超声心动图诊断左冠状动脉-右心室瘘1例

患者男,68岁,因"进食后咽部刺痛5天"入院。查体:血压135mmHg/90mmHg;心率80次/分,律齐,心前区闻及2~3级连续性杂音,以舒张期杂音为主。超声心动图:左冠状动脉起始部内径宽约16mm,内壁回声粗糙,可见强回声附壁斑块(图1A),左冠状动脉发出后全程扩张,走行纡曲,先向左再向     

超声诊断主动脉左冠状窦瘤破裂2例

正病例1,患者女,53岁,因"突发胸闷、心悸1周"入院。有反复口腔、外阴溃疡病史。查体:叩诊心界向左侧扩大。心尖部可闻及2/6级收缩期吹风样杂音,向左腋下传导。超声心动图:主动脉近端见一膜状结构,随心动周期呈连枷样运动,并于膜状结构上见一宽约7mm的中断口,探及舒张期血流频谱,血流速度约411cm/s(图1)。诊断:主动脉左冠状窦瘤破裂入左     

自发性内膜下血肿致急性心肌梗死合并左心室壁瘤1例

<正>患者男,63岁,主因"胸痛3天"入院。心电图:下壁病理性Q波,前壁T波倒置。实验室检查:肌酸激酶同工酶108U/L,肌钙蛋白Ⅰ21.2μg/L,均明显升高。睾酮水平(0.382 8ng/ml)明显下降。予以低分子肝素抗凝、抗血小板等治疗1周后行超声心动图检查,见心尖与下壁交界处室壁明显变薄、回声增强,向外膨出,约34.3mm×16.9 mm,室壁运动几乎消失(图1A)。冠状动脉造影:左前降支内膜光滑,中远段管状狭窄,最重处狭     

超声心动图预测心房颤动患者左心房血栓形成

心房颤动(房颤)可促进左心房血栓形成,而血栓脱落后引起的血栓栓塞是其最严重的并发症之一。准确预测房颤患者左心房血栓的形成,对房颤术前风险评估及临床抗凝治疗方案的选择有重要价值。超声心动图具有无创、经济等优点,可为预测房颤患者左心房血栓的形成提供可靠信息。     

实时三维超声心动图测量左心功能评价 冠状动脉搭桥术的效果

目的探讨实时三维超声心动图（RT-3DE）测量左心室整体峰值充盈率（gPFR）、整体峰值射血率（gPER）、左心室射血分数（LVEF）综合评价冠状动脉搭桥术（CABG）的效果。方法采集30例CABG患者（CABG组）术前3天、术后1周、术后1个月和22名正常志愿者（正常对照组）的左心室全容积图像。gPER、gPFR、LVEF通过分析软件获得。比较gPER、gPFR、LVEF在CABG组与正常对照组的差异、CABG手术前后的变化情况,以及在各组各时间点的相关性。结果CABG组的gPER、gPFR、LVEF均较正常对照组显著减低（P〈0.01）。CABG术后1周较术前无显著改变（P〉0.05）;术后1个月较术前及术后1周显著增高（P〈0.01）。相关性分析表明：正常对照组与CABG组术前3天、术后1周、术后1个月gPER与LVEF（r=0.98、0.90、0.96、0.86,P均〈0.01）、gPER与gPFR（r=0.98、0.98、0.98、0.97,P均〈0.01）均相关。结论RT-3DE作为一种新的无创、精确的技术,测量gPER、gPFR、LVEF能综合评价CABG效果。     

超声心动图介入心包置管在延迟性心脏压迫中的应用(附64例报告)

目的探讨超声心动图介入心包腔直接置管引流对延迟性心脏压迫（late cardiac tamponade，LCT）患者的治疗效果。方法LCT患者64例，行二维超声引导下心包腔直接置管引流。结果穿刺成功率为100％，心包内置管引流15h～4个月，治疗效果满意。结论二维超声引导下施行心包穿刺置管引流能有效缓解症状，成功率高，可替代传统穿刺方法。     

复杂性先天性心脏病并右位主动脉弓1例

孕妇,22岁,孕2产0,孕25周,既往身体健康,无遗传性疾病和各种不良接触史。使用GE-730彩色超声诊断仪行产前常规检查。超声发现,胎儿心脏结构异常,心脏四腔切面：心尖指向左侧,心胸比不大,左、右房室大小对称失调,右心细小,左、右心房与左、右心室连接一致,心脏中央“十”字交叉消失,见一组融合的瓣膜开闭。降主动脉位于脊柱的右前方（图1）。     

川崎病并发巨大冠状动脉瘤双源CT表现1例

患者男,22岁,反复心悸6年,伴黑朦2次。4岁时曾高热,持续数日。体检发现心界向左下扩大。实验室检查：血、尿常规,血沉,肝肾功能及心肌损伤标志物均正常。心脏彩超示左冠状动脉起始段内径增宽并瘤样扩张,管壁钙化;左心室扩大,左心室壁节段运动异常,左心室收缩功能受损,射血分数为0.43。双源CT冠脉扫描示左侧冠状动脉主干至前降支近段见管腔梭形膨大,最宽处约16.4 mm,管壁环形硬化斑块形成,     

Minimally invasive coronary artery bypass grafting surgery in a child with Kawasaki disease

An 8-year-old girl with Kawasaki disease underwent surgical revascularization to the left anterior descending coronary artery on the beating heart via a left anterior short thoracotomy. Angiography 21 months after surgery showed excellent graft patency. This case--the first success in minimally invasive surgical coronary artery revascularization in a child in the world--suggests that minimally invasive methods are a reasonable alternative in coronary artery revascularization in a child with Kawasaki disease whose left anterior descending artery is the only requiring it.     

Atypical Kawasaki disease: A patient with coronary,brain, and internal mammary arteritis

Here we report a rare case of atypical Kawasaki disease (KD) in a patient presenting with systemic arteritis affecting the coronary arteries, brain, and internal mammary arteries (IMAs). A 25‐year‐old man was referred to our institute with angina pectoris. Coronary angiography revealed coronary artery aneurysms and triple‐vessel disease. Three‐dimensional brain computed tomography showed multiple small saccular aneurysms on the vertebral and posterior inferior cerebellar arteries. Off‐pump coronary artery bypass (OPCAB) grafting ??????was performed; however, the bilateral IMAs were tightly adhered and not patent. OPCAB was completed using the bilateral radial and gastroepiploic arteries. This is the first report of KD involving the IMA.     

Treatment of a giant coronary artery aneurysm in an adult with a history of Kawasaki disease by resection and bypass grafting: Report of a case

We report herein the case of a 22-year-old man with a history of Kawasaki disease who developed a giant calcified aneurysm of the left main coronary artery. The aneurysm was successfully resected and coronary bypass surgery was performed using the bilateral internal thoracic arteries. The resected aneurysm, the maximal diameter of which was 27 mm, showed heavy calcification of the inner layer and extended into the adjacent coronary arteries, producing a significant narrowing of the lumen of both the left main trunk (50%) and the anterior descending branch (50%). Extensive intimal calcification presumably prevented normal luminal development and produced a significant narrowing as the patient grew into adulthood. A cause for stenotic lesions developing in the coronary artery adjacent to a coronary aneurysm in adults with a history of Kawasaki disease is suggested here by the resected aneurysm seen in this patient. Thus, adult patients with giant coronary artery aneurysms and significant stenotic lesions of the coronary artery associated with Kawasaki disease may require aneurysmectomy in addition to bypass surgery.     

儿童甲型流感合并川崎病的临床特征

目的分析儿童甲型流感合并川崎病（KD）的临床特征,增强对甲型流感合并川崎病的早期识别。 方法对首都医科大学附属北京地坛医院2018年1月1日至2019年12月31日收治的682例实验室确诊的甲型流感患儿资料进行回顾性分析,筛选甲型流感病毒感染合并川崎病儿童共14例（KD+甲流组）。选择同期就诊的符合纳入标准及排除标准的28例KD患儿为KD组,28例单纯甲型流感患儿为甲流组。比较KD+甲流组和KD组患儿临床表现、发热持续时间及冠状动脉病变发生率。比较KD+甲流组、KD组和甲流组患儿白细胞（WBC）、中性粒细胞百分比、淋巴细胞百分比、血小板、快速C-反应蛋白（CRP）、红细胞沉降率（ESR）、降钙素原（PCT）、血清淀粉样蛋白酶A（SSA）、白蛋白、转氨酶和心肌酶水平。 结果KD+甲流组患儿发热持续时间[（11.21 ± 3.36）d]较KD组[（6.29 ± 2.21）d]更长,差异有统计学意义（t = 5.81、P < 0.001）。KD+甲流组丙种球蛋白无反应型（IVIG）比例（42.9%）较KD组（14.3%）更高,差异有统计学意义（χ² = 4.1、P = 0.41）。KD+甲流组患儿WBC[（13.18 ± 4.39）× 10⁹/L]、ESR[（60.5 ± 15.82）mm/h]、CPR[55.5（17.56,61.0）g/L]、SSA[76.5（23.0,311.6）mg/L]和丙氨酸氨基转移酶（ALT）[49.5（23.1,78.0）U/L]均较KD组和甲流组升高,差异均有统计学意义（F = 27.92、P < 0.001,F = 47.97、P < 0.001,Z = 3.15、P = 0.007,Z = 4.36、P < 0.001,Z = 2.68、P = 0.027）。KD+甲流组较KD组患儿冠状动脉扩张发生概率更高（57.0% vs. 25.0%）,差异有统计学意义（χ² = 4.2、P = 0.041）。KD+甲流组患儿IVIG无反应型发生率较单纯KD组高（42.9% vs. 14.3%）,差异有统计学意义（χ² = 4.1、P = 0.041） 结论甲型流感合并KD患儿发热时间、明确诊断所需时间较长,其IVIG无反应型发生率更高,且血清SSA和ALT水平显著升高。     

超声诊断股静脉内膜撕脱并内膜下血栓1例

患者男,61岁,外伤致左侧股骨颈骨折,接受“骨折切开复位内固定术”后1周,患侧下肢肿胀疼痛,临床疑诊下肢静脉血栓形成。床旁超声于左股静脉壁内膜下见2．98cm×0．86cm斑片状实性略低回声,内部回声不均,边界与静脉内膜相连续,远心端显示开口,近心端为盲端,位于静脉瓣上方（大隐静脉人口上方）,呈条形,随腹压呈往返运动,边界尚清;左股静脉狭窄,残余管腔宽约0．30cm,可见自发显影（图1）;左侧股浅静脉内见实性条形斑片状回声,几乎充满管腔,血流信号稀疏,可见自发显影,其远心端显示模糊。     

基于互联网络的延续护理对川崎病并发冠状动脉瘤患儿家庭照顾负担的影响

目的探讨基于互联网络的延续护理对减轻川崎病并发冠状动脉瘤患儿家庭照顾负担的影响。方法选取川崎病并发冠状动脉瘤的连续病例68例,根据使用互联网络平台前后分为对照组33例和干预组35例。对照组使用常规的出院指导,干预组在此基础上采用微信、QQ、手机App等各形式实施延续护理。比较两组在出院后6个月在家庭负担会谈量表(FBS)、川崎病知识问卷得分。结果干预6个月后干预组照顾者的家庭日常活动、家庭娱乐活动、家庭关系、家庭成员躯体健康、心理健康维度评分及家庭负担总分显著低于对照组(P0.05,P0.01);川崎病知识问卷得分显著高于对照组(P0.01)。结论运用多种网络工具下的延续护理可以提高川崎病并发冠状动脉瘤患儿照护者对疾病的掌握度,减轻患儿的家庭负担。