彩色多普勒超声心动图在中老年动脉导管未闭介入治疗中的价值

目的探寻彩色多普勒超声心动图(CDE)在中老年动脉导管未闭(PDA)介入治疗中的价值。方法应用CDE筛选155例中老年PDA,用彩色多普勒血流显像(CDFI)估测PDA肺动脉端直径与心血管造影测量PDA肺动脉端直径进行统计学相关检验,观察CDFI估测PDA直径的准确性,所有患者均行经皮穿刺封堵术介入治疗,术后再用CDE观察介入治疗效果。结果根据CDE特征对所有中老年PDA患者全部做出正确诊断,根据CDE筛选155例中老年PDA实施介入治疗全部获得成功。中老年PDA的CDE特征和规律性明显:(1)M型超声和二维超声心动图显示左心房(93.5%)、左心室(51.6%)内径不同程度增大,室间隔与左室后壁运动幅度增大。(2)所有患者CDFI均显示过动脉导管左向右五彩镶嵌分流束血流信号。(3)根据CDFI测量PDA肺动脉端分流束血流信号宽度判断PDA肺动脉端直径与心血管造影对照,二者呈显著正相关(r=0.73,P<0.001)。(4)中老年PDA合并心脏瓣膜关闭不全明显增多,其中二尖瓣关闭不全(78.7%)、主动脉瓣关闭不全(61.3%)、三尖瓣关闭不全(34.8%)、肺动脉瓣关闭不全(30.3%)。(5)中老年PDA合并肺动脉高压明显增多(46.5%)。(6)中老年PDA患者女性(83.9%)明显多于男性(16.1%)。结论中老年PDA的CDE特征和规律性明显,CDE在中老年PDA介入治疗中具有重要价值。     

彩色多普勒超声心动图在老年房间隔缺损封堵术中的价值

目的探讨彩色多普勒超声心动图(CDE)在老年房间隔缺损(ASD)封堵术中的价值。方法选择老年ASD患者64例,封堵术前应用二维超声心动图观察ASD位置,测量ASD大小和残余边缘,彩色多普勒血流显像观察过房间隔分流束血流信号和过心脏瓣膜反流束血流信号,连续多普勒估测肺动脉压,合并心房颤动和多发ASD经食管超声心动图检查,筛选ASD封堵术适应证。ASD封堵术中应用二维超声心动图监视封堵器位置,用彩色多普勒血流显像监视有无过房间隔残余分流。ASD封堵术后应用CDE判断疗效。结果 64例老年ASD患者实施ASD封堵术全部获得成功,ASD封堵术后CDE判断疗效满意。结论 CDE在老年ASD封堵术中有重要价值。ASD封堵术前应用二维超声心动图观察ASD位置、大小和残余边缘,连续多普勒估测肺动脉压,合并心房颤动和多发ASD行经食管超声心动图检查是筛选老年ASD封堵术适应证的关键。     

老年继发孔房间隔缺损彩色多普勒超声心动图特征和规律性研究

目的 探寻老年继发孔房间隔缺损(ASD)彩色多普勒超声心动图(CDE)特征和规律性. 方法 应用CDE检查50例老年ASD,50例均经心导管对照,47例行封堵术介入治疗,3例行手术修补治疗. 结果 根据CDE图像特征对50例老年ASD全部做出正确诊断.老年ASD的CDE特征及规律性明显:(1) 所有患者二维超声心动图心尖四腔心切面均显示房间隔中部回声中断,直径最小为0.6 cm,最大为3.2 cm.左心房、右心房、右心室内径不同程度增大,左心室内径变小.所有患者胸骨旁大动脉短轴切面均显示两条大动脉位置关系正常,合并肺动脉高压患者显示肺动脉内径大于主动脉内径,肺动脉瓣关闭时间延长,开放时间缩短.(2) M型超声显示室间隔与左室后壁呈异向运动占40%,呈同向运动占60%.(3) 合并肺动脉高压患者连续多普勒测量三尖瓣反流频谱峰值最小为2.65 m/s,最大为4.18 m/s.(4) 所有患者彩色多普勒血流显像均显示过房间隔左向右五彩镶嵌分流束血流信号.合并二、三尖瓣关闭不全于收缩期显示过二、三尖瓣五彩镶嵌反流束血流信号;合并主、肺动脉瓣关闭不全于舒张期显示过主、肺动脉瓣五彩镶嵌反流束血流信号.(5) 老年人ASD合并心房纤颤和冠心病明显增多. 结论 CDE能比较准确地测定ASD的大小、肺动脉压和心脏各腔室大小,为临床医师选择治疗方案提供依据.     

动脉导管未闭伴发肺动脉高压的超声诊断

肺动脉压力的测定 ,以往均是用有创的心导管来进行。自从多普勒超声心动图应用于临床以后 ,肺动脉压可由连续多普勒技术 (CW)无创测定。本文进行了回顾性对 12 4例经超声心动图诊断的动脉导管未闭 (PDA)患者 ,用 CW检测肺动脉压力 ,比较分流压差、三尖瓣反流压差及肺动脉瓣反流压差估测 PDA合并肺动脉高压的价值。1　材料与方法1.1　病例选择选自 1998年 7月至 2 0 0 0年 7月 ,经超声心动图诊断PDA患者 12 4例 (己剔除合并肺动脉口狭窄、三尖瓣病变及一周岁以下的患者 )。其中男 41例 ,女 83例 ,年龄 1岁 2个月至 5 4岁 ,平均 8.5岁。…     

彩色多普勒超声心动图在室间隔缺损封堵术中的应用价值

目的:探讨彩色多普勒超声心动图（CDE）在室间隔缺损（VSD）封堵术中应用价值。方法:应用CDE封堵术前选择适应证,术中监视封堵器释放过程,术后判断封堵术疗效,远期随访。结果:应用CDE选择187例VSD,186例封堵成功,1例封堵器术中脱落,成功率99.5%。术后CDE复查发现2例过室间隔少量残余左向右分流。CDE随访3个月发现1例封堵器移位。CDE选择适应证是:①右室面VSD直径≥2mm,<10mm。②VSD边缘距主动脉瓣≥1mm,轻度以下主动脉瓣关闭不全,无主动脉瓣脱垂。③VSD边缘距三尖瓣隔叶≥2mm,中度以下三尖瓣关闭不全。④并发能介入治疗的畸形,如动脉导管未闭、继发孔房间隔缺损、卵圆孔未闭和肺动脉瓣狭窄。手术中CDE监测封堵器释放过程是:①心尖四腔心切面确定封堵器导管在左心室内。②胸骨旁五腔心切面确定封堵器位于室间隔的左右心室侧的位置,封堵器中间有室间隔回声。③确定封堵器不影响主动脉瓣和三尖瓣功能。④封堵器到位后彩色多普勒血流显像（CDFI）没有显示或显示微量过室间隔分流束血流信号。封堵术后判断疗效:①封堵器不移位。②CDFI没有显示过室间隔分流束血流信号。③主动脉瓣和三尖瓣功能正常。结论:CDE在VSD封堵术中具有重要临床价值,术前选择适应证,术中监视封堵器释放过程,术后判断封堵术疗效,远期随访,其它检查方法不可能与CDE媲美。     

多普勒超声心动图无创估测闭塞性肺血管病肺动脉高压

本研究旨在探讨多普勒超声心动图无创估测闭塞性肺血管病肺动脉高压的价值。通过对19例闭塞性肺血管病患者进行多普勒超声检查,并与48小时内进行的右心导管检查资料做对比分析。结果提示,压差法能够直接准确测定肺动脉收缩压(SPAP),但仅限于存在三尖瓣反流的患者;血流加速度时间(ACT)、血流加速度时间/右室射血时间(ACT/RVET)和右室射血前期/血流加速度时间(RPEP/ACT)能够定量估测肺动脉高压,但明显受心脏指数(CI)的影响。     

41例闭塞性肺动脉高压患者应用多普勒超声心动图法与右心导管法测定肺动脉压力的比较

目的:评价多普勒超声心动图法估测肺动脉收缩压(PASP)的可靠性.方法:用右心导管法(RHC)与多普勒超声心动图法分别测定闭塞性肺动脉高压患者的PASP,并将其结果进行比较.结果:多普勒超声心动图法与右心导管法测量PASP值,两者间比较有显著性差异(P＜0.05),平均差为(11.85±5.02)mmHg(1 mmHg=0.133 kPa),但两种方法得到的数值具有一定的相关性(r=0.635,P＜0.05).PASP值与动脉二氧化碳分压、肺泡-动脉氧差、血氧饱和度有关.结论:多普勒超声心动图法测量PAPS值与右心导管法有相关性,多普勒超声心动图法可作为估测肺动脉压力的一种可靠的无创检查方法.     

多普勒定量检测肺动脉高压

用脉冲和连续多普勒二维超声心动图(PDE和CDE)同时检测122例受检者的肺动脉血流时间间期和三尖瓣返流(TR),分析TR的检出率,肺动脉血流时间间期各值与三尖瓣返流压力阶差(TRPG)之间的关系,并用右室射血前期与肺动脉血流加速时间比值     

老年卵圆孔未闭患者经胸超声心动图特点及临床分析

目的对老年卵圆孔未闭(PFO)患者经胸超声心动图特点及临床分析。方法回顾性分析8例老年PFO患者的临床特点;并通过彩色多普勒超声诊断仪检测老年PFO患者的经胸超声心动图特点及心脏的变化。结果老年PFO患者多有不同程度的心功能不全表现,多伴有心房颤动、左右心房及左心室的扩大及肺动脉压增高、左心室射血分数减低。4例治疗后病情好转,PFO消失或显示不清。彩色多普勒血流频谱显示,8例PFO患者血液分流方向均为左向右分流,3例病情最重时出现双向分流。PFO大小均在3～4 mm。4例患者住院期间并发重度肺部感染死亡,4例仍健在,继续接受治疗。结论老年PFO患者有其独特的特征,多伴有心功能不全、心房颤动、心腔扩大、肺动脉高压等,PFO血液分流方向多为左向右分流,病情严重时出现双向分流,预后较差。     

连续波多普勒和双心导管同步测量动脉导管未闭分流压差的研究

在30例动脉导管未闭患者中,应用连续波多替勒超声心动图和双心导管技术,同步测量了跨动脉导管的分流压差。结果显示:两种技术测量的最大瞬时压差、舒张末期压差和平均压差均高度相关(r分别为0.99,0.96和0.98),三种多普勒压差分别与肺动脉收缩压、舒张压和平均压呈高度负相关(r分别为-0.85、-0.89和-0.90),表明多普勒超声心动图是估测跨动脉导管压差和肺动脉压力的可靠技术。     

Real-time bidimensional-color Doppler evaluation of patent ductus arteriosus

In order to assess the presence and severity of left-to-right shunt at ductal level, eleven patients with proven ductus arteriosus (PDA), ages 1 day to 16 years, were examined by real-time two-dimensional Doppler echocardiography. Eighteen subjects with no signs of cardiovascular disease were selected as normal controls. Normal pulmonary flow pattern was clearly visualized in the healthy subjects examined. The jet stream through the ductus was well imaged in the main pulmonary artery in patients with PDA and disappeared in two infants after pharmacologic manipulation with indomethacin. The colour-coded shunt area was related to the left-to-right shunt calculated at cardiac catheterization. Moreover, the combined use of colour-flow Doppler and continuous-wave Doppler yielded a reliable noninvasive assessment of pulmonary artery pressure.     

Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound

Doppler ultrasound examination was performed in 69 patients with a variety of cardiopulmonary disorders who were undergoing bedside right heart catheterization. Patients were classified into two groups on the basis of hemodynamic findings. Group I consisted of 20 patients whose pulmonary artery systolic pressure was less than 35 mm Hg and Group II consisted of 49 patients whose pulmonary artery systolic pressure was 35 mm Hg or greater. Tricuspid regurgitation was detected by Doppler ultrasound in 2 of 20 Group I patients and 39 of 49 Group II patients (p less than 0.001). Twenty-six of 27 patients with pulmonary artery systolic pressure greater than 50 mm Hg had Doppler evidence of tricuspid regurgitation. In patients with tricuspid regurgitation, continuous wave Doppler ultrasound was used to measure the velocity of the regurgitant jet, and by applying the Bernoulli equation, the peak pressure gradient between the right ventricle and right atrium was calculated. There was a close correlation between the Doppler gradient and the pulmonary artery systolic pressure measured by cardiac catheterization (r = 0.97, standard error of the estimate = 4.9 mm Hg). Estimating the right atrial pressure clinically and adding it to the Doppler-determined right ventricular to right atrial pressure gradient was not necessary to achieve accurate results. These findings indicate that tricuspid regurgitation can be identified by Doppler ultrasound in a large proportion of patients with pulmonary hypertension, especially when the pulmonary artery pressure exceeds 50 mm Hg. Calculation of the right ventricular to right atrial pressure gradient in these patients provides an accurate noninvasive estimate of pulmonary artery systolic pressure.     

Noninvasive Doppler echocardiographic evaluation of shunt flow dynamics of the ductus arteriosus

The pulsed Doppler technique was used to record the flow velocity patterns in the ductus arteriosus and the pulmonary artery in 26 patients with either isolated or complicated patent ductus arteriosus (PDA). In all patients, abnormal Doppler signals indicating left-to-right (L-R) or right-to-left shunt flow or both could be obtained at the site of the ductus arteriosus. These Doppler flow patterns determined within the ductus coincided with the direction of ductal flow seen on the contrast two-dimensional echocardiogram. No Doppler signals of shunt flow were demonstrated in any of 42 control subjects. The peak, mean, and diastolic velocities of the L-R shunt flow within the ductus were measured from the ductal flow velocity profiles. With the Doppler-derived measurements of the mean and diastolic velocities, patients with normal pulmonary arterial pressure and those with evidence of pulmonary hypertension could be correctly identified. In addition, the mean velocity of the diastolic antegrade flow portion obtained from the proximal left pulmonary artery, which was related to ductal L-R shunting, was measured in 16 patients with isolated PDA. This Doppler flow determinant showed a good linear correlation with the L-R shunt ratio determined by Fick's method (r = .88, p less than .01). Our technique permits the noninvasive evaluation of shunt flow dynamics in patients with PDA.     

Noninvasive estimation of pulmonary artery diastolic pressure in patients with tricuspid regurgitation by Doppler echocardiography.

OBJECTIVES: The purpose of this study was to determine whether Doppler echocardiographic assessment of right ventricular pressure at the time of pulmonary valve opening could predict pulmonary artery diastolic pressure. BACKGROUND: Doppler echocardiography has been used to estimate right ventricular systolic pressure noninvasively. Because right ventricular and pulmonary artery diastolic pressure are equal at the time of pulmonary valve opening, Doppler echocardiographic estimation of right ventricular pressure at this point might provide an estimate of pulmonary artery diastolic pressure. METHODS: We studied 31 patients who underwent right heart catheterization and had tricuspid regurgitation. Pulmonary flow velocity was recorded by pulsed wave Doppler echocardiography, and tricuspid regurgitant velocity was recorded by continuous wave Doppler echocardiography. The time of pulmonary valve opening was determined as the onset of systolic flow in the pulmonary artery. Tricuspid velocity at the time of pulmonary valve opening was measured by superimposing the interval between the onset of the QRS complex on the ECG and the onset of pulmonary flow on the tricuspid regurgitant envelope. The tricuspid gradient at this instant was calculated from the measured tricuspid velocity using the Bernoulli equation. This gradient was compared to the pulmonary artery diastolic pressure obtained by right heart catheterization. MEASUREMENTS AND RESULTS: The pressure gradient between the right atrium and right ventricle obtained at the time of pulmonary valve opening ranged from 9 to 31 mm Hg (mean, 19+/-5) and correlated closely with invasively measured pulmonary artery diastolic pressure (range, 9 to 36 mm Hg; mean, 21+/-7 mm Hg; r = 0.92; SEE, 1.9 mm Hg). CONCLUSION: Doppler echocardiographic measurement of right ventricular pressure at the time of pulmonary valve opening is a reliable noninvasive method for estimating pulmonary diastolic pressure.     

Noninvasive estimation of the pulmonary artery pressures in patent ductus arteriosus with continuous-wave Doppler echocardiography]

To develop a new method for noninvasive measuring of the pulmonary artery pressure (PAP) in patient ductus arteriosus (PDA), left and right heart catheterization (Cath) and continuous-wave Doppler echocardiography (CWD) were performed simultaneously in 30 cases with PDA. The results showed that there was high correlation of the systolic peak pressure gradient (delta pp), the end-diastolic pressure gradient (delta Pd) and the mean pressure gradient (delta Pm), across PDA measured with the two techniques (r = 0.99, 0.96 and 0.98, respectively). The CWD-derived pulmonary artery systolic (PASP), diastolic (PADP) and mean (PAMP) pressure, which were estimated by subtracting delta Pp, delta Pd and delta Pm from the brachial artery systolic, diastolic and mean pressure, correlated well with the corresponding PAP measured with Cath (r = 0.92, 0.89 and 0.94, respectively). It is concluded that CWD offers a reliable technique for estimating shunt pressure gradients and PAP in patients with PDA.     

Hemodynamic evaluation before and after balloon atrial septostomy in patients with transposition of the great arteries using pulsed Doppler echocardiography

In nine patients with transposition of the great arteries, hemodynamic changes after the initial balloon atrial septostomy (BAS) were investigated using pulsed Doppler echocardiography and cardiac catheterization. Patients consisted of five males and four females, who ranged in age from zero to 82 days (median, one day). All but one who had ventricular septal defect had no associated cardiac anomalies other than patent ductus arteriosus. Prostaglandin E1 was administered before and after BAS to four patients who had hypoxemia. At cardiac catheterization, right and left atrial pressures and arterial oxygen partial pressure were measured. Using pulsed Doppler echocardiography, the time-velocity curve was recorded at the tricuspid and mitral valves, pulmonary artery, ascending aorta and interatrial septum. The maximum diastolic velocity was measured from the tricuspid and mitral valve time-velocity curves. The product of the time-velocity integral and heart rate was measured from the time-velocity recordings at the pulmonary artery and ascending aorta. The duration of the left-to-right shunt at the foramen ovale was measured and was normalized by corresponding R-R intervals on the electrocardiogram. After BAS, left atrial pressures and pressure gradients between both atria decreased significantly (p less than 0.01). Arterial oxygen partial pressure increased from 24.4 +/- 7.2 to 40.4 +/- 6.0 mmHg (p less than 0.01). The maximum flow velocity at the tricuspid valve increased significantly (p less than 0.01), but that at the mitral valve showed no significant change after BAS. The velocity time integral of the aorta increased significantly (p less than 0.01), but that of the pulmonary artery did not.(ABSTRACT TRUNCATED AT 250 WORDS)     

Doppler-echocardiographic assessment of the degree of pulmonary hypertension and right-ventricular pressure in patients with ventricular septal defects

The study was performed in 53 children aged 3 months to 4 years who had ventricular septal defect. Systolic pressure in the right ventricle, pulmonary artery and the severity of pulmonary hypertension were determined by two way: 1) from arteriovenous shunt via ventricular septal defect before its surgical closure; 2) from systolic regurgitation via the tricuspid valve after its seal. Right ventricular diastolic pressure was measured by Doppler echocardiography using diastolic blood flow through the tricuspid valve. Before ventricular septal defect closure, the correlation ratio of Doppler echocardiographic to cardiac catheterization values was 0.76 and that of Doppler echocardiographic to intrasurgical manometry was 0.79. In the postoperative period, a catheter was left in the right ventricle in 14 children and its pressure was simultaneously measured by the blind method. The correlation was 0.97 for right ventricular systolic pressure and 0.89 for diastolic one.     

Pulmonary atresia with an intact septum: indications for the neonatal surgical treatment guided by 2-dimensional and Doppler echocardiography

Twelve neonates with pulmonary atresia and intact ventricular septum underwent surgical treatment based on two-dimensional and Doppler echocardiography. Ten patients with adequate morphology of the right ventricular outflow tract portion shown by means of two-dimensional echocardiography underwent pulmonary valvulotomy and systemic-to-pulmonary shunt. Two neonates with atresia of the right ventricular infundibulum on two-dimensional echocardiography underwent systemic-to-pulmonary artery shunt without valvulotomy. In all patients the qualitative and quantitative echocardiographic diagnosis was confirmed at surgery and/or with the subsequent angiocardiographic study. Two-dimensional and Doppler echocardiography is a precise diagnostic method for planning surgical treatment in neonates with pulmonary atresia and intact ventricular septum.