左心室憩室的产前超声诊断及出生后随访病例3例

<正>心室憩室是一种罕见的心脏畸形,最早于1816年被提出[1]。其主要解剖表现为心脏室壁的局部膨出,可伴发其他先天性胸腹畸形、心血管畸形或遗传综合征,亦可孤立发生,以左心室憩室（left ventricular diverticulum,LVD）较为常见[2]。一项国外超声研究发现LVD的发病率约0.04%[3]。由于目前诊断手段多样化,越来越多关于孤立性LVD的诊断或治疗的病例被报道,对孤立性左心室憩室的认识不断增加。本文对广东省妇幼保健院心脏中心产前诊断胎儿LVD并出生的3例病例,就其临床及超声资料报道如下：     

中国内地先天性室壁瘤和憩室临床特征文献的统计分析

目的 分析中国内地报道的先天性室壁瘤和憩室的临床特征。方法 通过检索万方数据库、中国知网全文数据库及PubMed数据库,获取2001年1月至2009年12月中国内地报道的先天性室壁瘤和憩室的文献资料,并对其临床特征进行分析。结果 共检索到符合要求的文献109篇,患者共116例,年龄l～80(33.5±21.3)岁,男性78例。先天性室壁瘤25例,其中包括一个家系的患者4例,男性13例;先天性憩室91例,男性65例。100例患者因体检或胸闷不适通过超声心动图检查出先天性室壁瘤和憩室。合并心内先天性缺陷34例,其中同时合并心外先天性缺陷4例。合并室性心律失常8例,血栓形成8例,心脏破裂2例,猝死4例（包括家系患者3例）。外科治疗46例,射频消融治疗3例,所有患者均未置人埋藏式心律转复除颤器。结论 先天性室壁瘤和憩室是一种罕见的先天性疾病,无症状患者可通过超声心动图检查发现。患者可能出现室性心律失常、血栓栓塞、室壁瘤或憩室破裂、猝死等病情,需要积极干预。     

成人先天性左室孤立型憩室一例报告

先天性心室憩室是罕见的 ,现报告一例先天性左室孤立型憩室。患者 ,男 ,4 1岁 ,因心悸、胸部不适 2个月 ,怀疑“前壁心肌梗死”而入院。该患者平时身体健康 ,无冠心病病史。13年前做过阑尾炎手术。体温 36 5℃ ,脉搏 6 8次 /ｍｉｎ ,呼吸14次 /ｍｉｎ ,血压 15 5 / 90ｍｍＨｇ(1ｍｍＨｇ=0 133ｋＰａ) ,发育正常 ,营养良好 ,结膜无苍白 ,皮肤无黄染 ,甲状腺不大 ,颈静脉无怒张 ,胸廓无畸形 ,心界不大 ,心律齐 ,心率 6 8次 /ｍｉｎ ,心脏听诊无杂音 ,腹平软 ,肝脾未及 ,脊椎、四肢正常。血生化检查 :肝功能、肾功能、心肌酶学、血电解质、…     

小儿先天性左心室憩室1例的护理体会

目的 总结1例小儿先天性左心室憩室患者的护理经验.方法 在护理方面要注意减轻或避免患儿上腹部受压和遭受撞击;术后早期要特别注意患儿左心功能的维护.结果 在全身麻醉下,患儿接受了“憩室切除术加动脉导管结扎术”,术后恢复顺利.结论 心外科护士要多了解有关小儿先天性左心室憩室的解剖,症状、体征,手术治疗的方式,并在护理方面作出有针对性的护理预案.     

射频消融位于冠状静脉窦憩室处的后间隔房室旁路

目的报道５例冠状静脉窦憩室处后间隔房室旁路的射频消融结果。方法对５例后间隔显性房室旁路患者进行电生理检查和射频消融术。术后冠状动脉造影,以观察冠状静脉窦形态。结果所有患者的冠状静脉窦近端有一憩室,并在憩室的颈部消融阻断房室旁路。成功靶点图：心室激动较体表心电图Δ波提前（３１±３．７）ｍｓ,其中４例患者伴有旁路电位。结论冠状静脉窦憩室与后间隔旁路存在着解剖关系。术中冠状静脉窦造影检查有助于发现憩室和确定有效的消融部位。     

中国人成人先天性孤立性左室憩室物临床和影像诊断特点

目的 总结成人先天性左室憩室的临床影像特点。方法对４例左室造影或（和）超高速确诊为成人先天性左室憩室患者的临床和影像特点进行分析。结果 临床无症状，然而无益工有冠心病，经左室造影确诊为先一性孤立性左室肌型憩室，其中２例需ＵＦＣＴ和ＭＲＩ补充诊断：二维超声心动图不仅与左室造影、ＭＲＩ和ＵＦＣＴ的影像特征一致，可弥补左室造影中因右室影像重叠而对憩室观察缺陷的不足，而且其独特的多普勒血流频谱，可与真、假     

成人及儿童心脏憩室临床分析

目的 :探讨成人与儿童心脏憩室的临床特点。方法 :将经心脏造影或手术证实为心脏憩室的 9例患者临床资料进行回顾性分析。结果 :14例成人患者 (成人组 )皆因并发冠心病在冠状动脉及左室造影检查时被偶然发现。 5例儿童患者 (儿童组 )中 4例因并存其他严重先天性心脏畸形而施行外科矫治手术时被确诊 ,另 1例经左室造影证实。2成人组平均憩室瘤体径为 2 0～ 48(36 .3± 11.8) mm,憩室颈径为 10～ 17(14.0± 2 .9) mm;儿童组平均憩室瘤体径 2 5～ 80 (42 .0± 2 2 .0 ) m m,憩室颈径为 4～ 12 (8.6± 3.9) mm。 3成人组均为孤立性左室肌型憩室 ,无与憩室有关的并发症 ,未行手术治疗 ;儿童组中仅 1例为孤立性左室肌型憩室 ,其余 4例均根据其并存的心脏畸形类型分别接受了憩室缝合术和房、室间隔修补术、三尖瓣成形术、二尖瓣置换术或动脉导管结扎术等治疗。结论 :成人与儿童心脏憩室的临床特点有许多不同之处     

中国人成人先天性孤立性左室憩室的临床和影像诊断特点

目的　总结成人先天性左室憩室的临床 (和 )影像特点。方法　对 4例左室造影或 (和 )超高速CT(UFCT)、MRI确诊为成人先天性左室憩室患者的临床和影像特点进行分析。结果　临床无症状 ,然而均合并有冠心病 ,经左室造影确诊为先天性孤立性左室肌型憩室 ,其中 2例需UFCT和MRI补充诊断 ;二维超声心动图不仅与左室造影、MRI和UFCT的影像特征一致 ,可弥补左室造影中因左室影像重叠而对憩室观察缺陷的不足 ,而且其独特的多普勒 (Doppler)血流频谱 ,可与真、假室壁瘤鉴别 ,对憩室有确诊价值。结论　 (1)中国成人先天性左室憩室多为孤立性肌型憩室 ;临床多无症状 ,多合并有冠心病 ,甚至心肌梗死 ;左室造影有确诊价值 ,但有时需UFCT或MRI补充。 (2 )超声心动图不仅与MRI和UFCT影像特征一致 ,而且其独特的Doppler血流频谱 ,对左室肌型憩室有确诊价值。     

16例先天性左心室室壁瘤或憩室患者的临床特征及长期随访结果

目的 观察并分析先天性左心室室壁瘤或憩室患者的临床特征及预后.方法 回顾性分析南京医科大学第一附属医院心血管内科自2004年1月至2020年12月明确诊断为先天性左心室室壁瘤或憩室的患者16例,随访(58.00±34.16)个月,观察终点为主要不良事件发生率及预后情况,主要不良事件包括恶性室性心律失常、心力衰竭和血栓栓...     

梅克尔憩室的诊断研究进展

梅克尔憩室是最常见的消化道先天性畸形,是一种具有小肠壁各组织学分层(黏膜、肌层和浆膜层)的真性憩室,由卵黄管不完全退化所致。最初由德国解剖学家Meckel于1809年提出~[1],并以其名字命名。梅克尔憩室的形态和发生特点可总结为"二原则",即:发病率约2%,长约2英寸,多     

Multimodality detection of multiple left ventricular diverticula: A case report and brief review of the literature

Left ventricular diverticula (LVD) are rare congenital anomalies usually detected incidentally in the adult population. Most commonly, they are found as a single left ventricular diverticulum in association with other congenital abnormalities but multiple LVD are exceedingly rare. We are describing a patient who was found to have multiple LVD on multimodality imaging studies. He had presented with a sudden cardiac arrest attributed to a combination of alcohol intoxication and QT interval prolongation from hypokalemia and antidepressant medications. The patient was managed conservatively and discharged with an implantable loop recorder for detecting any occult arrhythmias.     

Evolution of ventricular outpouching through the fetal and postnatal periods: Unabating dilemma of serial observation or surgical correction

Ventricular outpouching is a rare finding in prenatal sonography and the main differential diagnoses are diverticulum, aneurysm, and pseudoaneurysm in addition to congenital cysts and clefts. The various modes of fetal presentation of congenital ventricular outpouching include an abnormal four-chamber view on fetal two-dimensional echocardiogram, fetal arrhythmia, fetal hydrops, and pericardial effusion. Left ventricular aneurysm (LVA)/nonapical diverticula are usually isolated defects. Apical diverticula are always associated with midline thoracoabdominal defects (epigastric pulsating diverticulum or large omphalocele) and other structural malformations of the heart. Most patients with LVA/congenital ventricular diverticulum remain clinically asymptomatic but they can potentially give rise to complications such as ventricular tachyarrhythmias, systemic embolism, sudden death, spontaneous rupture, and severe valvular regurgitation. The treatment of asymptomatic LVA and isolated congenital ventricular diverticulum is still undefined. In this review, our aim is to outline a systematic approach to a fetus detected with ventricular outpouching. Starting with prevalence and its types, issues in fetal management, natural course and evolution postbirth, and finally the perpetual dilemma of serial observation or surgical correction is discussed.     

A case of congenital left ventricular diverticulum in an adult patient

Congenital left ventricular diverticulum (CL.koVD) refers to a localized cystic protrusion of the ventricular wall that interacts with the heart cavities through a narrow channel and is a rare heart malformation. In recent years, many cases of this disease involving infants and children have been reported, while few cases involving adults have been described. The case of an adult with CLVD who underwent successful surgery was retrospectively evaluated. The echocardiography examination indicated that the apical myocardium of the left ventricle was thin and bulging outward and that the contractile movement was significantly reduced. During the surgery, it was observed that the left ventricle was enlarged, and a left ventricular diverticulum structure was observed on the left side of the apex. A bovine pericardial patch of the corresponding size was used to continuously suture and repair the internal orifice of the diverticulum. The postoperative pathology revealed that the resected sample was composed of full myocardial tissue. This report focused on the imaging characteristics of left ventricular diverticula to improve the understanding of CLVD. With its simple, economical, and noninvasive characteristics, echocardiography presents the best option for diagnosing a ventricular diverticulum.     

Isolated congenital left ventricular diverticulum in adults.

Isolated congenital ventricular diverticulum or aneurysm is rare and usually arises from the left ventricle. The presentation of this condition is diverse. We report three cases of isolated congenital left ventricular diverticula. The age range was 17-30 years. Chest X-ray provided the earliest clinical suspicion in these three cases of a cardiac anomaly which was diagnosed by echocardiography and confirmed by angiocardiography. The location of the congenital left ventricular diverticulum was the left ventricular apex in two cases and basal in the other. We conclude that congenital left ventricular diverticulum is a disease of protean presentations. A high index of suspicion is necessary while interpreting chest X-rays and echocardiographs to diagnose congenital left ventricular diverticulum. A contractile accessory chamber of the left ventricle with a narrow neck with or without midline defects and an electrocardiogram without Q waves is consistent with the diagnosis of congenital left ventricular diverticulum.     

左心室憩室1例及文献复习

左心室憩室是一种在成人较为罕见的心脏畸形。本文报道了一例36岁左心室憩室患者,超声心动图提示左室侧壁及后侧壁自瓣环水平至心尖部可见一附加腔隙,与左室较大沟通,伴有收缩活动减弱。患者于我院行心憩室切除及左室成形术。通过文献整理复习,本文进一步总结超声心动图在诊断心脏憩室中的意义,并讨论心脏憩室的手术治疗方式。     

Peripheral arterial embolism due to a left ventricular diverticulum in a young adult

A 32-year-old man was admitted to the emergency department of our hospital after experiencing a peripheral arterial embolism. Investigation of the possible embolic sources in an otherwise asymptomatic patient revealed the existence of a left ventricular diverticulum. The left ventricular diverticulum is a rare congenital anomaly, either isolated or as a part of a syndrome including other congenital malformations. The treatment of choice, especially in symptomatic patients, is surgical resection, while in asymptomatic patients anticoagulation therapy is indicated.     

Congenital diverticulum of the right ventricle associated with coarctation of aorta, atrial and ventricular septal defect and ductus.

Congenital right ventricular muscular diverticula are extremely rare and are usually associated with other congenital cardiac anomalies, (in half of the cases tetralogy of Fallot). They functionally behave like an accessory ventricular chamber which contracts synchronously with the normal ventricles.Less than 30 patients with a right ventricular diverticulum have been reported in literature. An apical right ventricular diverticulum occurs in patients with thoraco-abdominal midline defects or abnormalities of the cardiac position([1]). However, an antero-superior diverticulum is usually associated with other congenital cardiac defects, such as a ventricular septal defect, tetralogy of Fallot, double outlet right ventricle and pulmonary stenosis([2--9]).We report an 11-year-old boy with an antero-superior diverticulum of the right ventricle associated with a coarctation of aorta, ductus arteriosus, and atrial and ventricular septum defects. To the best of our knowledge, such an association has not been reported before.     

成人孤立性左心室肌型憩室的多普勒超声心动图特点

目的：探讨多普勒超声心动图对诊断左心室肌型憩室的意义。　　方法：对２ 例经左心室造影和（或）心脏核磁共振成像（ＭＲＩ）和超高速计算机断层摄影术（ＵＦＣＴ）诊断为先天性孤立性左心室肌型憩室患者,行多普勒超声心动图检查对比。　　结果：多普勒超声心动图发现左心室壁局限性瘤样膨出,其颈部明显小于扩张的瘤体和左心室腔,瘤颈处室壁异常突出,酷似心脏破裂的室壁残端,其改变与ＭＲＩ或ＵＦＣＴ相符。但是多普勒于瘤颈处可探及收缩晚期出和舒张期入瘤体的血流频谱,说明瘤体有主动收缩和舒张功能,非室壁破裂所致,从而构成了左心室肌型憩室的特征性改变。　　结论：左心室肌型憩室的多普勒超声心动图所见与心脏ＭＲＩ和ＵＦＣＴ影像结果一致。而多普勒技术对显示血流频谱特征性改变上有其诊断价值。