多普勒超声评价胎儿房间隔瘤与房音隔缺损的相关性

目的 应用多普勒超声诊断胎儿房间隔瘤（ＡＳＡ）并评价与房间隔缺损（ＡＳＤ）的相关性。方法 对１０２０例胎儿进行多普勒超声心动图检测。结果 被检出的８例ＡＳＡ中３例合并中央型ＡＳＤ,其中２例伴严重的房性心律失常和三尖瓣反流;１例出生后复查示ＡＳＡ伴裂隙样小ＡＳＤ;２例出生后示卵圆孔（ＦＯ）未闭;２例瘤体缩小及１例消失。结论 ①胎儿ＡＳＡ的发生可能与妊娠早期ＦＯ处帘膜形成或继发隔的发育异常有关,因此与ＡＳＤ密切相关;②ＡＳＡ合并ＡＳＤ时更易诱发房性心律失常;③单纯的ＡＳＡ出生后常见ＦＯ未闭或小的房内分流而可能导致局部血栓物质的形成造成栓塞。     

立体超声心动图技术评价房间隔缺损的临床应用价值研究

目的：评价立体超声心动图技术（Stereo Echo）诊断继发孔型房间隔缺损的临床应用价值。方法：应用Stereo Echo技术观察12例继发孔型房间隔缺损患者的缺损形态、大小、空间位置及毗邻关系等。结果：12例患者均取得满意的实时三维超声图像。Stereo Echo模式能准确测定房间隔缺损的大小,普通三维显示模式和Stereo Echo测量的房间隔缺损直径未见明显差异[（2.89±0.73）cm vs （2.85±0.72）cm,P>0.05],二者间测值显著相关（r＝0.96,P<0.05）。Stereo Echo上缺损断面显示清晰、立体,与毗邻结构的前后层次关系明显。普通显示模式和Stereo Echo对冠状静脉窦的显示率分别为93.3%（10/12）,100%（12/12）;对上、下腔静脉的平均成像时间分别为（11.03±3.76）s vs （10.33±3.59）s（P>0.05）。结论：Stereo Echo能有效改善三维超声图像的清晰度,准确测量房间隔缺损大小,快速识别房间隔周邻结构,为外科微创或介入房间隔封堵术的安全、高效的进行具有重要潜在应用价值。     

Assessment of ventricular function with cardiovascular magnetic resonance

The high spatial and temporal resolution of cardiovascular magnetic resonance (CMR) images makes it well-suited for use in the assessment of right ventricular and left ventricular function in patients who have cardiovascular disorders. This article reviews CMR methods used to assess regional and global ventricular function.     

超声心动图在房间隔及室间隔缺损介入治疗中的作用

经心导管微创介入性治疗先天性心脏病是目前医学领域的研究热点之一,近几年发展极其迅速,并已逐渐形成一门新兴的学科分支。经心导管介入性治疗的先天性心脏病包括:房间隔缺损、室间隔缺损、动脉导管未闭、冠状动脉瘘、主动脉窦瘤破裂、肺动脉瓣狭窄等。超声心动图在先天性心脏     

超声心动图对房间隔缺损介入治疗后随诊观察

目的：评价超声心动图对继发孔型房间隔缺损（ASD）介入治疗的近期及远期疗效。方法：继发孔型ASD患者778例，男276例，女502例；男：女=1：1．8，年龄2-74岁，平均（29．6±9．6）岁；其中中央型765例，多发孔型13例，合并畸形91例。使用仪器：东芝6000型，Philips IE33彩色超声诊断仪（TIE）及1500型食道超声心动图（TEE）。探头频率分别为2．5MHz和5MHz。介入术后复查TTE，主要记录各心腔内径，包括右室流出道（RVOT）及右室内径（RV）。观察闭合器的位置、有无残余分流、瓣膜反流及心包积液和心功能状态。出院后1个月、3个月、半年及1年，TTE随诊。TTE选择切面为心尖四腔心及胸骨旁四腔心，剑突下四腔心及两房心切面，大动脉短轴及剑突下短轴切面。结果：超声检出介入手术并发症发生率2．3％。其中闭合器脱落5例，脑梗死2例，心包积液5例，残余分流4例，肺动静脉瘘1例。结论：超声对ASD介入治疗近期和远期疗效的判定有临床意义。     

Fast block flow tracking of atrial septal defects in 4D echocardiography

We are working to develop beating-heart atrial septal defect (ASD) closure techniques using real-time 3D ultrasound guidance. The major image processing challenges are the low-image quality and the processing of information at high-frame rate. This paper presents comparative results for ASD tracking in time sequences of 3D volumes of cardiac ultrasound. We introduce a block flow technique, which combines the velocity computation from optical flow for an entire block with template matching. Enforcing adapted similarity constraints to both the previous and first frames ensures optimal and unique solutions. We compare the performance of the proposed algorithm with that of block matching and region-based optical flow on eight in vivo 4D datasets acquired from porcine beating-heart procedures. Results show that our technique is more stable and has higher sensitivity than both optical flow and block matching in tracking ASDs. Computing velocity at the block level, our technique tracks ASD motion at 2 frames/s, much faster than optical flow and comparable in computation cost to block matching, and shows promise for real-time (30 frames/s). We report consistent results on clinical intra-operative images and retrieve the cardiac cycle (in ungated images) from error analysis. Quantitative results are evaluated on synthetic data with maximum tracking errors of 1 voxel.     

Transesophageal echocardiography to evaluate success of transcatheter closure of large secundum atrial septal defects in adults using the buttoned device

OBJECTIVES: To determine the success rate of transcatheter closure of secundum atrial septal defects (ASDs) in adults and to characterize anatomical structures predisposing to unsatisfactory results. PATIENTS AND METHODS: Preinterventional and follow-up transesophageal echocardiography of 17 consecutive patients treated with a Sideris buttoned device was reviewed. Residual jet size of 5 mm or smaller was considered an adequate result; jet size larger than 5 mm was inadequate. Maximal ASD diameter, ASD area, and anterior, posterior, superior, and inferior septal rims were measured. RESULTS: The 7 patients with adequate results (41%) had smaller defects before implantation of a buttoned device (mean +/- SD maximal ASD diameter, 12 +/- 4 vs 19 +/- 5 mm; P<.005). Total rim length (mean +/- SD) was longer in patients with an adequate result (71 +/- 8 vs 46 +/- 11 mm; P<.001). The ASD size and length of the superior septal rim were independent predictors for an adequate result. Only 3 patients, all with ASD diameter less than 13 mm, had completely closed defects. All patients with ASD diameter greater than 20 mm had inadequate results and an unsatisfactory device position. The defect size (mean +/- SD) was similarly reduced in patients with adequate and inadequate results (9 +/- 3 vs 8 +/- 4 mm). CONCLUSION: Adults with a small ASD are more likely to have an adequate result after treatment with the buttoned device. A sufficiently large superior septal rim is particularly important for an adequate result. Most patients with a large ASD have inadequate results, although their ASD size is reduced by a similar absolute area as in patients with an adequate result.     

Three-dimensional color Doppler echocardiography for assessing shunt volume in atrial septal defects.

Background Three-dimensional color Doppler echocardiography has been used to assess cardiac blood flow in experimental settings. We tested whether this technique can be applied to assess transatrial shunt flow in patients with atrial septal defect in a clinical setting. Methods In 46 consecutive patients with atrial septal defects, shunt flow was assessed during cardiac catheterization using the Fick method and by conventional 2-D quantitative transesophageal Doppler echocardiography. The averaged values for shunt flow obtained by both methods were used as a reference. Transesophageal 3-D color Doppler echocardiography was performed for analysis of the 3-D flow velocity field of transatrial shunt flow. Shunt volume was calculated by application of the Gauss theorem. Results We found a close correlation between shunt volume (L/min) obtained by either 3-D color Doppler echocardiography or the reference methods ( r = 0.981, P < .001). Using 3-D color Doppler data to predict the reference values, 95% confidence limits were -11.5 to +11.6%. Conclusions Shunt flow in patients with atrial septal defects can be assessed in a clinical setting by transesophageal 3-D color Doppler echocardiography.     

房间隔缺损的经胸多平面三维超声心动图剖析诊断研究

目的:探讨影响继发孔房间隔缺损(ASD)经胸三维超声心动图(3DTTE)重建的采样途径和三维剖析诊断方案。方法:选取ASD 21例,应用经胸多平面探头分别在胸骨旁、心尖部和剑突下采集图像,脱机三维重建,利用任意剖切功能,显示ASD及周边结构,测量缺损最大长轴径和短轴径。结果:20例ASD三维重建成功。从右房侧正对房间隔选择性剖切,正面动态成像了ASD完整的形状和在房隔的空间部位,除心尖部外,余部位采样测量ASD大小与手术测值均具有高度相关性。额面四腔顺序剖切能较好地观察ASD与周边结构的关系。结论:3DTTE能理想重建ASD,右房侧剖切剖视能完整显示ASD,结合额面四腔心剖视有利于ASD解剖分型。     

非X线下经胸壁超声全程引导经导管房间隔缺损封堵术的应用研究

目的 探讨非X线下、经胸超声心动图[常规经胸二维超声(TTE)和实时三维超声(RT-3DE)]全程引导经导管房间隔缺损封堵术(TCASD)的方法学要点和临床应用价值.方法应用GE Vivid 7彩色超声诊断仪,普通二维及矩阵3V经胸探头,在完全脱离X线条件下,实时引导11例房间隔缺损(ASD)患者的TCASD术.在常规二维多切面观察的基础上,结合RT-3DE引导多功能导管经腔静脉进入右房;引导导管经缺损进入左房并抵左上肺静脉;引导输送鞘准确进入左房中部;引导封堵器双面伞在左房展开,贴靠入位并准确释放.同期与58例条件类似行常规X线和TTE引导的TCASD患者比较.结果所有手术均顺利完成,无心包填塞等重大并发症发生,与对照组相比,除手术时间显著延长外,研究组在手术即刻及随访3 d、3个月内,残余分流、封堵器移位、房室瓣反流、栓塞及心律失常等并发症发生率与对照组比较差异无统计学意义.结论非经X线条件下、TTE结合RT-3DE全程引导TCASD是安全、经济、实用的超声介入技术,可减少对X线引导封堵的依赖性,对孕妇和儿童实施封堵治疗减少辐射伤害尤为有效.     

超声在房间隔膨出瘤并继发孔型房间隔缺损封堵术中的应用

目的 探讨超声心动图在房间隔膨出瘤（ASA）并发继发孔型房间隔缺损（ASD）封堵治疗中的应用价值。方法 应用经食管超声心动图（TEE）或经胸超声心动图（TTE）诊断ASA并发ASD17例，所有患者均在X线和术中TTE监测下行封堵治疗，术后TTE跟踪复查评价其疗效。结果 17例患者封堵器置人均获成功，共放置24个封堵器。封堵器选择的大小与术前判断大小相关性好（r=0．91，P〈0．001）。术后即刻显示17例患者21个封堵器处穿隔血流消失，有3例患者3个封堵器处仍有微量残余分流，术后1个月至3年复查1例有微量分流。结论 ASA并发ASD的患者可行封堵治疗且疗效确切，而超声心动图在病例选择、术中引导等方面有其特殊性，应引起超声医生和临床医生的重视。     

Transcatheter closure of secundum atrial septal defects in adults with the Amplatzer septal occluder: Intermediate and long-term results

AIMS: Transcatheter closure of secundum atrial septal defects (ASD) with the Amplatzer septal occluder (ASO) has become a standard procedure in most pediatric and adult patients. However, data addressing success rates and outcome in adults is limited. We sought to define the safety profile of the ASO in the community setting and identify the percentage of adults with ASD amenable to percutaneous closure with the ASO. METHODS: We performed a retrospective analysis of patients' records referred for transcatheter ASD closure from 1999 through 2005 at a single institution. Patients were evaluated with right heart catheterization and underwent closure of the ASD according to standard indications under transesophageal and fluoroscopic guidance. RESULTS: Two hundred and seven consecutive patients were taken to the catheterization laboratory for hemodynamic evaluation and possible interventional closure of an ASD. Of those patients, 18 were excluded because the defect and the left-to-right shunt were hemodynamically insignificant (n = 7) or because there was no distinct defect, but instead a multi-perforated septum (n = 11). Nineteen cases were excluded for anatomic reasons. Of the remaining 170 patients, ASO implantation was attempted and successfully performed in 166 (83% of 200 patients with hemodynamically significant ASD). Complications occurred in 11 cases (6.5%) (device dislocation = 4, transient ST-segment elevation = 4, TIA = 1, hemoptysis = 1, pericardial effusion = 1); none of these events were associated with long-term sequelae. During a median follow-up period of 13 months (range 6-80) there were no major clinical events. CONCLUSIONS: More than 80% of adults with a distinct, hemodynamically significant secundum ASD can be successfully treated with the ASO. The immediate success rates are excellent and follow-up data suggest that the ASO is a safe device well suited for transcatheter ASD closure.     

实时三维超声心动图在Ⅱ孔型房间隔缺损介入治疗中的应用

目的前瞻性观察实时三维经胸超声心动图(RT 3-D TTE)在Ⅱ孔型房间隔缺损(Ⅱ ASD)介入治疗中的应用价值.方法对13例Ⅱ ASD患者在介入治疗术中,同时行RT 3-D TTE和经食管超声心动图(TEE)全程监控导管走行、测量ASD直径、观察封堵伞位置,并对测量结果进行比较分析.结果 RT 3-D TTE和TEE对13例患者均可达到同样的影像辅助监测作用,在对ASD直径的测量中,球囊测量均值为(20.08±3.84)mm、TEE为(19.0±3.87)mm、RT 3-D TTE为(19.38±3.01)mm,三者间相比无显著性差异(P>0.05),但回归方程中发现RT 3-D TTE的估计标准误(SEE=1.65)较TEE的估计标准误(SEE=1.95)小.结论 RT 3-D TTE检查无创、无痛苦、图像直观,显示了较强的临床实用性,但其无法使用多普勒对残余分流情况进行评价.     

Assessment of mitral bioprostheses using cardiovascular magnetic resonance

Background

The orifice area of mitral bioprostheses provides important information regarding their hemodynamic performance. It is usually calculated by transthoracic echocardiography (TTE), however, accurate and reproducible determination may be challenging. Cardiovascular magnetic resonance (CMR) has been proven as an accurate alternative for assessing aortic bioprostheses. However, whether CMR can be similarly applied for bioprostheses in the mitral position, particularly in the presence of frequently coincident arrhythmias, is unclear. The aim of the study is to test the feasibility of CMR to evaluate the orifice area of mitral bioprostheses.

Methods

CMR planimetry was performed in 18 consecutive patients with mitral bioprostheses (n = 13 Hancock^®, n = 4 Labcore^®, n = 1 Perimount^®; mean time since implantation 4.5 ± 3.9 years) in an imaging plane perpendicular to the transprosthetic flow using steady-state free-precession cine imaging under breath-hold conditions on a 1.5T MR system. CMR results were compared with pressure half-time derived orifice areas obtained by TTE.

Results

Six subjects were in sinus rhythm, 11 in atrial fibrillation, and 1 exhibited frequent ventricular extrasystoles. CMR image quality was rated as good in 10, moderate in 6, and significantly impaired in 2 subjects. In one prosthetic type (Perimount^®), strong stent artifacts occurred. Orifice areas by CMR (mean 2.1 ± 0.3 cm²) and TTE (mean 2.1 ± 0.3 cm²) correlated significantly (r = 0.94; p < 0.001). Bland-Altman analysis showed a 95% confidence interval from -0.16 to 0.28 cm² (mean difference 0.06 ± 0.11 cm²; range -0.1 to 0.3 cm²). Intra- and inter-observer variabilities of CMR planimetry were 4.5 ± 2.9% and 7.9 ± 5.2%.

Conclusions

The assessment of mitral bioprostheses using CMR is feasible even in those with arrhythmias, providing orifice areas with close agreement to echocardiography and low observer dependency. Larger samples with a greater variety of prosthetic types and more cases of prosthetic dysfunction are required to confirm these preliminary results.     

经食管超声心动图对房间隔缺损封堵治疗适应证的筛选和评价

目的　对继发孔型房间隔缺损 (ASD)形态及整体状况进行定量评分 ,从而对欲行介入封堵的ASD术前筛选和术中监测作标准化评价。方法　 2 10例经临床及超声心动图等检查确诊的ASD患者 ,所有病例采用Amplatzer封堵器封堵 ,术前行经食管超声心动图 (TEE)检查并根据ASD的大小、形态、位置及周边结构进行评分 ,并据此对ASD进行评价。结果　 2 0 4例封堵成功 ,TEE测量ASD最大径 4～ 3 1mm[平均 (19.7± 6.3 )mm ] ,选用封堵器大小 10～ 3 6mm [平均 (2 3 .8± 6.6)mm ]。 6例失败。ASD评分≤ 6分为封堵适应证 ,7～ 9分为相对禁忌证 ,10～ 12分为封堵禁忌证。结论　TEE是诊断ASD最佳影像学检查方法 ,应用TEE评分系统可对ASD封堵适应证作术前筛选。     

Evaluation of aortic valve stenosis using cardiovascular magnetic resonance: comparison of an original semiautomated analysis of phase-contrast cardiovascular magnetic resonance with Doppler echocardiography

Background- Accurate quantification of aortic valve stenosis (AVS) is needed for relevant management decisions. However, transthoracic Doppler echocardiography (TTE) remains inconclusive in a significant number of patients. Previous studies demonstrated the usefulness of phase-contrast cardiovascular magnetic resonance (PC-CMR) in noninvasive AVS evaluation. We hypothesized that semiautomated analysis of aortic hemodynamics from PC-CMR might provide reproducible and accurate evaluation of aortic valve area (AVA), aortic velocities, and gradients in agreement with TTE. Methods and Results- We studied 53 AVS patients (AVA(TTE)=0.87±0.44 cm(2)) and 21 controls (AVA(TTE)=2.96±0.59 cm(2)) who had TTE and PC-CMR of aortic valve and left ventricular outflow tract on the same day. PC-CMR data analysis included left ventricular outflow tract and aortic valve segmentation, and extraction of velocities, gradients, and flow rates. Three AVA measures were performed: AVA(CMR1) based on Hakki formula, AVA(CMR2) based on continuity equation, AVA(CMR3) simplified continuity equation=left ventricular outflow tract peak flow rate/aortic peak velocity. Our analysis was reproducible, as reflected by low interoperator variability (<4.56±4.40%). Comparison of PC-CMR and TTE aortic peak velocities and mean gradients resulted in good agreement (r=0.92 with mean bias=-29±62 cm/s and r=0.86 with mean bias=-12±15 mm Hg, respectively). Although good agreement was found between TTE and continuity equation-based CMR-AVA (r>0.94 and mean bias=-0.01±0.38 cm(2) for AVA(CMR2), -0.09±0.28 cm(2) for AVA(CMR3)), AVA(CMR1) values were lower than AVA(TTE) especially for higher AVA (mean bias=-0.45±0.52 cm(2)). Besides, ability of PC-CMR to detect severe AVS, defined by TTE, provided the best results for continuity equation-based methods (accuracy >94%). Conclusions- Our PC-CMR semiautomated AVS evaluation provided reproducible measurements that accurately detected severe AVS and were in good agreement with TTE.     

Normal values for cardiovascular magnetic resonance in adults and children

Morphological and functional parameters such as chamber size and function, aortic diameters and distensibility, flow and T1 and T2* relaxation time can be assessed and quantified by cardiovascular magnetic resonance (CMR). Knowledge of normal values for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. In this review, we present normal reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques and sequences.

Electronic supplementary material

The online version of this article (doi:10.1186/s12968-015-0111-7) contains supplementary material, which is available to authorized users.     

Transcatheter closure of atrial septal defects

Transcatheter closure of atrial septal defects has evolved significantly over the last 20 years. Transcatheter closure has replaced surgical closure for the treatment of most secundum atrial septal defectsat the current time. A major reason for this is the lower morbidity of transcatheter closure procedures. Several closure devices have come into clinical use. The Amplatzer septal occluder (AGA Medical Co.) currently has the largest reported experience and subsequently the best-established safety and efficacy features. Clinically challenging situations, such as larger atrial septal defects, atrial septal defects with deficient rims and multiple atrial septal defects, are increasingly being addressed using the transcatheter approach, with improved results. The incidence of most complications has significantly reduced over time, and serious side effects are relatively uncommon. In this review, the literature is summarized regarding the current role of transcatheter closure, the evolution of the different available devices for clinical use and the complications that occur with their use. A comparison is also made with surgical closure techniques.     

Transcatheter closure of atrial septal defects

Transcatheter closure of atrial septal defects has evolved significantly over the last 20 years. Transcatheter closure has replaced surgical closure for the treatment of most secundum atrial septal defectsat the current time. A major reason for this is the lower morbidity of transcatheter closure procedures. Several closure devices have come into clinical use. The Amplatzer^® septal occluder (AGA Medical Co.) currently has the largest reported experience and subsequently the best-established safety and efficacy features. Clinically challenging situations, such as larger atrial septal defects, atrial septal defects with deficient rims and multiple atrial septal defects, are increasingly being addressed using the transcatheter approach, with improved results. The incidence of most complications has significantly reduced over time, and serious side effects are relatively uncommon. In this review, the literature is summarized regarding the current role of transcatheter closure, the evolution of the different available devices for clinical use and the complications that occur with their use. A comparison is also made with surgical closure techniques.