三维超声心动图定量左室局部射血分数对诊断室壁瘤的价值:与左室X-线造影的对照研究

目的探讨三维超声心动图定量分析左室节段收缩功能对心肌梗死后室壁瘤形成的诊断价值。方法38例心肌梗死患者分别进行了常规心电图检查、二维超声心动图检查、三维超声心动图检查及多投照体位左室造影检查，三维超声心动图定量分析左室节段收缩功能以左室节段射血分数为负值定义为局部室壁瘤形成，以左室造影为标准，计算3种方法诊断室壁瘤的敏感性和特异性。结果以左室造影为标准，常规心电图检查、二维超声心动图检查、三维超声心动图定量左室节段收缩功能分析诊断室壁瘤的特异性和敏感性分别为75％和92．3％，81．2％和92．8％，100％和94．1％。结论采用实时（动态）三维超声心动图定量分析左室节段射血分数能更准确地诊断心肌梗死后室壁瘤，其敏感性和特异性均显著高于二维超声心动图。     

左心室超声造影诊断左室心肌致密化不全的应用价值

目的 探讨左室超声造影在诊断左室心肌致密化不全中的应用价值.方法 对10例经胸超声心动图初步诊断和疑似的心肌致密化不全患者进行左室超声造影检查,进一步观察左室内过度增生的肌小梁的范围、心内膜连续性、致密心肌厚度及造影剂在小梁隐窝内充盈情况.结果 左室超声造影可更加清晰地观察到非致密心肌的范围,造影剂在小梁间隙和隐窝内充盈,超声造影对致密心肌厚度的测量更为精确、客观.结论 左室超声造影可用于诊断左室心肌致密化不全,是对常规经胸超声心动图的良好补充.

Abstract：

Objective To assess the usefulness of left ventricular contrast echocardiography in diagnosis of left ventricular myocardium noncompaction.Methods Contrast echocardiography was done in ten patients who were diagnosed or suspected with left ventricular noncompaction by common transthoracic echocardiography,for further study of the trabecular muscles extent,the continuity of the endocardium,the compact myocardium thickness,and the contrast agent in the trabecula recessus.Results By contrast echocardiography,noncompaction myocardium thickness can be perspicuously observed,the turgor of the contrast agent was vividly detected in the trabecular recessus.Especially for the measurement of compaction myocardium,the contrast echocardiography was more accurate than in the condition of the common echocardiography.Conclusions Left ventricular contrast echocardiography can be used in the diagnosis of left ventricular noncompaction,it was a good added method of conventional echocardiography.     

左心室超声造影诊断左室心肌致密化不全的应用价值

目的 探讨左室超声造影在诊断左室心肌致密化不全中的应用价值.方法 对10例经胸超声心动图初步诊断和疑似的心肌致密化不全患者进行左室超声造影检查,进一步观察左室内过度增生的肌小梁的范围、心内膜连续性、致密心肌厚度及造影剂在小梁隐窝内充盈情况.结果 左室超声造影可更加清晰地观察到非致密心肌的范围,造影剂在小梁间隙和隐窝内充盈,超声造影对致密心肌厚度的测量更为精确、客观.结论 左室超声造影可用于诊断左室心肌致密化不全,是对常规经胸超声心动图的良好补充.     

Usefulness of free-angle M-mode echocardiography in assessing left ventricular dimension and left ventricular systolic function

Objectives To assess the usefulness of free-angle M-mode echocardiography in measuring left ventricular (LV) dimension and global systolic function. Background The validity of conventional M-mode echocardiography in assessing LV dimension and global systolic function is well known; the incidental angle between the M-mode cursor and true LV minor axis diameter, however is a potential cause of measurement error. Free-angle M-mode echocardiography may overcome the limitation of M-mode cursor arrangement in conventional M-mode echocardiography. Methods Thirteen normal volunteers and 10 patients in whom abnormal left ventricular wall motion was not detected by echocardiography (mean age, 53±17 years) were enrolled in this study. Conventional and free-angle M-mode echocardiographic images of the LV were obtained by echocardiography (ALOKA SSD-5500) using a 2.5-MHz transducer, and the LV end-diastolic (LVDd) and end-systolic (LVDs) dimensions were measured by the leading edge method. LV end-diastolic and end-systolic volumes were calculated using a formula by Teichholz, and the LV ejection fraction (LVEF) was obtained. Data from conventional M-mode echocardiography and free-angle M-mode echocardiography were then compared. Results Measurements obtained with conventional M-mode and free-angle M-mode echocaardiography were strongly correlated. Correlation coefficients for LVDd, LVDs, and LVEF were 0.98, 0.98, and 0.96, respectively (p<0.001 in each case). Conclusions Assessment of left ventricular dimension, and global systolic function with free-angle M-mode can be as accurate as conventional M-mode in subjects in whom left ventricular wall motion abnormality is not detectable by echocardiogram. Moreover, when there is improper M-mode cursor direction in conventional echocardiography, free-angle M-mode echocardiography can assess global left ventricular systolic function more accurately and conveniently than conventional M-mode echocardiography.     

左室心肌质量三维超声心动图与MRI测值的对比研究

目的　以磁共振显像技术为对照标准 ,探讨动态三维超声技术测量左室心肌质量的准确性。方法　 33例患者分别应用经胸 M-型、二维、三维超声心动图检查和磁共振检查测定左室心肌质量。结果　以磁共振测量的心肌质量为标准 ,M-型、二维和三维超声心动图测定的心肌质量与 MRI法测值的相关系数分别为0 .90、 0 .91和 0 .98(P均 <0 .0 5 ) ;配对 t检验表明 ,M-型超声法测定值明显高于 MRI心肌质量测定值 [(2 0 8.91± 6 4 .18) g vs(182 .97± 5 5 .0 8) g,SEE=12 .2 6 g,P<0 .0 5 ],而二维超声面积 -长度法 [(181.0 2± 5 9.6 7) g]和三维超声心动图法心肌质量测定值 [(181.83± 5 5 .4 7) g]与 MRI法测定值之间则无显著性差异 (P均 >0 .0 5 ) ,SEE分别为 8.91g、 4 .2 2 g。结论　以磁共振显像为对照标准 ,三维超声测量心肌质量的准确性显著高于 M-型超声和二维超声心动图技术     

Assessment of left ventricular function by real-time 3-dimensional echocardiography compared with conventional noninvasive methods.

Quantitative assessment of left ventricular ejection fraction is an essential component of cardiac evaluation. We performed real-time 3-dimensional echocardiography in 56 consecutive patients who underwent multigated radionuclide angiography. Thirteen patients were excluded for the following reasons: 5 for large size of left ventricle required for image acquisition, 5 for suboptimal image quality in real-time 3-dimensional echocardiography, and 3 for atrial fibrillation. Finally, we compared left ventricular ejection fraction assessed by real-time 3-dimensional echocardiography and conventional 2-dimensional echocardiography with that obtained by multigated radionuclide angiography in 43 patients. Left ventricular ejection fraction was determined by real-time 3-dimensional echocardiography with the use of parallel plane-disks and sector plane-disks summation methods. A good correlation was obtained between both real-time 3-dimensional echocardiography methods and multigated radionuclide angiography (r = 0.87 and 0.90, standard error of estimate = 3.7% and 4.2%), whereas the relation between the 2-dimensional echocardiography method and radionuclide angiography demonstrated a significant departure from the line of identity (P <.001). In addition, interobserver variability was significantly lower (P <.05) for the real-time 3-dimensional echocardiography methods than that by the 2-dimensional echocardiography method. Real-time 3-dimensional echocardiography may be used for quantification of left ventricular function as an alternative to conventional methods in patients with adequate image quality.     

超声实时三平面法左心声学造影的临床应用研究

目的探讨超声实时三平面法左心声学造影临床应用的可行性。方法在20例患者中,经外周静脉弹丸式注射造影剂,进行超声实时三平面法左心声学造影,记录三平面法中各个切面中左室显影等级及造影剂空间分布情况,观察各个节段心肌显影效果。结果20例患者左室显影等级均为3级,造影剂空间分布均匀,心内膜边界显示清晰;所有患者左室壁心肌均获得了满意的显影效果。结论临床应用超声实时三平面法进行左心声学造影,能从多个切面和角度同时观察心腔和心肌造影的效果。     

心脏超声造影评价恶性肿瘤化疗患者左心室射血分数与左心室容积

目的比较心脏超声造影与常规超声心动图测量恶性肿瘤化疗患者左心室射血分数（LVEF）与左心室容积的可重复性,探讨心脏超声造影评估恶性肿瘤化疗患者左心功能的价值。 方法选择2016年7至12月华中科技大学同济医学院附属同济医院119例接受了常规超声心动图检查的恶性肿瘤化疗患者。其中图像清晰者42例,图像欠佳者77例。采集所有患者的胸骨旁左心室长轴、心尖四腔、二腔、左心长轴观以及三维动态图像,对于图像欠佳组患者还需采集心脏超声造影状态下的胸骨旁左心室长轴、心尖四腔、二腔、左心长轴观以及三维动态图像。两位资历相当的检查者分别运用EchoPac工作站测得所有患者不同测量方法的LVEF与左心室容积。 结果图像清晰组双平面Simpson法与三维全容积法测量的LVEF差异有统计学意义（t=4.224,P<0.01）,而左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）差异均无统计学意义;但图像欠佳组双平面Simpson法与三维全容积法测量的LVEF、LVEDV差异均有统计学意义（t=8.650、6.207,P<0.01）,而LVESV差异无统计学意义。对于图像清晰组,无论采用双平面Simpson法还是三维全容积法,2位检查者间测量的LVEF、LVEDV、LVESV差异均无统计学意义。而对于图像欠佳组,无论采用双平面Simpson法还是三维全容积法,2位检查者间测量的LVEF、LVEDV差异均有统计学意义（t=4.286、3.645、3.308、4.189,P<0.01）,而LVESV差异均无统计学意义;行心脏超声造影后,对于图像欠佳组,无论采用双平面Simpson法还是三维全容积法,2位检查者间测量的LVEF、LVEDV、LVESV差异均无统计学意义。组内相关系数（ICC）显示,图像清晰组、图像欠佳组造影前后双平面Simpson法、三维全容积法测量LVESV的可重复性均较好（ICC=0.901、0.858、0.935、0.920、0.884、0.952）。图像清晰组双平面Simpson法、三维全容积法测量LVEF、LVEDV的可重复性均较好（ICC=0.946、0.895、0.776、0.815）。对于图像欠佳组,双平面Simpson法测量LVEF的可重复性较差（ICC=0.625）,但行心脏超声造影后有明显提高（ICC=0.858）;双平面Simpson法、三维全容积法测量LVEDV的可重复性均较差（ICC=0.630、0.712）,但行心脏超声造影后均有明显改善（ICC=0.863、0.914）。 结论心脏超声造影能明显改善图像显示欠佳的化疗患者LVEF与左心室容积测量的可重复性。     

17例永存左上腔静脉畸形的超声检查与手术对比分析

对１７例经手术证实的先心病合并永存左上腔静脉畸形（ＬＳＶＣ）的患者进行回顾性对比分析，研究超声心动图诊断ＬＳＶＣ的敏感性并探讨提高其检出率的方法。发现在１７例已证实合并ＬＳＶＣ的多种先心病患者中，术前经胸超声心动图检出ＬＳＶＣ１２例，占７１％，胸骨上窝探查有特异表现。后回顾复习患者资料，作者认为多切面的仔细探查，绝大多数患者可用经胸超声心动图在术前检出，可为外科手术提供更多的信息，以指导手术     

双源CT与超声心动图评价左心室功能指标的相关性研究

目的：探讨双源CT（DSCT）和超声心动图左心室功能评价指标的相关性和一致性。材料与方法：79例患者行DSCT冠状动脉成像和超声心动图心功能检查的病人,其中39例为临床确诊为心肌梗死组（MI）,另40例无急性心肌梗死作对照组,所有病人于1周内进行了超声心动图心功能检查。分析DSCT评价左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）与超声心动图的相关性和一致性。结果：对照组、心肌梗死组病人DSCT与超声心动图在评价LVEF上有较强的相关性（r=0.751,r=0.718,P<0.01）,LVFS测量值两种方法相关度为中等（r=0.543,r=0.606）。结论：DSCT在冠脉成像评价冠脉病变的同时可以定量评价左心室功能。     

时间-空间关联成像联合B-flow在胎儿永存左上腔静脉产前超声诊断中的应用价值

目的探讨时间-空间关联成像(STIC)联合B-flow在胎儿永存左上腔静脉产前超声诊断中的应用价值。方法对产前胎儿常规二维超声心动图可疑或明确心脏畸形的132例胎儿进行B-flow显像及STIC数据采集,观察有无左上腔静脉,并将产前超声诊断结果与产后新生儿超声心动图及引产后胎儿尸体解剖病理检查结果进行对比分析。结果 132例胎儿中120例在B-flow显像模式下STIC数据采集成功,采集成功率为90.9%(120/132);120例STIC数据采集成功的胎儿中,常规二维超声心动图诊断永存左上腔静脉15例(15/20)。B-flow-STIC诊断永存左上腔静脉20例。其中5例伴无名静脉缺如,4例合并心脏严重复杂畸形(2例合并完全性房室间隔缺损,1例合并三尖瓣发育不良,1例合并右心室双出口,1例合并右位主动脉弓,5例合并室间隔缺损),6例为单纯性永存左上腔静脉。B-flow-STIC修正常规二维超声心动图诊断5例;其中2例常规二维超声心动图诊断为房间隔缺损,1例常规二维超声心动图诊断为完全性房室间隔缺损,1例常规二维超声心动图诊断为心内型肺静脉异位引流,均经B-flow-STIC修正诊断为永存左上腔静脉;1例常规二维超声心动图漏诊,B-flow-STIC诊断为永存左上腔静脉引流至左心房。结论 STIC联合B-flow可清晰显示胎儿永存左上腔静脉及其空间位置关系,有利于提高永存左上腔静脉产前超声诊断准确性。     

实时三维超声心动图评价儿童川崎病左心室收缩不同步性的应用研究

目的 探讨实时三维超声心动图对儿童川崎病左心室不同步性的应用价值研究.方法 收集了新华医院川崎病患者38 例,健康志愿者18 例.(1)分析所有患者的二维经胸超声心动图Simpson 法所测射血分数(EF)值.(2)经Q-lab软件分析所有患者的实时三维超声心动图并计算16 节段和12 节段的标准差及最大时间差的绝对值及占平均心动周期的百分比,并与正常组对比.结果 (1)川崎病患者Simpson 法所测EF 值与正常组相比明显降低,左心室整体收缩功能受损.(2)川崎病组16 节段的标准差及最大时间差的绝对值及占平均心动周期的百分比与正常对照组相比升高,但组间差异无统计学意义(P ＞0.05);12 节段组的标准差及最大时间差的绝对值及占平均心动周期的百分比与正常对照组相比,组间差异有统计学意义(P ＜0.05).二维Simpson 法所测左心室EF 与三维测量值呈中等程度相关.结论 实时三维超声心动图测定的16 和12 节段的标准差及最大时间差的绝对值可作为评价左心室心肌收缩不同步性的有效指标.二维超声心动图和实时三维超声心动图两种方法所测EF 值一致性较好.     

Spontaneous left atrial echocardiographic contrast in mitral stenosis: early disappearance after valve replacement.

We describe a patient with mitral stenosis and severely enlarged left atrium. Transthoracic echocardiography showed a false image of intraatrial thrombus, whereas transesophageal echocardiography showed massive spontaneous left atrial contrast. Intraoperative transesophageal echocardiography was performed. During cardioplegic arrest the contrast was enhanced, but it gradually and completely cleared 15 minutes after cardiopulmonary by-pass arrest. Transesophageal echocardiography is a useful technique for the study of intraatrial masses and may bring a new dimension to tissue characterization studies.     

Transesophageal echocardiography: detection of an acquired left ventricular-right atrial shunt

Communication between the left ventricle and right atrium has a reported prevalence of less than 1%. Acquired left ventricular--right atrial shunt is caused by chest trauma or valvular surgery. A case of acquired left ventricular--right atrial shunt after aortic valve surgery is reported. The detection was possible by use of echo-Doppler, color flow imaging, and transesophageal echocardiography. Combined use of these modalities and multiple transducer positions when transthoracic echocardiography is used are recommended to make the diagnosis.     

实时三平面超声心动图评价冠心病室壁瘤患者左心室功能

目的 探讨实时三平面超声心动图检测冠心病室壁瘤患者左心室容积及功能的可行性及准确性.方法 对25例冠心病室壁瘤患者,应用实时三平面超声心动图及二维超声心动图测量左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、每搏量(SV)及左心室射血分数(LVEF),并将测量结果与左心室造影测量结果进行比较分析.结果 实时三平面超声心动图和左心室造影所测的LVEDV、LVESV、SV、LVEF差异无统计学意义(P＞0.05),两种方法所测的LVEF有良好相关性(r＝0.94,P＜0.01).二维超声心动图检测的LVEDV、LVESV与左心室造影结果之间差异有统计学意义(P＜0.05),两者测量的LVEF差异无统计学意义(P＞0.05),有良好相关性(r＝0.85, P＜0.01). 结论实时三平面超声心动图为定量分析冠心病室壁瘤患者的左心室功能提供了一个无创、简便、准确的新方法.     

Clinical implications of the echocardiographic assessment of left ventricular long axis function

The assessment of the left and right ventricular long axis function by Doppler echocardiography was started many years ago with the use of M-mode. Two-dimensional echocardiography was subsequently used to study the longitudinal function of the left ventricle. The studies of that era led to useful conclusions. However, tissue Doppler imaging, a relatively new echocardiographic technique, recently became the first choice for such an assessment. Moreover, the advances of tissue tracking and strain rate also have an important contribution. New studies were conducted and new data derived for left and right ventricular function in various cardiac diseases. Τhe aim of this review was to present the accumulated knowledge of the Doppler echocardiography study of the left ventricular long axis function and the relevant clinical implications.     

永存左上腔静脉畸形的超声诊断及其临床意义

目的 探讨永存左上腔静脉的超声表现及临床意义。方法 21例患者行常规心脏超声检查及经双上肢双氧水心脏声学造影。结果 二维超声心动图检测，全部患者均见冠状静脉窦扩张，经左上肢静脉注射双氧水后，可见冠状静脉窦内充满微气泡；而经右上肢静脉注射双氧水后，仅于右房及右室内充满微气泡，冠状静脉窦内则无微气泡显示，结论 常规心脏超声检查结合经双上肢行双氧水心脏声学造影可准确诊断永存左上腔静脉，提高此类患者心内直视手术的安全性及心内导管插入的成功率。     

超声心动图在卵圆孔未闭封堵中的应用及卵圆孔未闭分流方向的探讨

目的探讨超声心动图在卵圆孔未闭(PFO)治疗中的应用价值.方法 7例封堵治疗PFO患者,术前经胸(TTE)或经食管超声心动图(TEE)明确PFO诊断,术中TTE和X线引导监护,术后TTE随访;并对157例PFO分流方向进行统计分析.结果 7例PFO封堵患者右向左分流的确诊方法:TTE 1例,TEE 4例,TTE或TEE 右心声学造影各1例.术后TTE随访PFO分流消失.157例TTE诊断的PFO以左向右分流表现为主,少数右向左分流和双向分流者多伴其他心脏结构和功能改变.结论超声心动图在PFO封堵术中具有多方面重要作用.TEE及声学造影诊断PFO右向左分流的敏感性高于单纯TTE.常规TTE检查PFO多表现为左向右分流,而非理论定义的右向左分流.     

Right superior vena cava draining into the left atrium: prenatal diagnosis and postnatal management.

Right superior vena cava (RSVC) draining into the left atrium, causing hypoxemia, represents a very rare congenital malformation which has not previously been described in the fetus. We describe a case in which fetal echocardiography at 22 weeks' gestation revealed an enlarged superior vena cava connecting abnormally with a mildly enlarged left atrium. Neonatal transthoracic echocardiography confirmed the diagnosis and showed an abnormal connection of the right pulmonary veins to the RSVC. Right-to-left shunt due to anomalous drainage of the RSVC into the left atrium associated with an atrial septal defect and anomalous pulmonary venous return were diagnosed on echocardiography and confirmed by angiography. The newborn was hemodynamically stable at birth and at the 1-year follow-up.     

超声心动图在诊断新生儿期永存左上腔静脉中的价值

目的探讨超声心动图对新生儿期永存左上腔静脉的诊断价值。方法我院产前胎儿超声心动图检查时明确诊断或疑为永存左上腔静脉胎儿共11例,出生后再行超声心动图检查,总结永存左上腔静脉的声像图特征。结果 11例胎儿产后均明确诊断为永存左上腔静脉。超声图像表现为永存左上腔静脉全程可显示,位于主动脉弓左侧,由左颈内静脉与左锁骨下静脉交汇形成,呈"Y"形,近心端与冠状静脉窦相连;永存左上腔静脉血流频谱与右侧上腔静脉相一致。结论超声心动图对新生儿期引流入冠状静脉窦到右心房的永存左上腔静脉有较好的诊断价值。