高血压患者主动脉根部扩张机制的探讨

目的：观察高血压对主动脉根部管径的影响及与主动脉瓣返流的关系,探讨其主动脉根部扩张的机制。方法：对60例高血压患者和60例正常成人分别应用二维超声心动图测量4个水平主动脉管径,并利用彩色多普勒观察瓣口有无返流。结果：高血压患者主动脉上嵴及升主动脉近段管径显著增宽,主动脉返流率较正常组显著增高。结论：高血压可使主动脉根部远段部分增宽,并可能导致主动脉瓣返流,这对临床早期处理高血压、主动脉返流所引起的心衰具有重要的指导意义。     

高血压与主动脉根部管径及主动脉瓣返流关系的研究

目的探讨高血压对主动脉根部管径的影响及其与主动脉瓣返流的关系。方法应用二维超声心动图对220例临床确诊为原发高血压患者和220例正常健康人的主动脉根部分别测量4个水平的管径,用彩色多普勒血流观察主动脉瓣口有无返流。结果高血压组主动脉上嵴和升主动脉近段管径显著增加,主动脉瓣返流率较正常血压组显著增高。结论高血压可使主动脉根部远段管径部分增宽,并可能导致主动脉瓣返流,对早期诊断心衰,降低死亡率有重要意义。     

定量组织多普勒评价正常人及高血压患者升主动脉不同节段的弹性

目的:通过心尖长轴切面应用定量组织多普勒成像技术评价正常人及高血压患者升主动脉瓣环处、根部、距离瓣环处5 cm远端三个节段弹性特征.方法:收集高血压81例,及正常对照组72例,取心尖长轴切面,显示升主动脉切面,将取样点置于主动脉瓣环处、主动脉根部、距主动脉瓣环5 em处远端处的升主动脉前壁,得到升主动脉前壁的收缩期S峰、舒张早期A峰、舒张晚期A峰速度曲线.并计算出E/A值.结果:正常组与高血压组升主动脉前壁S峰、E峰,主动脉根部运动速度最高,瓣环处次之,远端最低(P＜0.05);正常组与高血压组舒张晚期A峰主动脉根部速度最高,明显高于瓣环处与动脉根部(P＜0.05),但瓣环处与远端之间运动速度无明显差异(P＞0.05).升主动脉三个节段(瓣环处、根部、远端),高血压组收缩期S峰值、舒张早期E峰值明显低于正常对照组(P＜0.05);舒张晚期A峰值与正常对照组对比无显著性差异(P＞0.05),但E/A值比较有显著差异,高血压组值明显低于对照组(P＜0.05).结论:升主动脉前壁各节段运动速度是有规律性的,主动脉根部运动速度最高,瓣环处次之,远端最低.高血压患者的升主动脉弹性功能降低.通过心尖长轴切面应用定量组织多普勒方法测量主动脉壁运动速度具有简单、直接、干扰因素相对较少、可操作性强的优点.     

超声诊断无冠窦瘤伴血栓1例

患者男,79岁。因结肠癌术后2年近几个月有胸闷、心悸来诊。行腹部超声检查未见明显异常。心脏超声检查:心脏四腔不大,二尖瓣回声正常,主动脉搏动幅度降低,主动脉瓣回声增强,CDFI:舒张期左室流出道内可见源于主动脉瓣口的返流束,返流面积1.2cm2,左室长轴切面,在主动脉根部下方有     

主动脉瓣关闭不全患者升主动脉、降主动脉和腹主动脉血流参数的变化趋势

本文应用脉冲及彩色多普勒超声心动图对４２例主动脉瓣关闭不全患者和４２例对照组的升主动脉、降主动脉和腹主动脉的血流参数进行了系统观察和测量。结果表明：主动脉瓣关闭不全时，不仅升主动脉、降主动脉和腹主动脉有舒张期返流血，返流速度随着动脉向远方延伸逐渐减慢，返流频谱的持续时间逐渐变短，射血前期依次递增，从主动脉射血到出现舒张期返流频谱的时间逐渐延长，而且对收缩期血流也有影响，各阶段动脉的收缩期峰值流速都大于对照组。     

主动脉夹层动脉瘤的超声心动图诊断方法探讨

例1 患者男,40岁,1992年11月13日升主动脉造影示主动脉根部扩张及主动脉瓣关闭不全改变,整个胸主动脉管径基本正常,未见假腔及破口。1992年11月28日超声心动图检查结果:升主动脉前壁根部显著扩张,外径60mm,升主动脉前壁向右膨出,距主动脉根部22mm处在血管腔内可见一膜样回声随血流飘动,反复探查未见破口。继续用CDFI探查,经仔细反复观察后发现在主动脉根部内有二股方向相反的血流存     

无症状性主动脉瓣返流的临床分析

主动脉瓣返流可由主动脉瓣或升主动脉壁的异常引起,随着彩色多普勒的临床应用主动脉瓣返流的诊断率明显提高,为研究无症状性主动脉瓣返流的临床特征,本文对168例此类患者进行了分析.总结如下。     

多普勒超声检测主动脉瓣返流患者颈动脉血流变化

本文旨在观测主动脉瓣返流患者颈动脉血流动力学变化。观察组42例，其中主动脉瓣返流30例，主动脉瓣返流伴二尖瓣病变12例；正常组42例。正常顿总动脉频谱形态呈三峰形，舒张早期可有反向频谱，Vr10．8±3．6cm／s，△T／T比值＜1／10。主动脉瓣返流患者颈动脉收缩期V1、AC、DC均显著增大；舒张期可出现“返流频谱”，即△T／T比值≥1／10。根据△T／T比值可大致分级主动脉瓣返流程度，轻度返流：△T／T比值＜1／4或正常；中度；△T／T比值1／4～1／2；重度：△T／T比值＞1／2；可作为分级主动脉瓣返流程度的一种简便辅助方法。对于临床听不到杂音的主动脉瓣返流患者，颈动脉“返流频谱”可作为有用线索，提示病变存在。本文还探讨了收缩期颈动脉血流动力学变化。     

犬主动脉瓣关闭不全的实验研究

我们以彩色Doppler和声学造影对5只开胸狗的主动脉瓣血流进行研究时发现:2只狗在生理状态下存在主动脉瓣轻度返流征象,但从主动脉根部注射声学造影剂后,未证实存在主动脉瓣返流。4只狗的主动脉瓣被破坏1～4mm后,彩色Doppler和声学造影均显示明显的返流,返流束特征与瓣膜破坏前有显著性差异。据此探讨了主动脉瓣生理性返流的发生机理和鉴别要点。     

主动脉瓣关闭不全患者升主动脉,降主动脉和腹主动脉血流参数…

本文应用脉冲及彩色多普勒超声心动图对４２例主动脉瓣关闭不全患者和４２例对照组的升主动脉，降主动脉和腹主动脉的血流参数进行了系统观察和测量。结果表明：主动脉瓣关闭不全时，兴驻升主动脉，降主动脉和腹主动脉有舒张斯返流血，返流速度随着动脉向远方延伸逐渐减慢，返流频谱的持续时间逐渐变短，射血前期依次递增，从主动脉射血到出现舒张期返流频谱的时间逐渐延长，而且对收缩期血流也有影响，各阶段动脉的收缩期峰值流速都     

超声心动图评价二叶主动脉瓣畸形与升主动脉扩张的关系

目的　使用超声心动图评价二叶主动脉瓣畸形 (BAV)与升主动脉扩张的关系。方法　使用二维超声在四个部位检测 42例主动脉瓣功能正常的BAV患者 (病例组 1)、3 7例主动脉瓣狭窄的BAV患者 (病例组 2 )和 40例年龄、体表面积、血压等匹配的健康人 (对照组 )的升主动脉内径 :瓣环、瓦氏窦、主动脉上嵴及升主动脉近端。结果　病例组 2升主动脉瓦氏窦、主动脉上嵴及近端内径最大 ,其次为病例组 1(P <0 .0 5～P <0 .0 0 1)。但病例组 1中有一部分BAV患者的升主动脉内径与对照组无显著差异。结论　BAV常合并升主动脉扩张 ,提示两者可能为同一发育异常 ,即先天性主动脉壁发育缺陷的不同表现形式。     

Aortic valve commissural tear mimicking type A aortic dissection.

A 52-year-old man came to the local emergency department with symptoms of heart failure and transient chest pain. Transthoracic echocardiography showed severe aortic regurgitation and a dilated ascending aorta. Aortic dissection was suspected, and he was transferred to our institution. Transesophageal echocardiography appeared to confirm the presence of a type A dissection. A mobile, linear structure was present in the proximal ascending aorta, suggesting the presence of dissection flap. Aortic cusp prolapse and severe aortic regurgitation were seen. At surgery, no aortic dissection was present. Rather, the commissure between right and left aortic valve cusps was separated from the wall of the aorta. Motion of the torn commissure with the cardiac cycle apparently led to the transesophageal echocardiographic appearance described. The ascending aorta was dilated. Histopathologic examination of the aorta confirmed the visual appearance of cystic medial necrosis. Aortic valve commissural tear is a rare event, which may lead to severe aortic regurgitation. This entity may lead to the false-positive transesophageal echocardiographic diagnosis of type A dissection.     

Normal aortic dimensions and flow in 168 children and young adults

Background: Knowledge of normal aortic dimensions is important while evaluating children with aortic root dilatation. Objective: The purpose of the study was to create normal values for aortic dimensions with two‐dimensional echocardiography and for aortic flow velocities with Doppler echocardiography in healthy children and young adults. Design and patients: One hundred and sixty‐eight healthy children were studied by a single observer using digitized two‐dimensional (2DE) and Doppler echocardiography. Methods: The 2DE measurements were obtained at the level of aortic annulus, sinus, sinotubular junction, before the origin of innominate artery, before and after the origin of left carotid artery, after left subclavian artery and descending aorta at the level of the diaphragm. Doppler measurements were made from ascending aorta and from descending aorta. Results: For the analysis the subjects were divided into five groups according to body surface area (BSA): 0·5–0·75 m², 0·75–1·0 m², 1·0–1·25 m², 1·25–1·5 m² and over 1·5 m². Aortic dimensions normalized to BSA were greater in smaller children at all levels. All diameters correlated closely with age, BSA, height and weight (for each r>0·75, P<0·001). The best predictor of aortic dimensions was BSA with r values over 0·84 for all estimates (P<0·001). The diameters of ascending and descending aorta were similar in both genders when indexed to BSA. Flow velocities in descending aorta were greater than those measured in ascending aorta (P<0·001 for all measurements). There were significant inverse correlations with heart rate and velocity time integral in ascending and descending aorta (r = ?0·32 and ?0·53, P<0·001, respectively). Conclusions: The presented aortic dimensions at eight levels from the valve annulus to the descending thoracic aorta by 2DE in conjunction with Doppler measurements of ascending and descending aorta in 168 healthy subjects will serve as reference data for further studies and clinical use in patients with various cardiac abnormalities.     

Assessment of aortic regurgitation by means of pulsed Doppler ultrasound

A comparison of aortic regurgitation ratios measured by pulsed Doppler ultrasound techniques and electromagnetic flowmetry was performed. The ultrasonic measurements were made preoperatively in the aortic arch, and the electromagnetic measurements preoperatively on the ascending aorta. Through mathematical correction for aortic arch flow characteristics, preoperative ultrasonic Doppler measurements in this area demonstrated a fairly close relationship to the aortic valve regurgitation volume determined by electromagnetic flowmetry on the ascending aorta intra-operatively.     

Spontaneous Aortic Laceration Causing Flail Aortic Valve and Acute Aortic Regurgitation

Spontaneous laceration of the aorta is an unusual cause of flail aortic valve. We report a case of acute aortic regurgitation caused by flail aortic valve as a result of spontaneous laceration of the ascending aorta. The role of transesophageal echocardiography in the diagnosis of this condition is discussed. (J Am Soc Echocardiogr 1999;12:76-8.)     

Symmetry吻合装置应用于非体外循环冠状动脉旁路移植

目的:报告临床应用桥血管-主动脉吻合装置,在非体外循环冠状动脉旁路移植手术的初步经验,探讨其可行性与安全性。方法:2003年10月-12月,23例在非体外循环下冠状动脉旁路移植(OPCAB)手术中应用Symmetry桥血管-主动脉吻合装置实现主动脉无钳夹技术。4例患者伴有严重的升主动脉钙化性粥样硬化。应用吻合装置完成近端吻合口共计59个,平均2.6个/例。术前应用升主动脉薄层CT平扫评价其粥样硬化及钙化程度,术中采用升主动脉超声检查结合手指扪查升主动脉的方法,避开钙化斑块,进行近端吻合口的定位。再血管化的顺序为:(1)左乳内动脉与左前降支远端吻合;(2)应用主动脉无钳夹技术,以吻合装置完成所有静脉桥血管与主动脉近端吻合;(3)顺次完成所有静脉桥血管与冠状动脉远端吻合。术后以抗血小板药物治疗6个月。术后患者均接受门诊或电话随访。结果:全组应用吻合装置完成近端吻合口59个均获得成功,术中未发现吻合口漏血需手工缝合修补情况。全组无手术死亡病例。围术期未发生心肌梗死。无脑血管意外、二次开胸止血、心功能衰竭等严重围术期并发症。术后1年随访,发现23例患者中有2例心绞痛症状复发,其中1例复查冠状动脉造影证实所有桥血管均通畅。另1例患者未能复查冠状动脉造影,于术后18个月死亡。结论:Symmetry桥血管-主动脉吻合装置可以安全地应用于OPCAB手术。特别是为实现冠脉手术的主动脉无钳夹技术,以解决升主动脉钙化问题,提供了一种可选择的方法。但其对于静脉桥血管远期通畅率的影响值得关注,并有待进一步大组病例临床研究的证实。     

Large Ascending Aortic Aneurysm and Severe Aortic Regurgitation in a 7-year-Old Child with Marfan Syndrome and a Review of the Literature: Marfan Syndrome in Childhood

A 7-year-old girl was admitted because of dyspnea on exertion and palpitations. Her symptoms had gradually worsened for the last 6 months. She had physical features of the Marfan syndrome. Transthoracic echocardiography showed an ascending aortic aneurysm, severe aortic regurgitation, and mildly dilated left ventricle. Because of marked aortic aneurysm and severe aortic regurgitation, the patient was treated with a beta-blocker and an angiotensin converting enzyme inhibitor. Surgery was refused by her parents. We describe here a child with Marfan syndrome in whom significant dilatation of the ascending aorta and severe aortic regurgitation is encountered and major cardiovascular complications of Marfan syndrome were reviewed.     

Aortic dilatation and calcification in asymptomatic patients with bicuspid aortic valve: analysis in a Korean health screening population

Entire anatomic area involved in the bicuspid aortic valve (BAV) disease has not been studied well, especially in Asian populations. We investigated prevalence and vascular characteristics of the BAV disease in a Korean population. In a health screening program from 2005 through 2010, 38 BAV patients (BAV group, 0.16 %, 35 males) were isolated among a total of 23,291 persons based on echocardiography. Each BAV patient was matched with three TAV patients (TAV group, n = 114) of the same age, gender, BSA, and hypertension. Using echocardiography and low-dose chest CT scan, diameters of the aortic root to proximal descending aorta (pDA) and pulmonary artery (PA), morphologic types of BAV, and calcification in the aortic root were evaluated in both groups. Diameters of the sinotubular junction and ascending aorta in BAV group were larger than in TAV group (29 ± 7 vs. 27 ± 3 mm, p = 0.046; 42 ± 7 vs. 34 ± 4 mm, p < 0.001, respectively). Diameters of the annulus, sinus of Valsalva, aortic arch, pDA, and PA were not different between two groups. Calcification in the aortic root was approximately seven times more common in BAV group (p < 0.001). Diameters of the aortic root were larger in the R-L type (n = 24) than in the R-N type (n = 11). Prevalence of BAV in a Korean population appears lower than in Western populations. Within the entire anatomic boundaries of BAV, the ascending aorta was predominantly dilated in BAV patients. The R-L type showed more dilatation than the R-N type, not in the ascending aorta but in the aortic root.     

Aortic compliance measured by non-invasive Doppler ultrasound: description of a method and its reproducibility

1. Aortic compliance (expressed as percentage increase in lumen diameter for a pulse pressure of 10 mmHg) was calculated from the characteristic pulse wave velocity deduced from 'foot to foot' transit times of the blood flow pulse over a measured length of aorta. Two continuous wave Doppler ultrasound transducers were used: one insonating the root of the left subclavian artery, the other the abdominal aorta proximal to its bifurcation. Measurements were made after the subject had been supine for 5 min to achieve stable conditions. 2. Transit times were calculated on-line in real-time from the delay between the start of the systolic upstroke in the flow velocity sonograms recorded by the two transducers. 3. Within-visit variation was minimized by measuring over 45 cardiac cycles repeated three separate times and calculating an overall mean value for aortic compliance. A full measurement took 5-10 min. 4. Reproducibility of this overall mean value of aortic compliance was assessed at 1 month in 30 subjects (aged 60 +/- 7 years, mean +/- SD) and at 3 months in 23 different subjects (59 +/- 8 years). Aortic compliance values ranged from 0.1 to 2.0%/10 mmHg. 5. The mean paired difference between aortic compliance values was -0.02 between 0 and 1 months, and 0.03 between 0 and 3 months, with respective 95% confidence limits of -0.06 to 0.03 and -0.03 to 0.09 embracing zero, thus not differing significantly from baseline.(ABSTRACT TRUNCATED AT 250 WORDS)