先天性主动脉瓣下隔膜型狭窄的电子束CT诊断

目的 探讨电子束CT(EBCT)诊断先天性主动脉瓣下隔膜型狭窄的实用价值。方法 对EBCT造影诊断为先天性主动脉瓣下隔膜型狭窄的4例患者进行回顾性分析研究,全部病例均经普通X线、超声心动图检查,1例行心血管造影,2例经手术及病理证实。EBCT检查采用心电门控单层连续容积扫描和心脏长、短轴面电影扫描。结果 4例先天性主动脉瓣下隔膜型狭窄患者的EBCT图像均清晰显示出主动脉瓣下隔膜状的负性充盈征象。1例合并镜面右位心、主动脉瓣关闭不全,1例合并动脉导管未闭、房间隔缺损和主动脉瓣、二尖瓣病变,1例合并有室间隔缺损、右位主动脉弓(Ⅱ型),1例合并有主动脉瓣、二尖瓣关闭不全。结论 EBCT对先天性主动脉瓣下隔膜型狭窄及并发的心血管畸形可以获得准确的病理解剖诊断,能满足临床诊断和手术治疗的要求,在左室流出道局部细节的显示上甚至优于常规的心血管造影。在术后随诊观察方面可取代心血管造影。     

Digital subtraction ventriculography in determining global and regional left ventricular parameters compared to left catheterization cardiography

Since May 1982 we studied more than 150 patients with heart diseases by means of digital angiography, out of them 46 patients with a history of transmural myocardial infarction were selected. Urografin 76, 30 ml, was administered at a flow rate of 18 ml/s by means of a catheter in the superior vena cava during digital subtraction ventriculography. Results were compared with conventional contrast ventriculograms. The correlation coefficient was r = 0.93 (p less than 0.001) for determination of ejection fraction with both methods. The data in individual cases suggest that DSV is more sensitive than conventional contrast ventriculography in determination of severely reduced ejection fractions. The methods are practically identical in qualitative evaluation of disorders of regional wall motion in the anterolateral region, while DSV is more sensitive than conventional ventriculography in evaluating the apical region. Sensitivity was 85.7% when the two methods were compared in evaluation of the inferior region of the left ventricle. Both methods are identical in demonstration of severely deformed ventricles. Digital subtraction ventriculography may replace conventional contrast ventriculography in some of the situations discussed above.     

Hemodynamic effects of a new iso-osmotic contrast medium in selective left ventriculography

To evaluate the myocardial hemodynamic effects of a new iso-osmotic contrast agent (Hexabrix 160: H 16) a randomized cross-over study was performed comparing Hexabrix 160 with Sodium Meglumine diatrizoate (Radioselectan 76: R 76) in 20 patients with ischemic heart disease. H 16 produced substantially smaller (p less than 0.001) increases in heart rate (68 +/- 11 to 73 +/- 12) than R 76 (69 +/- 12 to 88 +/- 15) and smaller decreases in left systolic ventricular pressure (131 +/- 15 to 128 +/- mmHg) than R 76 (132 +/- 14 to 94 +/- 15 mmHg). Both contrast media resulted in an increase in contractility beginning three to five seconds after the onset of the injection and reached its maximum at 45 seconds. However the increases in contractility was smaller with H 16 than R 76: H 16 caused a significantly smaller (p less than 0.01) increases in V max. (0.1 CIRC/s) than R 76 (0.35 CIR/s). The hemodynamic effects of H 16 were probably in relation with the Frank-starling mechanism. The lowest variation of preload observed (left ventricle end-diastolic pressure: 12 +/- 4 to 14 +/- 5 mmHg) showed that this contrast medium appeared to behave like isotonic serum. These results suggest that H 16 may preferable for digital left ventriculography.     

老年性主动脉瓣下狭窄的超声心动图分析（附5例报告）

本文总结自2006年5月开展超声心动图检查以来，在1000例中老年受检者中发现5例单纯因室间隔上段局限性增厚而导致的左室流出道狭窄的病例，现将其超声心动图表现分析如下。     

Detection of a false left ventricular aneurysm by first-pass radionuclide ventriculography

A false left ventricular aneurysm complicating an inferior myocardial infarction was successfully identified by computerized first-pass radionuclide ventriculography using a multicrystal gamma camera. The aneurysmal chamber exhibited paradoxical systolic expansion, a pattern of contraction confirmed by contrast cineangiography. Because of the propensity of false aneurysms to rupture, early noninvasive firm diagnosis is desirable and may be accomplished by first-pass radionuclide angiography.