Ⅰ型永存动脉干手术矫治一例

１　临床资料患儿,男,９岁,体重２０ｋｇ。生后４个月发现心脏杂音,幼年时常有肺部感染史,活动耐力较同龄儿童低。血压１６／６ｋＰａ,股动脉枪击音和甲床毛细血管搏动均阳性,胸骨左缘第３、４、５肋间有２／６级收缩期杂音和舒张期叹息样杂音。胸部Ｘ线平片：双肺血增多,左、右心室增大。超声心动图：室缺直径２－５ｃｍ,动脉干骑跨在室缺上,骑跨程度为４０％。动脉干内径３－８ｃｍ,升主动脉内径３－５ｃｍ。动脉干瓣叶为４个,瓣口有舒张期反流信号。动脉干根部可见有分支血管,内径１－６ｃｍ,沿其走行探测到两个分支分别为…     

多排螺旋CT心电门控技术对肺静脉口径的研究

目的 利用多排螺旋CT(MDCT)心电门控技术评价1个心动周期内肺静脉口径的变化.方法 前瞻性收集25例利用回顾性心电门控技术进行扫描的检查者,进行10个时相的肺静脉重建.首先在横断位同一层面上测量出右下肺静脉(RIPV)各个时相的口径,得出其最大值及最小值所对应的2个时相,然后在这2个时相下运用多种后处理技术重建4条肺静脉,最后分别测量其口径最大值与最小值并进行统计学分析.结果 横断面上右下肺静脉最大值出现在35%时相(16.21±2.53),最小值出现在85%时相(13.29±2.11);4条肺静脉口径在35%时相的最大值与85%时相最小值比较具有统计学意义(P<0.01).结论 MDCT心电门控技术可以更准确描述肺静脉口径,在1个心动周期内肺静脉口径呈现周期性变化.     

超声检查胎儿肺动脉瓣缺如的临床分析

目的探讨产前超声诊断胎儿肺动脉瓣缺如的临床价值。方法回顾性分析8例经引产后尸检证实的肺动脉瓣缺如胎儿的声像图资料及尸检结果,总结其声像图特征及病理改变。结果 8例胎儿右室流出道切面均显示主肺动脉扩张与肺动脉瓣环狭窄,呈"沙漏状"征象,无肺动脉瓣叶回声及启闭活动,其中5例主肺动脉及左、右肺动脉呈瘤样扩张;彩色多普勒均显示肺动脉瓣口往返的五彩镶嵌血流信号,频谱多普勒显示肺动脉瓣口全收缩期湍流和全舒张期反流频谱。8例肺动脉瓣缺如胎儿中3例伴发法洛四联症,2例伴发三尖瓣闭锁、右心发育不良,伴发右室双出口、三尖瓣下移畸形各1例,1例为孤立性肺动脉瓣缺如。伴发法洛四联症及右室双出口的4例胎儿均显示室间隔缺损、动脉导管缺如,另4例胎儿室间隔完整并显示动脉导管。结论产前超声诊断胎儿肺动脉瓣缺如具有重要临床价值,应注意其合并症的诊断。     

64层螺旋CT冠状静脉系统心动周期不同时相形态学对比研究

目的 探讨64层螺旋CT冠状动脉成像的同时评价心动周期不同时相冠状静脉系统的可行性.方法 筛选行冠状动脉CTA检查无冠状动脉病变、心电图及超声心动图检查均正常的患者40例,分别于收缩期和舒张期进行二维、三维图像重建,观察冠状窦(CS)及其属支的显示情况,采用3D法测量主要属支汇入处的夹角,运用CORO SINUS血管分析软件测量CS及其属支的形态学参数,并计算变化率.结果 CS及其属支在收缩期和舒张期均获得较高质量图像.收缩期与舒张期相比,各属支与CS-GCV心房侧的夹角大小无明显变化.除CS长度外,CS及其属支各项测量值收缩期均大于舒张期.结论 64层螺旋CT可用于评价心动周期不同时相CS及其属支的变化规律,为临床工作及CS血流动力学的MSCT研究提供有用参考.     

320排冠脉CTA对动脉间型右冠状动脉起自左冠窦的评价

目的探讨320排冠脉CTA评价动脉间型右冠状动脉起自左冠窦的价值。方法 320排冠脉CTA检查中发现右冠状动脉起自左冠窦且右冠状动脉近段走行于升主动脉与肺动脉之间(动脉间型)8例患者纳入本组,同时分析8例右冠状动脉起始正常的冠脉CTA资料作为对照组。运用MPR、MIP以及VR等技术显示右冠状动脉的起源、开口和走行。利用测量工具评价收缩期和舒张期右冠状动脉近段管径的变化以及升主动脉右前壁与右冠状动脉近段之间的夹角,计算收缩期狭窄率。采用独立样本t检验比较2组间患者年龄、射线剂量、右冠状动脉近段管径在收缩期和舒张期的变化以及升主动脉与右冠状动脉之间夹角的差异。结果 8例动脉间型右冠状动脉起自左冠窦通过VR和薄层MIP重组均可以确诊,VR重组显示该变异最为直观。两组患者年龄和射线剂量差异无统计学意义。患者组右冠状动脉近段收缩期管径为(2.1±0.3)mm,舒张期为(2.6±0.7)mm,升主动脉与右冠状动脉之间夹角为(18.4°±1.4°),较对照组[收缩期(4.7±0.7)mm,舒张期(4.9±0.6)mm,夹角(60.7°±9.4°)]均明显缩小,差异有统计学意义(P0.05)。结论320排冠脉CTA能清楚显示右冠状动脉的异常起源和走行,动态评价近段血管在心动周期内的变化,为查明心肌缺血原因提供线索。     

部分房室通道合并双孔二尖瓣一例报告

１　临床资料男孩，９岁。自幼发现心脏杂音，术前有心慌、气短，活动能力较同龄人低。胸左缘第二、三肋间和心尖部均有３～４／６级收缩期杂音，肺动脉瓣第二音亢进。胸部Ｘ线平片：心胸比值０．６４，肺血多，肺动脉段球样外凸，左、右心室和右房扩大。心电图：电轴－５６°，Ⅰ度房室传导阻滞，左前分支阻滞。超声心动图：房间隔中下部回声中断，二尖瓣前叶中部回声中断，收缩期有花色血流经此反入左房。术前诊断：先心病，部分房室通道，肺动脉高压。１９９６年１２月２５日，在体外循环下行部分房室通道修复术。术中见心脏普遍扩大，右…     

不全性Kartagener综合征伴肺动脉瘤样扩张1例

患者男,51岁,发热、咳嗽、咳痰1周入院.患者轻度智障,其兄右位心,既往易感冒,有反复慢性咳嗽、咳痰、鼻塞、流涕等症状.查体:心脏各瓣膜区可闻及收缩期杂音,以心尖部为著. 胸片示心影增大,右位心,右心缘见弧形膨隆影.CT及MRI显示内脏镜像转位,右位心,主肺动脉位于右侧,腹主动脉位于脊柱左侧,肝脏位于左侧膈下,肠系膜上静脉汇入下腔静脉;右肺下叶支气管扩张,右肺见片状影.主肺动脉明显瘤样扩张,最大直径104 mm.MRI示二尖瓣收缩期返流,肺动脉瓣及主动脉瓣有不同程度的舒张期返流.临床诊断:不完全性Kartagener综合征.     

经导管堵闭术中动脉导管形态变化的临床意义

目的：研究经导管堵闭术中动脉导管(PDA)形态变化规律，探讨最佳测量方法，为术中Amplatzer堵闭器(ADO)的选择提供客观依据。方法：22例PDA患者，堵闭术前侧位主动脉弓降部造影，测量收缩期、舒张期PDA最窄径，应用ADO成功行介入治疗；堵闭术后造影复测收缩期、舒张期时ADO腰部最窄径，并与术前造影及心脏超声测量值做对比分析。结果：堵闭术前造影显示PDA最窄径随心动周期的时相不同而变化，收缩期测量可以得到最大的PDA最窄径；而堵闭术后测量显示收缩期、舒张期ADO腰部直径无明显变化，相关性分析表明术前心脏超声胸骨上窝测量PDA准确性优于胸骨旁大动脉短轴。结论：PDA形态随心动周期的时相不同而变化，收缩期测量可以得到最大的PDA最窄径，选择体部直径比收缩期PDA最窄径大2-4mm的ADO，可以取得理想疗效。     

超声二维应变技术评价肝硬化患者右室纵向收缩功能

目的：应用超声二维应变技术评价肝硬化患者右室纵向收缩功能。方法：选取34例肝硬化患者作为实验组,35例健康志愿者作为对照组。常规超声心动图心尖四腔切面记录右室舒张末期横径,右房收缩期横径。记录心尖四腔切面的三个完整心动周期的高帧频二维图像,应用二维应变分析软件测量右室游离壁三个节段收缩期的峰值应变（ε）,应变率（SRs）及速度（Vs）。测量右室游离壁舒张早期峰值应变率（SRe）和速度（Ve）,右房收缩期峰值应变率（Sra）和速度（Va）。结果：肝硬化组右房收缩期横径较对照组增大,差异具有统计学意义（P〈0.05）。肝硬化组右室游离壁三个节段的收缩期峰值应变及应变率、舒张早期峰值应变率及右房收缩期峰值应变率较对照组明显减低（P〈0.05）,肝硬化组右室基底段及中间段收缩期峰值及舒张早期峰值速度较对照组减低,差异具有统计学意义（P〈0.005）,右室心尖段收缩期峰值速度、舒张早期峰值速度及右房收缩期峰值速度较对照组减低,差异不具有统计学意义（P〉0.05）。结论：超声二维应变技术可以快速准确地评价肝硬化患者右心功能,提示临床医生诊断和治疗肝硬化性心肌病以改善肝硬化患者预后。     

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     

基于肺部血流MRI信号在心动周期内变化的灌注成像技术研究

目的探讨血流变化对肺部MRI信号的影响，并研究1种新的MR肺血流灌注成像方法。方法对健康志愿者15例，采用相位对比电影MRI技术测量大肺动脉血流速度和流量在心动周期内的变化；并选用单次激发半傅立叶变换超快速自旋回波序列观察肺实质MR信号的相应改变，评价其相关性；根据不同心动期相肺实质MR信号的差异进行图像减影。结果肺实质．MRI信号表现为心脏收缩期降低，舒张期升高。大肺动脉的瞬时速度、瞬时流量与其呈负相关(r=-0．878、-0．770，P=0，002、0．015)。经肺部MRI信号差异最大的舒张末期和收缩中期的MRI减影可获得肺灌注像。结论肺实质MRI信号的改变与肺血流模式和速度有关。该技术是1种简便易行的非对比剂性的MR肺灌注评价新方法。     

Variation of the size of pulmonary venous ostia during the cardiac cycle: optimal reconstruction window at ECG-gated multi-detector row CT

The aim of this study was to investigate the variation of the size of pulmonary vein ostia during cardiac cycle using ECG-gated multi-detector row CT (MDCT). Nineteen patients were included in this study. Transaxial images at the level of right inferior pulmonary vein (RIPV) were reconstructed in increments of 5%. The ostial diameter of RIPV was measured, the reconstruction windows showing maximal and minimal diameters were selected. The ostial areas of four pulmonary veins were measured at axial image sets of two selected reconstruction windows. The measurement of RIPV revealed that the maximal diameter (1.50±0.32 cm) was generally 35% and the minimal diameter (1.28±0.28 cm) was usually at 85%. The measurement of ostial areas showed that the ostia enlarged at the end of ventricular systole when compared with those at the end of ventricular diastole, by the factors of 1.44±0.55 for the right superior, 1.25±0.23 for the right inferior, 1.45±0.81 for the left superior, and 1.31±0.26 for the left inferior pulmonary vein (P<0.05). The size of the pulmonary vein ostia is variable during the cardiac cycle and the measurement of the pulmonary veins should always be in the same phase of the cardiac cycle during the follow-up of patients.     

Imaging of post-traumatic cardiac rhabdomyolysis with normal coronary arteries

Numerous cases of acute myocardial infarction (AMI) have been reported in the literature following closed chest injuries, due to post-traumatic dissection or thrombosis of a coronary artery. In the follow-up of AMI, wall thickness during diastole and systole provides important information on heart viability. Multidetector computed tomography (MDCT) is currently the only noninvasive instrumental investigation which provides an appreciable assessment of the coronary arteries, as well as heart wall thickness measurements. We describe and discuss the clinical and imaging findings, especially of MDCT, in a case of post-traumatic regional myocardial necrosis with normal coronary arteries.     

Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.     

Coronary MR angiography during peak-systole: Work in Progress

The purpose of this study is to compare the quality of images of coronary arteries obtained with two-dimensional breath-hold coronary MR angiography during peak systole and mid diastole. Two-dimensional coronary MR angiography was performed in eight normal volunteers at peak systole and in mid diastole with a commercial 1.5-T MR imager. An ultrafast gradient-echo sequence with incremented flip angle series and k-space segmentation was used. The image quality grade, length, and proximal diameter of each visualized coronary artery were measured. The highest quality images in systole and diastole were compared. Coronary MR angiography provided high quality images in systole and diastole in 14 of 16 coronary vessels (87.5%). In 8 of 14 vessels (57%), there was no visible coronary MR angiogram image degradation when comparing peak systolic with mid-diastolic images. In 4 of 14 vessels (29%), there was mild MR image degradation. There was significant MR image degradation in only one case (7%). And in one case (7%), there was mild image improvement during systole. The width and length of the visualized coronary vessels did not change significantly from diastole to systole. Existing two-dimensional breath-hold coronary MR angiography provides MR images during peak systole and mid-diastole with little or no perceptible difference in quality.     

CT-determined pulmonary artery diameters in predicting pulmonary hypertension

This study was to determine if the diameters of pulmonary arteries measured from computed tomographic (CT) scans could be used 1) as indicators of pulmonary artery hypertension and 2) as a reliable base for calculating mean pulmonary artery pressure. The diameters of the main, left, proximal right, distal right, interlobar, and left descending pulmonary arteries were measured from CT scans in 32 patients with cardiopulmonary disease and in 26 age- and sex-matched control subjects. Diameters were measured using a special computer program that could display a CT density profile of the artery and its adjacent tissues. The upper limit of normal diameter for the main pulmonary artery was found to be 28.6 mm (mean + 2 SD). In the patient group, the diameters were correlated with data from cardiac catheterization. In these patients, a diameter of the main pulmonary artery above 28.6 mm readily predicted the presence of pulmonary hypertension. The calculated cross-sectional areas of the main and interlobar pulmonary arteries (normalized for body surface area [BAS]) were found to give the best estimates of mean pulmonary artery pressure (r = 0.89, P less than 0.001 and r = 0.66, P less than 0.001). Multiple regression analysis gave the useful equation: mean pulmonary artery pressure = -10.92 + 0.07646 X area of main pulmonary artery/BSA + 0.08084 X area of the right interlobar pulmonary artery/BSA (r = 0.93, P less than 0.0001). Because CT allows precise, noninvasive measurement of the diameter of pulmonary arteries, it can be of value in detecting pulmonary hypertension and estimating mean pulmonary artery pressure.     

Central thrombi in pulmonary arterial hypertension detected by MR imaging

Differentiation of thrombi from slow flow in the pulmonary arteries, sometimes observed in the presence of pulmonary arterial hypertension, can be equivocal. Magnetic resonance (MR) imaging was performed in a patient with chronic pulmonary thromboembolism and pulmonary arterial hypertension using an electrocardiographically gated technique that allowed visualization of the pulmonary arteries at the end of diastole and multiple times during systole. These images were compared with those of a patient with primary pulmonary hypertension and those of healthy subjects. Thrombi were discrete structures, seen throughout the cardiac cycle on both the first and second spin-echo images, and decreased in signal intensity on the second image. Slow flow increased in signal intensity and changed in structure during the cardiac cycle and was seen best on the second image. MR may play an important role in excluding large central thrombi as the cause of pulmonary arterial hypertension. It is a noninvasive method for defining pulmonary arterial wall thickness and for direct visualization of chronic pulmonary thrombus.     

The normal diameter of the fetal aorta and pulmonary artery: echocardiographic evaluation in utero

Measurements of the fetal aorta and pulmonary artery can aid in the detection and diagnosis of congenital heart defects. In a prospective study of 403 normal fetuses whose gestational ages were between 14 and 42 weeks, two-dimensional (2D) real-time and M-mode echocardiography were used to measure the diameters of the aortic root and the pulmonary artery in utero. The goals were to establish norms for the diameters of these structures as a function of both gestational age and biparietal diameter, to compare measurements obtained in systole and diastole, and to compare 2D and M-mode measurements. A high correlation was found between measurements made during systole and diastole (r = .994 for aorta, r = .996 for pulmonary artery) and between 2D and M-mode measurements for each vessel (r = .992 for aorta, r = .973 for pulmonary artery). The differences between systolic and diastolic measurements and between M-mode and 2D measurements were small (2.2-4.6%) for both the aorta and the pulmonary artery. The norms established here provide an objective standard for comparison when a cardiac anomaly involving a fetal aorta or pulmonary artery of abnormal size is suspected. The results indicate that a sonographic facility need not have M-mode equipment to obtain technically adequate measurements.     

双时相3D SSFP 成像技术在先天性心脏病诊断中的应用初探

目的：探讨双时相三维稳态进动快速成像序列（3DSSFP）对先天心脏病的诊断价值。方法：60例平均心率108次／分的先天性心脏病患儿行收缩末期和舒张中晚期的双时相3D SSFP成像,对图像质量及对比噪声比进行分析比较。结果：心电触发收缩期延迟时间为180～300ms,平均（235．41士35．59）ms;舒张期延迟时间为384～550ms,平均（443．77土50．81）ms。3DSSFP收缩期图像上显示心内结构及肺静脉、上下腔静脉的清晰度优于舒张期,两者间图像质量的差异有统计学意义（P〈o．05）。舒张期图像上对无狭窄主动脉及肺动脉的显示清晰度高于收缩期,但两者间差异无统计学意义（P〉o．05）。收缩期图像上心内结构的对比噪声比（CNR）均高于舒张期,且两者比较差异有统计学意义（P〈0．05）。上腔静脉及下腔静脉在收缩期图像上的CNR均高于舒张期,但仅下腔静脉CNR的差异有统计学意义（P〈0．05）;主动脉和肺总动脉则在舒张期图像上的CNR高于收缩期,但两者比较差异无统计学意义（P〉0．05）。伴有肺动脉辫及辫下狭窄的肺动脉分支在收缩期的显示率（39．1％）明显低于舒张期（73．9％）。结论：双时相3DSSFP综合利用收缩期和舒张期不同时相的成像优势,能更准确地诊断先天性心脏病患儿的心内及心外大血管结构的畸形。     

海拔5200m重体力劳动45天心肺X线改变及对劳动能力的影响

作者对海拔５２００ｍ从事重体力劳动４５天的４８名青年在劳动前后现场摄取Ｘ线胸片。结果：心脏横径、心脏长径、心脏面积、心胸比率较初入高原时显著缩小（Ｐ〈０．０１）；肺动脉干横径、肺动脉段突度、右肺下动脉横径、右肺下动脉与气管横径比值显著增加（Ｐ〈０．０１）；升主动脉和主动脉横径、胸宽和肺面积增加或显著增加（Ｐ〈０．０５或Ｐ〈０．０１）。其中２例诊断为高原性心脏病，３例诊断为高原性肺水肿。在海拔５２０