。其检出率在总受检人群中为1.23％(15/1223),在老年人群中为1.95％(15/770,15例均≥60岁)。而115名正常人中无1例SAR。将SAR组与病例对照组及正常对照组进行配对比较分析发现:SAR组左室增大、主动脉瓣钙化较多、主动脉根部较增宽,提示本组SAR可能与主动脉根部扩张、主动脉瓣钙化、高血压及老年退行性变有关。     

超声心动图评价牛心包置换单叶主动脉瓣治疗主动脉瓣关闭不全

目的 应用经胸和经食管超声心动图评价牛心包置换单叶主动脉瓣治疗主动脉瓣关闭不全的效果.方法 应用经胸和经食管超声心动图对25例牛心包置换单叶主动脉瓣治疗主动脉瓣关闭不全患者行术前、体外循环停机后术中检测和术后3～6个月随访,判定瓣膜结构、病变和反流程度,同一切面相同时相测量手术前后左房、左室内径.结果 25例患者术前经胸超声检测反流与停机后术中反流程度差异有统计学意义(P＜0.001);术中停机后经食管超声与术后3～6个月经胸超声检测反流程度比较差异无统计学意义(P＞0.1);术后3～6个月左房内径[(3.19±0.90)cm]、左室内径[(4.72±1.19)cm]较术前[左房(3.80±1.37)em,左室(5.75±1.32)em]明显回缩,手术前后测值差异有统计学意义(P＜0.001).结论 牛心包置换单叶主动脉瓣治疗主动脉瓣关闭不全近期疗效较好,远期效果尚待观察.     

超声心动图评估主动脉瓣置换术后早期并发症的临床应用

主动脉瓣置换术(AVR)是目前治疗有症状的主动脉瓣病变的标准手术。AVR可明显改善主动脉瓣狭窄或反流患者的临床症状及血流动力学,手术效果好,远期生存率高。尽管经导管主动脉瓣置入术(TAVI)也被认可为治疗主动脉瓣病变的有效手段,但目前AVR仍然是最可靠的手术方式。超声心动图是主动脉瓣狭窄或反流最重要的诊断方法,是一种安全可靠的无创检测技术,在术前评估、明确手术指证、选择手术方式、判断预后等方面有重要的价值。AVR术后30d内发生的早期并发症影响患者预后,目前主要依靠超声心动图来检测和诊断。常规超声心动图的应用最为广泛,近年来超声心动图新技术如组织多普勒显像(TDI)、二维或三维斑点追踪显像、负荷超声心动图的应用也得到越来越多的临床医师重视。然而,超声心动图对AVR术后早期并发症的预测价值尚无充分的证据证明。笔者对AVR术后主要早期并发症及超声心动图检测方法进行系统回顾,以期为探究超声心动图指标预测术后早期并发症的价值提供参考。     

超声心动图对儿童风湿性主动脉瓣关闭不全的诊断价值

目的　探讨超声心动图对儿童风湿性主动脉瓣关闭不全的诊断价值。方法　采用彩色多普勒超声心动图检查技术对 12 2例风湿性心瓣膜病儿童的瓣膜病变进行检测。结果　 12 2例风湿性心瓣膜病患儿中 ,临床诊断为主动脉瓣关闭不全 (AR) 12例 ,而超声心动图检测出 AR4 8例。 4 8例均同时合并二尖瓣病变。 4 8例中轻度 AR2 2例 ,中度 AR2 4例 ,重度 AR2例。 4 8例 AR临床与超声心动图诊断比较其符合率分别为轻度 9.1% (2 / 2 2 ) ,中度 33.3% (8/ 2 4 ) ,两组之间差异有显著意义 (P<0 .0 5 )。重度 2例临床与超声诊断符合。表明超声心动图检查方法较临床对 AR诊断有很高的准确率。结论　超声心动图对诊断儿童风湿性 AR是一项敏感和有价值的检查方法     

超声心动图诊断肥厚型心肌病合并主动脉瓣狭窄及关闭不全1例

超声心动图诊断肥厚型心肌病合并主动脉瓣狭窄及关闭不全１例邮政编码５１８１０４深圳市宝安区沙井人民医院唐国成本例以反复晕厥为主要临床表现，以主动脉瓣区收缩期喷射性杂音和胸骨左缘３、４肋间叹气样杂音为体征，心电图检查酷似急性心肌梗塞，超声心动图检查发现的...     

室间隔缺损合并主动脉瓣关闭不全的彩色多普勒超声心动图诊断

目的：探讨室间隔缺损（ＶＳＤ）合并主动脉瓣关闭不全（ＡＶＩ）的彩色多普勒超声心动图（ＣＤ－ＵＣＧ）显像特点。材料与方法：借助ＣＤ－ＵＣＧ多切面观察２６例ＶＳＤ合并ＡＶＩ病列。分析其中异同点以及与手术中所见的关系。结果：全组病例均经手术证实诊断。手术方式亦有异同。结论：ＣＤ－ＵＣＧ对ＶＡＳ合并ＡＶＩ诊断具有肯定的价值,对手术方式的选择有一定的指导意义。     

超声心动图对干下型室间隔缺损合并主动脉瓣下隔膜及主动脉瓣关闭不全的诊断价值

目的 总结先天性干下型室间隔缺损合并主动脉瓣下隔膜及主动脉瓣关闭不全的超声心动图特征,并探讨超声心动图对本病的诊断价值.方法 入选15例干下型室间隔缺损合并主动脉瓣下隔膜及主动脉瓣关闭不全患者,超声心动图检测室间隔缺损与主动脉瓣下隔膜的关系,室水平分流特点,主动脉瓣下隔膜引起狭窄的程度,主动脉瓣关闭不全的程度,分析它们之间的相互关系及血流动力学特点.结果 (1)室水平分流频谱为收缩及舒张期连续性左向右分流.(2)主动脉瓣关闭不全的程度与室间隔缺损的大小呈正相关性(0.001＜P＜0.002 5).(3)术前超声测量室间隔缺损数据组比术中实际值小,P＜0.05差异有统计学意义.结论 超声心动图对先天性干下型室间隔缺损合并主动脉瓣下隔膜及主动脉瓣关闭不全的患者,具有较高且独特的诊断价值.     

对比全身成像三维量化超声心动图与MRI定量评估主动脉瓣反流

目的对比全身成像三维量化(GI3DQ)超声心动图与MRI定量评估主动脉瓣反流(AR)的效果。方法 45例AR患者均接受实时三维超声心动图及MR检查。采集AR全容积图像,导入QLab 3DQ Adv软件和GI3DQ三维图像工作站,脱机测量AR容积(AR-Vol)及反流分数(RF%)。采用TrueFISP电影序列行MR扫描,以血流分析软件分析AR相位图,获得AR-Vol及RF%。对比GI3DQ与MRI所测AR-Vol及RF%的差异,并对2种方法测值进行相关性和一致性分析。结果 GI3DQ与MRI测得的AR-Vol、RF%差异均无统计学意义(P均>0.05),2种方法所测AR-Vol(r=0.93,P<0.001)、RF%(r=0.94,P<0.001)均呈正相关,且一致性分析显示差异无统计学意义(P均>0.05)。结论 GI3DQ可定量评估AR,且其测值与MRI的相关性和一致性均较好。     

先天二叶式主动脉瓣畸形临床及超声心动图特征分析

目的:探讨先天二叶式主动脉瓣畸形(BAV)患者主动脉瓣功能异常和大血管病变的分布特征和危险因素.方法:对复旦大学附属中山医院2012年1月至2015年12月确诊为BAV患者的超声心动图数据进行横断面分析.结果:共纳入BAV患者2781例,占超声心动图检查总人数的1.1％,其中70.2％ 为男性,60.4％ 伴中度以上主...     

Quadricuspid aortic valve abnormality associated with aortic stenosis and aortic insufficiency.

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. Transthoracic 2-dimensional echocardiography can delineate aortic valve and diagnose most quadricuspid aortic valves. This article is a report of a quadricuspid aortic valve associated with aortic stenosis and aortic insufficiency diagnosed by transthoracic echocardiography.     

Diagnostic criteria and clinical evaluation of tricuspid aortic valve asymmetry

AIM: To investigate size of the aortal root and its valves in young patients and correlation between tricuspid aortal valve (TAV) asymmetry and connective tissue dysplasia (CTD). MATERIAL AND METHODS: TAV symmetry was studied in young patients. Morphological examination consisted in phenotypic study of 34 corpses of young people who had died of noncardiological causes with a focus to internal signs of CTD signs and measurements of TAV and each cusp. Echocardiographic examination comprised phenotypic, clinical and echocardiographic studies of 144 young patients. RESULTS: Echocardiographic diagnostic criteria of TAV asymmetry were specified. They consisted in eccentricity of the line of diastolic closure of aortal cusp (M-mode echocardiography) > 1.2; distinct differences in the size of the cusps (two-dimentional study), shift of at least one of the comissures by I hour at the "clock-face". A close correlation was detected between TA V asymmetry, external and clinical manifestations of CTD. The morphological criterion of TA V asymmetry--a more than 38% increase in the ratio of cusp area to sectional area of aortal root. CONCLUSION: TAV asymmetry is detected in 20% young people. It is closely related to external signs and clinical manifestations of CTD, other minor heart anomalies and may be accompanied with aortal regurgitation.     

Anatomic three-dimensional echocardiographic correlation of bicuspid aortic valve.

This study was undertaken to verify the echocardiographic characteristics of bicuspid aortic valve (AV) using 3-dimensional transesophageal echocardiography by comparing the findings with anatomic examination of autopsy specimens from carriers of this condition. Three-dimensional reconstructions of transesophageal echocardiograms were performed on 14 patients with bicuspid AV, and 20 autopsy specimens of bicuspid AVs were analyzed. Echocardiographic images and autopsy material were correlated. Two variants of bicuspid aorta were identified. In group I the AV had 2 leaflets. This group included 9 (9/14) 3-dimensional echocardiographic studies and 13 (13/20) necropsies. In group II 3 sigmoid leaflets had originally developed and 2 underwent dysplastic fusion, resulting in functionally bicuspid valves. Five (5/14) echocardiographic studies and 7 (7/20) anatomic specimens fell into this category. There was a clear correspondence between anatomic and echocardiographic findings, which leads to the conclusion that 3-dimensional echocardiography is a technique that reliably defines the morphological details of bicuspid AV with the precision of anatomopathologic examination.     

二尖瓣关闭不全的超声分型改进与术式选择的关系

目的分析二尖瓣关闭不全的超声分型改进与手术方式选择以及预后的关系,为二尖瓣关闭不全患者术前手术方式的选择提供新的形态学依据。方法４７例行二尖瓣重建术和４１例行二尖瓣置换术患者术前采用ＨＰＳｏｎｏｓ２５００多功能超声仪和２．５ＭＨｚ的探头行超声检查,根据二维显像上瓣叶的对位和对合情况分为三型。Ⅰ型：二尖瓣前后叶瓣尖处对位和对合均正常;Ⅱ型：二尖瓣对位正常,但对合异常;Ⅲ型：二尖瓣对位和对合均异常。结果４７例成形术患者的超声显像分型示,Ⅰ型占２０例,Ⅱ型３例,Ⅲ型２４例。术后接受超声随访的３４例患者中,１１例术后出现二尖瓣中、重度返流,包括Ⅰ型２例和Ⅲ型９例。Ⅲ型患者的预后远不如Ⅰ型和Ⅱ型（Ｐ＜０．０５）。４１例行二尖瓣置换术的患者中,Ⅲ型占３１例（７５．６％）,其中合并腱索断裂或（和）严重瓣膜、瓣下结构受损者共占２５例。结论超声分型与二尖瓣关闭不全手术方式的选择有直接关系。