彩超测量肺动脉内血流速度对肺动脉瓣狭窄鉴别诊断的意义

本文经彩色多普勒技术对经手术证实的２３例肺动脉瓣狭窄和４０例心内分流患者的肺动脉血流速度的研究，结果表明：两者均能导致肺动肺血流速度增快，但肺动脉瓣狭窄此起肺动脉血流速度增显著高于间隔缺损，一旦间隔缺损上起肺动脉内血流速度达到肺动脉瓣狭窄水平时，证明缺损很大，很容易明确论断。     

彩色多普勒超声探讨法洛三联症肺动脉血流速度与病变程度的关系

肺动脉瓣狭窄是法洛三联症严重程度的主要因素，采用彩色多普勒超声和连续多普勒测量肺动脉内血流速度是判断本病程度一种有价值的方法。本研究应用超声检查26例法洛三联症患者，并与手术进行对照，探讨其临床意义。     

肺动脉瓣前向血流速度加快的探讨

目的探讨肺动脉内血流速度加快的意义及对先天性性心脏病心内分流及肺动脉瓣狭窄的鉴别诊断。方法应用彩色多普勒观察46例肺动脉内前向血流速度和频谱形态的变化，结合心脏形态学改变、瓣膜情况等探讨其他先天性心脏病与肺动脉瓣狭窄的区别并与手术对照。结果房间隔缺损中肺动脉内血流速度最快达2．5m／s，室间隔缺损中肺动脉内血流速度最快达3．5m／s(多见于干下型室间隔缺损)，肺动脉瓣狭窄中，肺动脉内血流速度最快达4．5m／s。结论房间隔缺损时肺动脉前向血流速度一般不超过2．5m／s，且肺动脉内血流速度与房间隔缺损大小呈正比，干下型室间隔缺损时肺动脉前向血流速度可明显加快，达3．5m／s，肺动脉瓣狭窄者肺动脉前向血流速度显著加快可达4m／s以上，同时要结合房室腔大小的变化及瓣膜情况综合分析。     

胎儿肺动脉瓣缺如综合征产前超声诊断分析

目的：总结胎儿肺动脉瓣缺如综合征产前超声图像特征。方法对2010年1月至2014年1月四川大学华西第二医院产前超声诊断并经尸解证实的5例肺动脉瓣缺如综合征胎儿超声心动图表现进行总结分析,观察胎儿心脏四腔观（4CH）、左心室流出道观（LVOT）、右心室流出道观（RVOT）、三血管气管观（3VT）各个常规切面观二维超声、彩色多普勒血流成像（CDFI）及脉冲多普勒血流流速曲线特征。结果5例肺动脉瓣缺如综合征胎儿中3例超声心动图表现为典型的肺动脉瓣缺如综合征征象：（1）肺动脉主干呈瘤样扩张且瓣环处狭窄。（2）在心脏搏动周期内,肺动脉内见红蓝交替的往返血流信号。（3）频谱多普勒示肺动脉内呈双期双向血流流速曲线,收缩期前向血流与舒张期反向血流速度、流速曲线宽度等均相似,血流速度无明显增加。5例胎儿中2例无肺动脉瓣缺如综合征肺动脉主干瘤样扩张特征性征象,其中1例胎儿肺动脉瓣缺如伴三尖瓣闭锁,右心发育不良,肺动脉主干无瘤样扩张,反而狭窄。1例胎儿肺动脉瓣缺如伴三尖瓣下移畸形,肺动脉主干虽扩张,但无瘤样扩张。结论胎儿肺动脉瓣缺如产前超声多有特征性表现,易于诊断,对无特征性肺动脉主干瘤样扩张征象肺动脉瓣缺如综合征胎儿,重视对肺动脉瓣口彩色多普勒血流信号及血流流速曲线的观察有助于正确诊断。     

胎儿右室流出道梗阻的彩色多普勒血流显像及频谱形态分析

目的 探讨产前彩色多普勒超声诊断胎儿右室流出道梗阻的临床价值.方法 回顾分析32例产前超声诊断胎儿右室流出道梗阻的超声资料,总结其声图像特征.结果 (1)单纯肺动脉瓣狭窄时常于肺动脉瓣口局部显示五彩镶嵌血流信号,频谱多普勒显示其峰值流速常大于1.8 m/s;(2)动脉导管早闭时常于动脉导管处显示五彩镶嵌血流信号,频谱多普勒显示峰值流速常大于1.8 m/s,且为双期同向血流频谱;(3)法洛四联症及右室双出口伴肺动脉狭窄时常于肺动脉主干内显示其血流信号稍鲜艳,但频谱多普勒显示峰值流速常小于1.8 m/s,严重狭窄时肺动脉主干内血流信号暗淡,甚至其动脉导管内出现反向血流信号及频谱;(4)肺动脉瓣闭锁时常于动脉导管及肺动脉内显示反向血流信号及反向频谱,频谱多普勒显示峰值流速常小于1.8m/s.结论 彩色多普勒血流显像及频谱形态分析能为胎儿右室流出道梗阻的产前诊断提供有价值的信息.     

房间隔缺损并肺动脉瓣狭窄的彩色多普勒超声诊断

目的 本文分析我院经手术证实的先性房间隔缺损（ASD）并肺动脉瓣狭窄（PS）的彩色多普勒血流（CDFI）特征。方法 13例ASD并PS的患者行彩色多普勒超声检查并与51例单纯ASD比较。结果 13例ASD并PS病例均显示房水平双向分流或右向左分流穿隔血流,肺动脉瓣口收缩期五彩射流速度明显增快大于3m/s。单纯ASD无肺动脉高压时房水平穿隔血流为左向右分流血流,且肺动脉内血流速度不超过3m/s。结论 房水平双向分流或右向左分流,并肺动脉内血流速度明显增快大于3m/s可作为本病的诊断依据。     

彩色多普勒超声心动图诊断法洛氏三联症及其血流动力学特征分析

目的分析法洛氏三联症超声心动图及其血流动力学特征,提高诊断正确率。方法将47例法洛氏三联症患者超声心动图检测房缺、肺动脉狭窄与手术测量结果进行比较,对法洛氏三联症患者肺动脉瓣狭窄及房水平分流特征进行分析。结果彩色多普勒超声心动图对法洛氏三联症诊断正确率为93.6%。超声测量房缺大小及肺动脉瓣狭窄程度与手术测量相关良好,分别为r＝0.51(P＜0.01)和r＝0.78(P＜0.001)。法洛氏三联症肺动脉瓣上最大流速(375.0±96.9)cm/s,显著大于单纯房缺肺动脉瓣上最大流速(174.0±29.3)cm/s,P＜0.0001。法洛氏三联症彩色多普勒房水平左向右分流、双向分流、右向左分流及无分流者分别占46.8%、36.2%、10.6%和6.4%。结论彩色多普勒超声心动图诊断法洛氏三联症具有较高的准确性。肺动脉瓣狭窄应采用二维超声心动图、彩色多普勒血流图及频谱多普勒联合检测。房水平分流根据肺动脉狭窄程度不同具有多样化特性,检查中应根据情况具体分析。     

超声诊断胎儿法洛四联症伴肺动脉瓣缺如1例

孕妇,30岁.孕1产0,孕28周.胎儿超声心动图示:四腔心不对称,右心室轻度增大,室间隔上段缺损6 mm,主动脉与肺动脉位置关系正常,主动脉内径6 mm,骑跨于室间隔上,肺动脉呈瘤样扩张,内径约11 mm,右室流出道切面显示右室流出道无狭窄,肺动脉瓣环明显狭窄,无肺动脉瓣叶回声及启闭活动,彩色多普勒血流显像示肺动脉瓣口呈全收缩期湍流频谱及全舒张期反流血流,连续多普勒显示肺动脉瓣口呈连续双向射流与反流频谱,三尖瓣口显示少量反流血流,未能显示动脉导管血流.     

左室双出口的彩色多普勒超声诊断

目的评价超声对左室双出口的诊断价值。方法两例经彩色多普勒确诊的病例,与心血管造影及手术结果进行对照分析。结果两例均为主动脉开口下室间隔缺损,心房正位,心室正位,大血管右型转位。其中一例合并有肺动脉瓣、瓣环及主肺动脉狭窄;另一例无肺动脉口狭窄。结论超声对左室双出口具有特异性诊断价值,诊断关键是二维超声见两大血管起始于左心室,彩色多普勒超声显示收缩期红色血流束由左心室直接射入主动脉与肺动脉     

先天性右心梗阻性疾病的彩色多普勒超声诊断

本组18例,其中17例经手术证实的先天性右心梗阻性疾病患者,包括肺动脉分支狭窄、肺动脉瓣膜性狭窄,右室漏斗部狭窄、右室双腔心.通过彩色多普勒超声与手术对照研究,表明彩色多普勒超声能准确地显示梗阻的部位,程度,合并畸形,及血流动力学改变,对本病的诊断具有决定性的价值.     

先天性肺静脉狭窄的彩色多普勒超声心动图诊断

目的探讨先天性肺静脉狭窄的彩色多普勒超声心动图诊断价值。方法对4例先天性肺静脉狭窄患者的彩色多普勒超声心动图检测结果进行分析。结果4例患者共检出6支肺静脉狭窄,其中1例为3支肺静脉狭窄,3例为1支肺静脉狭窄,合并其它先天性心脏病2例。结论彩色多普勒超声心动图对于评定先天性肺静脉狭窄提供了直观有效的方法,具有重要的诊断意义。     

Cor triatriatum with isolated pulmonary venous stenosis in an adult: diagnosis with transesophageal two-dimensional echocardiography

The diagnosis of cor triatriatum in an adult was made from routine two-dimensional transthoracic echocardiography. The findings of aliasing and turbulence in the roof of the left atrium suggested pulmonary venous stenosis. A transesophageal echocardiogram defined both the hemodynamic features of nonobstructing cor triatriatum and the presence of isolated pulmonary venous stenosis. The clinical use of transesophageal echocardiography with color flow Doppler in the elucidation of complex anatomic substrate is demonstrated.     

Color Doppler US pulmonary artery vessel signal: a sign for predicting the benign lesions

The lung cancer blood supply originates from the bronchial artery. If vessel signals within pulmonary lesions can be confirmed to be those of the pulmonary artery, color Doppler ultrasound (US) should be able to predict and differentiate benign lesions from lung cancers. Two hundred sixty-four patients with abutting thoracic lesions (including 125 lung cancers and 139 benign lesions) underwent color Doppler US examinations. A pulsatile flow, with the vessel signal length on sonographic appearance > or =1 cm demonstrated by color Doppler US, was arbitrarily defined as a pulmonary artery vessel signal. Of the 264 thoracic lesions, 73 (58%) lung cancers and 107 (77%) benign lesions had detectable color Doppler US pulsatile flow vessel signals. Analyzing the pulsatile flow vessel signals, the color Doppler US pulmonary artery vessel signal was present in 74 (53%) benign lesions, but was found in only two (2%) lung cancers of a specific alveolar cell carcinoma with lobar consolidation. Using the pulmonary artery vessel signal, color Doppler US can be valuable in predicting and differentiating benign lesions from lung cancers (p < 0.0001, sensitivity = 0.53, specificity = 0.98 and positive likelihood ratio 26.5). In conclusion, color Doppler US pulmonary artery vessel signal sign is useful in predicting and differentiating benign lesions from lung cancers.     

彩色多普勒血流会聚新方法在二尖瓣狭窄定量中的应用

本研究应用彩色多普勒血流会聚新方法评价了对二尖瓣狭窄的定量诊断，并与二维超声、压力降半时间及综合法测量二尖瓣狭窄进行了比较。结果表明：彩色多普勒血流会聚是一种可行、可信的定量二尖瓣狭窄的新方法，但其准确性有赖于混叠速度的正确选择。在本组二尖瓣狭窄的条件下，３７ｃｍ／ｓ的混叠速度最适合于校正半球形血流会聚方法。     

肺动脉口狭窄时肺动脉血流速度的探讨

本文用连续多普勒技术对经手术证实的１３例肺动脉口狭窄（肺狭）和３７例心内分流患者的肺动脉血流峰速度Ｖｐａ．ｍａｘ进行了分析，探讨了肺狭与心内分流患者Ｖｐａ．ｍａｘ之间的差异，以及不同部位和同一部位、不同大小的间隔缺损对Ｖｐａ．ｍａｘ的影响。结果表明：肺狭患者的Ｖｐａ．ｍａｘ显著高于间隔缺损患者的Ｖｐａ．ｍａｘ，前者一般＞２００ｃｍ／ｓ，后者一般≤２００ｃｍ／ｓ，但是，高位室缺和巨大间隔缺损患者的Ｖｐａ．ｍａｘ亦可＞２００ｃｍ／ｓ，如果结合二维心脏超声情况，它将有助于肺动脉口狭窄的诊断。     

Assessment of blood flow velocity waveforms of the pulmonary circulation by multigate spectral Doppler scanning and traditional pulsed Doppler ultrasonography.

OBJECTIVE: To assess (1) pulmonary artery and peripheral pulmonary blood flow by using a multigate spectral Doppler system and standard pulsed color Doppler ultrasonography and (2) the reproducibility of peripheral pulmonary artery blood flow velocity waveforms. METHODS: Thirty-three women were enrolled in the study Fetal pulmonary artery flow velocity waveforms were investigated by multigate spectral Doppler scanning and traditional pulsed Doppler ultrasonography plus color flow mapping. To establish the relationship between these 2 methods, we calculated the correlation coefficient, coefficient of variation, and limits of agreement. RESULTS: The 2 methods were not significantly correlated. The range of measurement agreement for these 2 methods suggests that there is a significant difference between the main and peripheral pulmonary artery blood flow, and the difference should be taken into account in the interpretation of Doppler flow velocity studies of the pulmonary artery. CONCLUSIONS: Multigate spectral Doppler scanning with power Doppler imaging may be a better way to assess the average flow impedance in a highly vascularized organ. This technique supplies a large number of Doppler signals in the region of interest and offers a quantified range of Doppler measurements, improving our understanding of fetal hemodynamics.     

Hydrodynamics of color M-mode Doppler flow wave propagation velocity V(p): a computer study.

This study was designed to show the hydrodynamic mechanism of left ventricular (LV) flow wave propagation and to relate this propagated velocity to 2-dimensional (2D) color and color M-mode Doppler echocardiograms. A computer model is developed describing 3-dimensional axisymmetrical LV filling flow. The unsteady Navier-Stokes flow equations are solved in an LV truncated ellipsoid geometry with moving LV walls, including relaxation and compliance of the wall. The computed results confirm both intraventricular flow and pressure patterns during filling. Vortices are formed during the acceleration phases of the early and atrial filling waves. During the deceleration phases, the vortices are amplified and convected into the ventricle. The vortices are recognized on the derived 2D color echocardiograms as in vivo. The propagation of this vortex determines the propagation of the maximum velocity observed in the color M-mode Doppler echocardiogram. For pseudonormal filling of the left ventricle, the LV flow wave propagation velocity decreases.     

超声心动图对肺动脉闭锁伴室间隔缺损的评价

目的应用二维超声心动图结合彩色多普勒评价肺动脉闭锁伴室间隔缺损及肺动脉血供情况。方法2003～2004年期间用超声心动图和彩色多普勒对22例年龄15h～7岁(平均347d)的儿童肺动脉闭锁伴室间隔缺损以及肺动脉血供进行了研究。结果22例肺动脉闭锁的患儿全部合并室间隔缺损，14例未闭动脉导管(PDA)，为肺动脉供血来源。6例体肺侧支动脉通道，其中3例合并小的PDA。2例既未探测到PDA又未发现体肺侧支动脉。所有PDA患儿均见到肺动脉融合部。彩色多普勒能精确地检测到有无侧支血管和供血起源，6例有体肺侧支、肺动脉融合的患儿中，5例(85％)可见到逆向血流。3例未能发现肺动脉主干。结论超声心动图结合彩色多普勒对新生儿和儿童肺动脉闭锁合并室间隔缺损的肺动脉血供有重要诊断价值。