电子束计算机断层摄影术在小儿复杂先天性心脏病诊断中的应用

目的 :评价电子束计算机断层摄影术 (EBCT)在小儿复杂先天性心脏病 (先心病 )诊断中的价值。　　方法 :对 2 6例患者经胸常规超声心动图 (TTE)诊断为复杂先心病 ,同时做 EBCT增强单层容积扫描 ,并由计算机工作站进行图像三维重建。其中 9例又做了常规心血管造影 ,11例经外科手术 ,进行对照研究。　　结果 :全组 11种复杂先心病共 6 1处畸形 ,其中心内畸形 2 1处 ,EBCT与 TTE均作出正确诊断。然而 ,心外大血管畸形及心室—大血管连接异常诊断中两者有明显差别 ,在 40处畸形中 ,EBCT过多诊断 1处 (动脉导管未闭 ) ,手术证实为假阳性 ,EBCT诊断符合率为 97.5 % (39/ 40 ) ;TTE诊断 35处 (误诊 1处 ,漏诊 4处 ) ,TTE诊断符合率 87.5 % (35 / 40 )。EBCT与TTE诊断的正确率有显著差异 (χ2 =3.936 ,P<0 .0 5 )。TTE与 EBCT相结合使诊断的总准确率提高到 98.4% (6 0 / 6 1)。　　结论 :EBCT对复杂先心病中某些畸形的检出优于 TTE。EBCT血管造影与 TTE及心血管造影相结合 ,可提高对复杂先心病诊断的准确率 ,以指导手术。     

双源64层CT与经胸超声心动图在诊断复杂先天性心脏病中的对照研究

目的:探讨双源64层CT（DSCT）在诊断复杂先天性心脏病(CCHD)中的应用价值,并与经胸超声心动图（TTE）进行对照研究。方法: 对186例CCHD患者同期行DSCT和TTE检查,以手术结果为标准,在心内异常解剖、心外大血管畸形的诊断上进行回顾性分析。结果: 手术证实心血管畸形共538处。DSCT检出506处,检出率为94.1%,TTE检出497处,检出率 为92.4%,两者差异无统计学意义,但两者联合检查检出529处,检出率达98.3%,明显高于单项检查（P<0.01）。其中,①心脏部分畸形:共 209处,DSCT检出190处,检出率为90.9%,TTE检出200处,检出率为 95.7%,两者差异无统计学意义;②心脏-大血管连接部分异常:共103 处,DSCT检出94 处,检出率为91.3%,TTE检出91处,检出率为88.4%,两者差异无统计学意义;③大血管部分畸形:共226处,DSCT检出222处,检出率为98.2%,TTE检出 206处,检出率为91.1%,两者差异有统计学意义（P<0.01）,DSCT检出率显著高于TTE。结论: ①DSCT诊断心外大血管畸形的检出率高于TTE,对可疑并发大血管畸形的复杂先天性心脏病应作为常规检查手段;②DSCT与TTE联合应用可提高CCHD术前诊断的检出率。     

双源CT在复杂性先天性心脏病中的诊断应用

目的：探讨双源CT在复杂性先天性心脏病的诊断价值。方法：对20例经手术证实的复杂先心病患者的心脏双源CT（DSCT）和经胸壁超声心动图（TTE）检查资料进行回顾性分析。结果：20例患者中手术证实畸形84处．DSCT与TTE均检出69处．检出率为82．14％。其中,心脏部分畸形29处．DSCT检出率75．86％．TTE检出率93．10％．二者的检出率差异无显著性（P〉0．05）;心脏-大血管连接部畸形12处．DSCT检出率66．67％,TTE检出率83．33％．二者的检出率亦无显著差异（P〉0．05）;大血管部分畸形43处．DSCT检出率90．70％．TTE检出率74．42％,DSCT的检出率显著高于TTE（P〈0．05）。结论：心脏双源CT对心外大血管畸形的检出率优于经胸壁超声心动图．可作为复杂性先心病的术前常规检查手段。     

先天性心脏和大血管畸形的电子束计算机断层摄影术诊断--与超声心动图的对照研究

目的:探讨电子束计算机断层摄影术(EBT)和超声心动图在先天性心脏和大血管畸形诊断中的价值. 方法:收集34例分别经超声心动图和EBT检查的心脏和大血管畸形诊断资料,其中18例经心血管造影检查证实,21例有手术结果对照.结果:EBT诊断符合率82.4%,超声心动图诊断符合率73.5%.EBT对心外大血管畸形诊断准确率为97.9%,明显优于超声心动图(53.2%).而超声心动图对心内畸形的诊断准确率为95.9%,高于EBT(81.6%).对大血管与心室、房室连接处的畸形二者的诊断准确率基本相同.结论:超声心动图与EBT检查相结合,可明显提高先天性心脏病的诊断准确率,减少有创的心血管造影检查.     

超声心动图分段分析诊断复杂先天性心脏病的应用价值

目的探讨超声心动图分段分析诊断复杂先天性心脏病的准确率。方法回顾性分析近两年在我院经外科手术或心血管造影证实的26例复杂先天性心脏病患儿,包括中位心3例,镜像右位心1例,右旋心1例,左、右房异构各1例,单心室4例,左、右心室与大动脉连接不一致6例,心房与心室连接不一致3例,右室双出口7例,肺动脉闭锁2例,肺静脉畸形引流4例,且所有病例均存在两种以上畸形,以上病例均按照超声心动图分段分析方法顺序检查。结果手术证实26例患儿超声误诊漏诊左房异构1例,心室左袢2例,合并其他心脏血管畸形1例。结论超声心动图分段分析对大多数复杂先天性心脏病可以做出准确诊断,但对于极为复杂的心内结构及血管异常等还需造影或心导管检查。     

CT血管成像和心动超声在肺静脉异位引流诊断中的价值

目的评价CT血管成像(CTA)和经胸心动超声(TTE)对先天性心脏病伴随肺静脉异位引流的诊断价值。方法回顾性分析CTA检查和3D后处理的41例肺静脉异位引流(APVC)病人,观察异位引流肺静脉的位置、形态及其异位连接(心腔或静脉),以手术或心导管造影所见为参考标准,评价CTA、TTE检查诊断的准确性,分析合并的心脏大血管畸形。结果 41例病人中,30例完全性APVC和11例部分性肺静脉异位引流,CTA诊断的准确率均为100%。TTE检查的准确率为88.9%,完全性和部分性两组准确率分别为93.3%和72.7%。单纯性肺静脉异位引流21例;复杂性20例,合并心脏大血管畸形包括:肺动脉狭窄或闭锁9例,室间隔缺损6例,房间隔缺损2例,单心室5例,右室双出口2例,完全性心内膜垫缺损2例,心房内脏异构6例,大动脉异位4例,主动脉弓发育不良1例,右肺动脉缺如1例。异位肺静脉发育不良:2例肺静脉狭窄,4例共汇发育不良,2例右肺三支肺静脉。CTA检查均明确显示,TTE未明确显示。结论 CTA评价APVC的价值优于TTE,对临床诊断和手术方案的制定起到重要作用。     

64排螺旋CT在发绀型先天性心脏病肺血管成像中的应用

目的 评价64排螺旋CT(multislice spiral computed tomography,MSCT)对于发绀型先天性心脏病肺血管成像的临床应用价值.方法 回顾335例发绀型先天性心脏病患者的64排螺旋CT影像学资料,男218例,女117例,年龄1 d～37岁,中位年龄4岁.其中152例曾行手术治疗,另42例同时行血管造影术(cardioangiography,CAG)检查,对比其结果 并进行统计学分析.结果 152例患者经手术证实肺血管共有271处畸形.64排MSCT确诊258处畸形,符合率95.2%(258/271).42例患者经手术证实109处畸形,64排MSCT确诊102处畸形,符合率93.6%(102/109);CAG确诊106处畸形,符合率97.2%(106/109).MSCT和CAG对比,诊断符合率差异无统计学意义(P>0.05).结论 64排MSCT对发绀型先天性心脏病肺血管畸形的诊断有较高的符合率.且快捷、无创,具有较高的临床应用价值.     

CT血管成像与经胸超声心动图诊断部分型肺静脉异位引流

目的 对比分析CT血管成像（CTA）与经胸超声心动图（Trans Thoracic Echocardiography，TTE）对部分型肺静脉异位引流（PAPVC）的诊断价值。方法 回顾性分析21例PAPVC患者的CTA及TTE特点，并将二者检出情况与手术结果进行对比分析。结果 单纯性PAPVC 2例，CTA及TTE均检出。复杂性PAPVC 19例，CTA误诊1例，TTE误诊6例。CTA与TTE对PAPVC检出率分别为95.2%（20/21）和71.4%（15/21），两者差异具有统计学意义（P＜0.05）。对于已检出的病例，CTA漏诊的合并其他畸形主要为房室间隔缺损和细小血管畸形，而TTE主要为心外血管畸形。结论 TTE的优势在于心内细致结构、尤其是瓣膜病变的检出，可作为PAPVC首选筛查方法。CTA的优势在于心外大血管畸形的检出，可作为TTE的有效补充手段。对于部分肺静脉回流显示不清、疑有心外血管异常及合并其他畸形者应联合两种检查方法，才能最大程度降低漏诊误诊的发生。     

镜像右旋心伴双侧心房、心室肥大1例报告

右旋心是心脏胚胎发育期心脏旋转异常引起的一种先天性畸形,患者心脏呈右位,多合并有心内复杂畸形。本例心脏转位,左右反置但心脏在左侧,心尖指向左侧,各心腔间关系为右旋心右位心的镜中像,称左位心。我院自1956年至今16余万份心电图,仅发现1例,实属罕见。患儿男性,13岁,自幼口唇青紫,活动后紫绀加重。体检:心界向左扩大,心尖搏动位于左第5肋间锁中线外0.5cm,胸骨左缘第3、4肋间闻及Ⅲ—Ⅳ级收缩期杂音,触诊猫颤。X线报告:先天性心脏病,法乐氏五联症,内脏反位。B型超声波示:心脏巨大室间隔缺损,双侧心房心室肥大;肝、脾、肾及大血管左右反位。经右大隐静脉作右心导管检查并经心室造影证实:左右心房心室反位。心电图(附图见第102页)示:     

先天性右位心合并心脏畸形的诊断和手术治疗

目的总结先天性右位心合并心脏畸形的诊断和手术治疗经验。方法回顾性分析3例右位心合并心脏畸形并行外科手术治疗患者的临床资料，着重分析手术方法、结果及预后。结果3例先天性右位心合并心脏畸形的患者，其中镜面右位心2例，右旋心1例。分别合并房间隔缺损、双腔右心室、双上腔、法洛四联症。3例患者均通过超声心动图，X线胸片，腹部B超明确诊断并进行手术治疗。包括房间隔缺损修补，双腔右心室矫治，法洛四联症根治术等。3例均手术顺利，痊愈出院，无并发症。结论右位心合并简单的心脏畸形，超声心动图、X线胸片和腹部B超足以明确诊断，右位心合并心脏畸形积极手术治疗能取得良好疗效。     

Dextrocardia: an analysis of cardiac structures in 125 patients

BACKGROUND: Dextrocardia is associated with multiple and complex congenital cardiac anomalies. Precise anatomical diagnosis is essential for successful surgery. Spectrum of congenital malformations in cases of dextrocardia is based primarily on two-dimensional echocardiographic studies. The purpose of the current study was to use colour Doppler echocardiography in large number of patients. METHODS: Patients of dextrocardia were studied retrospectively, by reviewing database of our echocardiographic laboratory over last 10 years. Standard criteria for diagnosis of situs were used. Detailed segmental analysis for cardiac anatomy and associated malformations was done using previously suggested and well accepted terms and definitions. Cardiac anatomy was confirmed on catheterization and during surgery in few cases. RESULTS: Of total 125 patients, dextrocardia was most common with situs inversus (39.2%) followed by situs solitus (34.4%) and situs ambiguous [26.4% (right isomerism in 18.4% and left isomerism in 8.0%)]. Mean age was 9.2+/-11.2 years (range; 3 days to 60 years), 82 males and 43 females. In situs inversus dextrocardia, majority (73.4%) had concordant atrioventricular (AV) connections while discordant AV connections and univentricular atrioventricular connections (UVAVC) were present in 12.2 and 14.3% patients, respectively. Majority of patients with concordant AV connections (72.2%) also had concordant VA (ventriculo-arterial) connections (conotruncal anomalies were commonest). Similarly, majority of patients with discordant AV connections (66.7%) also had discordant VA connections. Commonly (44.9%), these patients presented with decreased pulmonary blood flow (Qp). Total 28.6% patients had normal intracardiac anatomy (10.2% presented with rheumatic heart disease). In situs solitus dextrocardia, majority (51.2%) had AV concordance while discordant AV connections and UVAVC were present in 41.9 and 7.0% patients, respectively. In patients with concordant AV connections, majority (77.2%) had VA concordance (majority presented with increased Qp due to pre or post-tricuspid shunts). Similarly, majority of patients with discordant AV connections (88.9%) also had discordant VA connections (88.9% presented with decreased Qp). Only 7.0% patients with situs solitus dextrocardia had normal intracardiac anatomy. The striking features of right isomerism were male predominance (male:female ratio 2.2:1), cyanosis with decreased Qp in 86.9%, and high incidence of UVAVC and venous system anomalies (39.1% each). Striking features of left isomerism were biventricular ambiguous AV connections in all except one, presentation with increased Qp in 60.0% and presence of inferior vena caval interruption in 60.0% patients. CONCLUSIONS: Present study, largest study of dextrocardia till date reconfirms that these patients have variable intracardiac anatomy depending upon their situs and types of segmental connections. These patients can present with different haemodynamic subsets, which can be correctly identified by colour Doppler echocardiography. Diagnostic accuracy and a better understanding of the various types of dextrocardia are essential, since improved surgical techniques have made it possible to correct many of these complex abnormalities.     

12导联动态心电图与冠状动脉造影对比分析

目的探讨12导联动态心电图对冠心病的诊断价值。方法将150例12导联动态心电图与冠状动脉造影结果进行对比分析。结果150例患者中，12导联动态心电图阳性84例，其中冠脉造影阳性69例，冠脉造影阴性15例。12导联动态心电图阴性66例．其中冠脉造影阴性43例．冠脉造影阳性23例。在不同年龄组中，男性患者冠脉造影阳性率均高于12导联动态心电图阳性率．但差异不显著（p〉0．05）。女性患者中，65岁以上年龄组，12导联动态心电图阳性率与冠脉造影阳性率一致（p〉0．05）。女性45岁以下及56～65岁年龄组，冠脉造影阳性率均低于12导联动态心电图的阳性率，但差异不显著（p〉0．05）。女性45～55岁年龄组，12导联动态心电图阳性率与冠脉造影阳性率相比较，差异有显著性（p〈0．01）。另外，随着冠状动脉病变支数的增多，12导联动态心电图诊断冠心病的阳性率亦增高。结论12导联动态心电图是临床诊断冠心病的重要无创性检查方法之一，它操作简单、经济、实用。适合临床广泛应用。     

CTA在不同冠心病亚组中的诊断价值

目的评价CT冠状动脉成像（CTA）在不同冠心病亚组中的诊断价值。方法分别利用CTA（采用64层螺旋CT）与冠状动脉造影（CAG）对冠状动脉狭窄程度与冠脉内斑块性质进行对比分析,评价CTA与CAG的诊断符合率,并探讨稳定型心绞痛、不稳定型心绞痛、非ST段抬高性心肌梗死的斑块性质差异及临床意义。结果与CAG相比,CTA在显示冠状动脉病变的敏感性为96．96％,特异性为93．76％,假阴性率3．04％,假阳性率为6．24％,阳性预测值90．25％,阴性预测值为98．11％;以CAG为标准,CTA在显示冠脉斑块的整体符合率为85％;稳定型心绞痛（SAP）、不稳定型心绞痛（UAP）、非sT段抬高性心肌梗死（NSTEMI）的钙化斑块比例顺次降低,而混合斑块与软斑块比例顺次升高。结论CTA与CAG的诊断符合率较高,可用于诊断冠脉病变,并可对冠脉斑块性质作出初步诊断。     

慢性萎缩性胃炎内镜与病理诊断的相关性研究

目的　探讨中重度慢性萎缩性胃炎 (CAG)的胃镜下表现与病理结果的关系。方法　对4 9例中重度CAG的胃镜下诊断及表现与病理学结果进行相关性研究。结果　病理诊断中重度CAG33例 ,轻度CAG1 0例 ,正常 6例。肠上皮化生 (IM) 2 7例 ,异型增生 30例。中重度CAG的胃镜诊断与病理结果比较肉眼符合率为 6 7 35 %。其中 2 0例患者胃镜下美蓝染色后 ,诊断符合率为80 %。胃镜下表现与病理结果比较 ,胃黏膜的各种表现对CAG的阳性预测值均达到 80 %以上 ,多种表现同时存在对CAG阳性预测值可达 90 %以上 ,其阳性率之间比较无显著差异。各种胃镜下表现的灵敏度及特异度均在 95 %以上。黏膜变薄等表现对IM及异型增生的阳性预测值均较低在 70 %以下 ,灵敏度及特异度在 30 %以下。黏膜粗糙不平对IM及异型增生诊断的灵敏度分别为 92 85 %和83 33% ,特异度也均在 70 %左右。结论　中重度CAG的胃镜下诊断符合率较低 ,但是通过对胃镜下表现的认识以及染色技术的应用 ,可提高诊断符合率     

Are Anomalies of the Caval Veins More Common in Complex Congenital Heart Disease?

BACKGROUND AND PURPOSE: Anomalies of the caval veins are considered to be common cardiac malformations. The knowledge of the varieties of the caval venous system is essential for cardiovascular surgery, pacemaker implantation, intensive care medicine or cardiac catheterization. The authors wanted to know, if anomalies of the caval veins are related to the type and complexity of congenital heart disease. MATERIAL AND METHODS: The records of 1,631 patients who were catheterized between 1991 and 2003 were reviewed. RESULTS: 92 of these had anomalies of either the superior or inferior caval vein. 23 had simple congenital heart disease, while in 69 this was considered to be complex (p < 0.001). Embryologic considerations are discussed. CONCLUSION: It could be proven that anomalies of the caval veins are more often related to complex congenital heart disease. Embryologic considerations show at least a coincidence of the development of the caval veins and of congenital heart disease. For clinical work with these patients the knowledge of these anomalies is important.     

The role of cross sectional echocardiography and pulsed Doppler ultrasound in the management of neonates in whom congenital heart disease is suspected. A prospective study

The application of cross sectional echocardiography and pulsed Doppler ultrasound to the management of symptomatic neonates with suspected congenital heart disease was studied in 96 consecutive cases. The ability of echocardiography to establish a complete and accurate diagnosis and a correct management plan was evaluated. Sequential segmental analysis of data from cardiac catheterisation and necropsy identified 536 cardiovascular anomalies. Of the 536 anomalies 512 were correctly diagnosed by echocardiography (sensitivity 95.5%). Seven false positive echocardiographic diagnoses were made (specificity 98.6%). Nearly all the missing diagnoses and all the false positive diagnoses made by echocardiography were extracardiac vascular anomalies. Normal cardiovascular anatomy was at all times correctly identified by echocardiography. In 12 babies (12.5%) a management plan could not be established because of inconclusive echocardiographic findings. Of the 84 proposed plans based on the echocardiographic findings, eight were found to be inappropriate after catheterisation. Thus, 76 babies (79.2%) could have been correctly managed without cardiac catheterisation. The combination of cross sectional echocardiography and pulsed Doppler ultrasound not only allows diagnosis of congenital cardiac anomalies in most neonates but can facilitate appropriate clinical management. Only a minority of neonates with suspected congenital heart disease require cardiac catheterisation and angiography.     

The role of cross sectional echocardiography and pulsed Doppler ultrasound in the management of neonates in whom congenital heart disease is suspected. A prospective study.

The application of cross sectional echocardiography and pulsed Doppler ultrasound to the management of symptomatic neonates with suspected congenital heart disease was studied in 96 consecutive cases. The ability of echocardiography to establish a complete and accurate diagnosis and a correct management plan was evaluated. Sequential segmental analysis of data from cardiac catheterisation and necropsy identified 536 cardiovascular anomalies. Of the 536 anomalies 512 were correctly diagnosed by echocardiography (sensitivity 95.5%). Seven false positive echocardiographic diagnoses were made (specificity 98.6%). Nearly all the missing diagnoses and all the false positive diagnoses made by echocardiography were extracardiac vascular anomalies. Normal cardiovascular anatomy was at all times correctly identified by echocardiography. In 12 babies (12.5%) a management plan could not be established because of inconclusive echocardiographic findings. Of the 84 proposed plans based on the echocardiographic findings, eight were found to be inappropriate after catheterisation. Thus, 76 babies (79.2%) could have been correctly managed without cardiac catheterisation. The combination of cross sectional echocardiography and pulsed Doppler ultrasound not only allows diagnosis of congenital cardiac anomalies in most neonates but can facilitate appropriate clinical management. Only a minority of neonates with suspected congenital heart disease require cardiac catheterisation and angiography.     

Left pulmonary artery sling associated with right pulmonary hypoplasia and ventricular septal defect

The pulmonary artery sling is a congenital malformation where the left pulmonary artery forms a vascular sling that bends around the right border of the lower trachea. Its clinical manifestations are signs of tracheal compression in the first months of life. The diagnosis of this rare anomaly is suspected on radiological and echocardiographic grounds and confirmed by oesophagography, tracheoscopy and angiocardiography. Diagnostic problems may be encountered when the condition is associated with tracheobronchial (50% of the cases) or cardiovascular malformations. In the case reported here respiratory symptoms and heart failure were present in a 1-month hypotrophic infant who also had ventricular septal defect and dextrocardia due to right lung hypoplasia. The pulmonary artery sling was diagnosed by angiography. The severity of the clinical signs precluded all attempts at surgical repair of the cardiovascular anomalies. The child died at the age of 2 1/2 months.