经胸与经食管超声心动图对先天性与获得性主动脉瓣病变诊断的比较

目的比较经胸超声心动图(TTE)与经食管超声心动图(TEE)对先天性与获得性主动脉瓣病变诊断的准确率.方法应用TTE与TEE检查,诊断先天性与获得性主动脉瓣病变及并发症.结果107例患者主动脉瓣听诊区可闻及Ⅱ～Ⅲ级收缩期及舒张期杂音,TTE检查不能明确诊断.而TEE检查均可明确诊断.结论TEE检查可进一步明确诊断先天性与获得性心脏病,有利于临床诊断及治疗.     

二维超声心动图诊断先天性二叶式主动脉瓣畸形

本文报告7例经手术和病理证实的先天性二叶式主动脉瓣畸形的二维及M型超声心动图特征。二维超声正确地诊断了6例,符合率为85.7%,,而M型超声主动脉瓣关闭偏心指数(EI),诊断符合率仅57%。     

超声心动图诊断先天性四叶式主动脉瓣畸形的临床价值

目的：探讨超声心动图诊断先天性四叶式主动脉瓣畸形的价值。方法采用SONOS HP5000、PHILIPSIE33电脑声像仪,探头频率2.5-4.0M Hz。发现主动脉瓣为四叶式后重点大动脉短轴及主动脉长轴切面观察主动脉瓣四叶分布形态、回声、启闭及血流动力学情况。结果9例中四叶式主动脉瓣呈＋字形排列3例,呈＆#215;形排列6例。1例合并主动脉瓣狭窄,9例均有主动脉瓣关闭不全,合并其他先天性心脏病4例。结论超声心动图对先天性四叶式主动脉瓣畸形诊断具有重要的价值,可提供瓣膜的详细情况,明确诊断及选择相应的治疗方案。     

经食管超声心动图对先天性心脏病房间隔缺损定量诊断的临床研究

目的:探讨经食管超声心动图对先天性心脏病房间隔缺损(房缺)定量诊断的准确性.方法:选择经胸与经食管超声心动图检查诊断为先天性心脏病房缺,并经介入或外科手术治疗的患者36例,以术中所见为确诊标准,分析经食管超声心动图定量诊断房缺在判断缺损部位、数目和大小等方面的作用.结果:36例房缺患者中,经胸超声心动图诊断多孔房缺4例,与手术结果比,多孔房缺漏诊3例,单孔房缺32例;经食管超声心动图诊断为多孔房缺7例,与手术结果相比无漏诊,单孔房缺29例.结论:经食管超声心动图较经胸超声心动图在房缺的定量诊断方面更有优越性,在定量诊断缺损大小、部位及其与周围解剖结构的关系方面,经食管超声心动图的准确率更接近介入或手术测值.从而为治疗方案的选择提供更可靠的依据.     

三维经食管超声心动图在二叶式主动脉瓣狭窄经导管主动脉瓣置入术中的应用研究

目的:应用三维经食管超声心动图(3D-TEE)评估二叶式主动脉瓣狭窄(BAS)患者的主动脉瓣环,探讨3D-TEE指导BAS患者行经导管主动脉瓣置入术(TAVI)的可行性。方法:分析我院成功行TAVI的BAS狭窄患者24例,对术前3D-TEE与多层螺旋CT(MSCT)测量的主动脉瓣环最大径、最小径、面积及面积衍生直径进行一致性分析,根据两者面积衍生直径预测瓣膜型号,比较两者在指导人工瓣膜型号选择上的一致性。结果:3D-TEE与MSCT在测量主动脉瓣环最大径、最小径、面积、面积衍生直径方面无统计学差异(P>0.05),ICC相关系数分别为：0.817、0.781、0.885、0.869(P<0.001);3D-TEE与MSCT预测的瓣膜型号无统计学差异(P>0.05)。结论:对于二叶式主动脉瓣重度狭窄的患者,3D-TEE可为TAVI提供瓣膜型号选择,因此,在特殊情况下可作为MSCT的替代手段,帮助临床选择合适的人工瓣膜。     

先天性二叶式主动脉瓣畸形所致主动脉瓣狭窄的外科治疗体会

目的总结先天性主动脉瓣二叶式畸形所致的主动脉瓣狭窄手术治疗的经验。方法1995年9月至2010年12月福建医科大学附属协和医院心外科共为46例二叶式主动脉瓣畸形所致主动脉瓣狭窄患者实施了瓣膜置换术。对这些患者的手术效果及其影响因素进行回顾性总结。结果术后随访3个月至12年,死亡1例（为猝死）,1例出现与抗凝有关的脑部并发症;心功能Ⅰ级36例,心功能Ⅱ级9例。术后超声心动图测得主动脉瓣跨瓣压差17～51（29．2±11．5）mmHg。结论主动脉瓣置换术是治疗先天性主动脉瓣二叶式畸形所致主动脉瓣的有效疗法,应尽可能选择有效瓣口面积较大的人造瓣膜,这样可以有效降低术后主动脉跨瓣压差,提高手术安全性和远期疗效。     

胎儿二叶式主动脉瓣畸形的超声心动图特征分析

目的：探讨确诊二叶式主动脉瓣（BAV）畸形的胎儿超声心动图特征及预后。方法：对生后确诊BAV的患者产前超声心动图进行回顾和分析，并对其特征进行总结。结果：14例生后确诊患者产前胎儿超声心动图均有异常超声征象提示，包括直接征象（主动脉瓣增厚、回声增强、融合嵴、两个交界及“鱼嘴样开口”、活动及开放受限、一字型关闭线或偏心关闭线）及间接征象（主动脉瓣上流速增快，升主动脉增宽）。其中2例患者产前均进行了3次胎儿超声心动图检查，发现主动脉瓣上流速及升主动脉内径随着孕周的增大而增加。14例患者中，2例（14.3%）出生后因主动脉瓣中重度狭窄出现生长发育受限，其中1例于2个月龄进行主动脉瓣球囊扩张治疗。结论：胎儿BAV主要依靠产前超声心动图筛查，直接超声征象结合间接超声征象可帮助诊断。超声医师疑诊胎儿BAV应建议其父母规律随访患儿主动脉瓣及主动脉情况，有助于确诊及预后咨询。     

经食管超声心动图在先天性心脏病围术期中的运用

经食管超声心动图（TEE）是70年代发展起来的一种超声技术。本文就TEE的方法，及其在先心围术期中的应用适应症和并发症等方面作一综述。     

实时三维结合二维超声心动图对先天性主动脉瓣下膜性狭窄的诊断价值

目的:回顾性分析实时三维结合二维超声心动图,对先天性主动脉瓣下膜性狭窄的诊断价值。方法:收集2010年7月至2014年6月,在我院诊断为先天性主动脉瓣下膜性狭窄并经手术证实的患者21例,其中女性13例,男性8例,年龄18~63岁,平均(36.3±13.9)岁。二维及三维经胸超声心动图观察瓣下隔膜的形态。对于2例经胸超声心动图显示不清的患者,采取经食管超声心动图检查,同时应用实时三维和二维超声显示,三维图像存储后进行后切割处理。结果:与手术结果对照,21例患者的实时三维超声图像均能清楚显示瓣下膜性结构,并能清晰显示隔膜的形状。其中6例隔膜紧邻主动脉瓣,15例隔膜距离主动脉瓣>5mm。8例患者的隔膜为环型,13例为边缘型。实时三维超声对瓣下隔膜的显示率及形状类型的诊断正确率均为100%;而二维超声对瓣下隔膜的显示率为81%,对于环形隔膜及边缘型隔膜的诊断正确率分别为25%和61.5%。21例患者中,1例无左心室流出道狭窄,但合并主动脉瓣重度关闭不全;其余均有中到重度左心室流出道狭窄左心室流出道平均压差≥46mm Hg(1mm Hg=0.133k Pa)。同时,所有患者中,10例合并中度以上关闭不全,7例轻度关闭不全,4例微量反流。结论:实时三维超声心动图结果与手术结果完全相符,在隔膜的显示率尤其是对于分型的诊断正确率方面均优于二维超声心动图。经胸及经食管实时三维结合二维超声心动图,能提高主动脉瓣下膜性狭窄的诊断率,更加清晰立体的显示主动脉瓣下隔膜形态及结构,为手术提供更加全面的诊断信息。     

二叶主动脉瓣的超声分析

目的 探讨二叶主动脉瓣的超声心动图特征。方法 采用回顾性方法分析了26例先天性二叶主动脉瓣,其中主动脉瓣狭窄17例（有或无主动脉瓣关闭不全）和单纯主动脉瓣关闭不全9例。结果 在主动脉瓣狭窄组、轻度狭窄14例（82％）;二叶主动脉瓣感染性心内膜炎的发生率为42％;主动脉瓣狭窄组与单纯主动脉瓣反流组相比,主动脉瓣增厚钙化有极显性差异（P＜0．00005）,结果表明,二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。结论：二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。二叶主动脉瓣感染性心内膜炎的发生率较高。彩色多普勒二维超声心动图对二叶主动脉瓣的诊断具有重要价值。     

Parachute mitral valve accompanied by bicuspid aortic valve on three-dimensional transesophageal echocardiography

We report the findings of three-dimensional (3D) transesophageal echocardiography (TEE) in a patient with a parachute mitral valve (MV) accompanied by aortic valve (AV) malformation. The results indicated an enhanced echo in MV anterior leaves, incrassate, and shortened subvalvular chordae tendineae, and posteromedial papillary muscle that had echo reinforcement, calcification, retroposition, and a significant decrease compared with anterolateral papillary muscle. In addition, the anterolateral papillary muscle was huge, with the bilateral papillary muscles fused partly, and the posterior subvalvular chordae tendineae incrassate, shortened, and attached parachute-like to the anterolateral papillary muscle. The MV appeared dome-shaped for the open limit in diastole with an MV area of 1.6cm. Moreover, the left ventricle increased in size and the bicuspid AV was malformed. Continuous wave Doppler angiograph showed that the flow rate increased to 398cm/seconds at the AV orifice area. A 3D form of the MV structure was observed from the left ventricle using 3D-TEE inspection. The anterolateral papillary muscle was fused with its posteromedial homologue. The chordae tendineae was attached to the anterolateral papillary with the parachute-like structure, indicating dome movement.     

Echocardiographic diagnosis of congenital bicuspid aortic valve in gonadal dysgenesis

Among the gonadal dysgenesis, Turner's syndrome (T.S.) is often associated with cardiovascular malformations, mainly of the aorta. In order to assess noninvasively the incidence of those abnormalities we have evaluated 36 consecutive female patients (pts) with gonadal dysgenesis, mean age 13.3 +/- 2 years, range 3-24 years, without a prior history of cardiovascular disease, by clinical examination chromosomal karyotyping, 12 leads electrocardiography (ECG), and by Time Motion (TM) and Two-Dimensional (2D) Echocardiography (Echo). The following parameters were considered: presence of an auscultatory systolic ejection click (SEC); evidence of a bicuspid aortic valve (BAV); aortic valve stenosis (AVS); aortic valve eccentricity index (AVEI); left ventricle wall hypertrophy (LVWH). 9 pts out 36 (25%) presented a BAV at the 2D Echo; 8 pts out of 36 (22%) presented a SEC, 3/9 (33%) mild AVS, 2/9 (22%) displayed AVEI on TM study and 3/9 (33%) had LVWH. These findings indicate that an isolated BAV is present in a high percentage of pts with gonadal dysgenesis, more than before suspected. Echocardiography shows to be particularly useful and reliable in the assessment of that abnormality.     

Comparison of accuracy of aortic valve area assessment in aortic stenosis by real time three-dimensional echocardiography in biplane mode versus two-dimensional transthoracic and transesophageal echocardiography

Our aim was to validate the clinical feasibility of assessment of the area of the aortic valve orifice (AVA) by real time three-dimensional echocardiography (RT3DE) in biplane mode by planimetry and to compare it with the echo-Doppler methods more commonly used to evaluate valvular aortic stenosis (AS).RT3DE in biplane mode is a novel technique that allows operators to visualize the aortic valve orifice anatomy in any desired plane orientation. Its usefulness and accuracy have not previously been established.Using this technique, we studied a series of patients with AS and compared the results with those obtained by two-dimensional transesophageal echocardiography (TEE) planimetry and two-dimensional transthoracic echocardiography using the continuity equation (TTE-CE). RT3DE planimetries in biplane mode were measured by two independent observers. Bland-Altman analysis was used to compare these two methods.Forty-one patients with AS were enrolled in the study (15 women, 26 men, mean age 73.5 +/- 8.2 years). RT3DE planimetry was feasible in 92.7%. Average AVA determined by TTE-CE was 0.76 +/- 0.20 cm, by TEE planimetry 0.73 +/- 0.1 cm, and by RT3DE planimetry 0.76 +/- 0.20 cm(2). The average differences in AVA were-0.001 +/- 0.254 cm(2) and 0.03 +/- 0.155 cm(2) (RT3DE/TEE). The correlation coefficient for AVA (RT3DE/TTE-CE) was 0.82 and for AVA (RT3DE/TEE) it was 0.94, P < 0.0001. No significant intra- and interobserver variability was observed. In conclusion, RT3DE in biplane mode provides a feasible and reproducible method for measuring the area of the aortic valve orifice in aortic stenosis.     

Quadricuspid aortic valve by transthoracic echocardiography

A 55-year-old woman seeks medical attention with palpitations, atypical chest pain and dyspnea upon exertion, lasting for 12 months. ECG showed left ventricular hypertrophy. Transthoracic Doppler echocardiogram confirmed hypertrophy of the left chambers and showed a quadricuspid aortic valve, with equal-sized cusps, in addition to a moderate regurgitant central flow. Upon echocardiography, the quadricuspid valve is identified by its characteristic "X" form during diastole and rectangular aspect during systole. Heart failure symptoms are presumably caused by valve insufficiency due to abnormal leaflet coaptation. Considering the possibility of progressive regurgitation, follow up on the patient was performed with periodic echocardiographic control. Symptoms responded to treatment.