彩色多普勒超声心动图对冠状动脉瘘的诊断价值

目的分析冠状动脉瘘的彩色多普勒超声心动图像特征，探讨彩色多普勒超声心动图诊断冠状动脉瘘的价值。方法应用彩色多普勒超声的二维图像、多普勒频谱和彩色显像对10例冠状动脉瘘的解剖异常及心腔内异常高速血流进行观察。结果彩色多普勒超声诊断的共同特征是：（1）解剖异常的冠状动脉显著扩张，走行迂曲，可间断或全程显示瘘管。（2）单纯冠状动脉瘘时无论冠状动脉瘘人哪个心腔，均可见左室扩大，主动脉根部内径增宽，瘘人右心腔者右室亦扩大。（3）右冠状动脉右心瘘多见，瘘人左心者少见。（4）心腔内异常高速血流，右心瘘者，分流呈双期连续性血流，左心瘘者分流仅见于舒张期。结论彩色多普勒超声心动图对冠状动脉瘘的诊断有很高的直观性及实用性价值。     

超声心动图诊断左冠状动脉右房瘘5例

【】目的:分析左冠状动脉右房瘘的彩色多普勒超声心动图特征,探讨超声心动图对诊断左冠状动脉右房瘘的价值。方法：应用超声心动图的二维图像、彩色显像和频谱多普勒观察左冠状动脉右房瘘的解剖异常及心腔内异常高速血流。结果：超声心动图均可见解剖异常的左冠状动脉显著扩张,走行迂曲,全程追踪显示瘘管,并于心腔内可见异常双期连续高速分流频谱,与冠状动脉造影及手术结果相符。结论：超声心动图对左冠状动脉右房瘘的诊断有很高直观性及实用性价值     

经胸超声心动图评价先天性冠状动脉瘘

目的探讨经胸超声心动图对先天性冠状动脉瘘病变的诊断价值。方法回顾性分析43例先天性冠状动脉瘘手术病例的经胸超声心动图检查结果,并与手术病理结果相对照,计算超声诊断准确率及瘘管走行、瘘口显示率。结果43例患者包括右冠状动脉瘘21例,左冠状动脉瘘19例及双冠状动脉瘘3例。经胸超声诊断准确率为88.4%。瘘管走行的总显示率为68.2%,其中肺动脉瘘瘘管多细小,其瘘管走行显示率为21.4%,瘘至其他心腔的瘘管走行显示率为92.6%。瘘口的总显示率为86.8%,其中单发瘘口的显示率为96.6%,多发瘘口的显示率为75.0%。先天性冠状动脉瘘超声表现为病变冠状动脉起始段增宽、瘘管走行迂曲扩张并瘘入心腔或大血管、瘘口处异常血流信号等。结论经胸超声心动图可作为无创性诊断先天性冠状动脉瘘的首选方法,但对细小瘘管及多发瘘口仍应建议结合冠状动脉造影检查。     

彩色多普勒超声对冠状动脉瘘的诊断研究

目的:探讨二维超声及彩色多普勒血流显像对冠状动脉瘘的诊断价值.方法:应用彩色多普勒超声心动图对11例冠状动脉瘘患者进行检查分析.结果:冠状动脉瘘累及右冠状动脉多于左冠状动脉;累及的冠状动脉均有不同程度扩张;瘘口所在的心腔内均探及形如火焰状的五彩镶嵌异常分流血流信号;瘘入左房、右房、右室及肺动脉显示双期连续性血流频谱,舒张期流速较高,收缩期流速较低,瘘入左室者表现为舒张期湍流频谱.结论:彩色多普勒超声心动图对冠状动脉瘘具有特征性表现及重要的诊断价值.     

彩色多普勒超声诊断冠状动脉瘘的临床应用价值

目的 评价彩色多普勒超声在冠状动脉瘘诊断中的方法与临床应用价值.方法 应用彩色多普勒超声诊断仪,观察12例冠状动脉瘘的病变部位、数目、血流状态,并与手术结果进行对照分析.结果 彩色多普勒超声诊断的12例中患者右冠状动脉瘘8例,左冠状动脉瘘4例.右冠状动脉瘘入右房5例,瘘入右室3例.左冠状动脉入左房2例,瘘入肺动脉2例,合并房间隔缺损1例.术前超声心动图诊断与手术结果完全一致.结论 彩色多普勒超声是诊断冠状动脉瘘的有效方法.在治疗方案的选择和术后疗效评价中均有重要的临床应用价值.     

彩色多普勒超声心动图诊断冠状动脉瘘的价值

目的：探讨各类型冠状动脉瘘（CAF）的彩色多普勒超声心动图（CDE）图像特征及超声心动图诊断CAF的价值。方法：对11例CAF患儿进行回顾性分析，寻找CAF图像特征及规律性。结果：根据CDE图像特征对11例患儿作出正确诊断。CAF的CDE具有明显的图像特征：①在瘘入的心腔或肺动脉内彩色多普勒血流显像（CDFI）显示异常血流束信号；②瘘的冠状动脉明显扩张；③右冠状动脉瘘多见，瘘入右心系统者最常见；④瘘入右房、右室、左房、肺动脉时均为双期连续湍流频谱，瘘入左室时为舒张期湍流频谱。结论：CDE对CAF的诊断有很高的价值。     

胎儿冠状动脉瘘的超声心动图评价

目的通过回顾性分析胎儿冠状动脉瘘的超声图像特征,探讨超声心动图在胎儿冠状动脉瘘诊断中的价值。 方法选取2016年1月至2017年12月在武汉协和医院行产前超声心动图检查诊断为冠状动脉瘘的胎儿9例,对其二维超声图像、彩色多普勒图像、血流频谱特征及其合并畸形情况进行分析,其中5例与出生后超声诊断结果或引产后尸检结果进行对照。 结果产前超声心动图诊断为冠状动脉瘘的9例胎儿,均可观察到受累冠状动脉扩张,彩色多普勒血流成像（CDFI）可显示冠状动脉瘘管的起源、走行、内径、血流情况及瘘入部位,频谱多普勒可探及瘘管内特征性血流频谱。9例胎儿中,2例出生后经超声心动图检查确诊为冠状动脉瘘,3例引产后尸检证实为冠状动脉瘘,4例引产后未行尸检。 结论胎儿冠状动脉瘘的超声心动图具有特征性改变,产前正确诊断胎儿冠状动脉瘘对评估胎儿预后及早期治疗有重要意义。     

彩色多普勒超声诊断右冠状动脉左室瘘1例

患者 ,男 ,5 7岁。因“间断胸闷、胸痛伴乏力三个月”就诊。查体 :生命体征平稳 ,神清语明 ,无贫血外貌 ,口唇无紫绀 ,听诊心律规整 ,胸骨左缘第三、四肋间可闻及较粗糙的舒张期杂音。术前超声所见 :左心室扩大 (6 .8cm) ,余各房室腔内径正常。左冠状动脉起源正常 ,内径不宽。右冠状动脉自右冠窦发出 ,开口处增宽约 1.44 cm,起始部内径明显增宽约 2 .8cm (见图1) ,主干向右后沿右房室沟下行 ,走行迂曲 ,内径普遍增宽 ,粗细不均 ,最后于左室后侧壁心底部近二尖瓣后瓣附着处瘘入左室 ,瘘口内径为 1.3cm。主动脉瓣未见脱垂。彩色多普勒显示 :右…     

先天性冠状动脉瘘的产前超声特征分析

目的 分析先天性冠状动脉瘘的产前超声图像特征,总结其预后及转归。方法 回顾性分析我院产前超声检出的7例先天性冠状动脉瘘胎儿的检查资料,总结其产前超声表现,随访其临床结局。结果 产前超声诊断的7例先天性冠状动脉瘘胎儿中,孤立性冠状动脉瘘3例,合并其他畸形4例;4例为左冠状动脉瘘,3例为右冠状动脉瘘。二维超声表现：7例于左室流出道切面主动脉根部可见受累的冠状动脉显示不同程度的增宽扩张,内径2.5～4.4 mm;2例于四腔心切面可见左、右心不对称,左心偏小,其余5例基本对称。CDFI表现：7例胎儿主动脉根部或房室沟等区域探及管状异常湍流血流信号。临床结局：2例孤立性冠状动脉瘘出生后手术效果好;1例合并肺动脉狭窄、室间隔缺损及心包积液,孕37周胎死宫内;4例引产。结论 应用产前超声发现主动脉根部或房室沟等切面探及异常明亮的管状血流信号时,通过追踪其起源、走行及终点后需警惕冠状动脉瘘可能,对胎儿出生后早期治疗具有重要的临床价值。     

彩超诊断右冠状动脉右室瘘1例

患儿,男,2岁.听诊发现心脏杂音.超声检查:左、右心室扩大,房室间隔连续完整,大动脉短轴切面见右冠状动脉开口明显增宽,内径约为12mm,左冠状动脉正常.CDFI显示右冠状动脉口可测及舒张期正向血流,峰值流速1.2m/s.四腔心切面右心外侧房室交界处可见一连续五彩血流,舒张期峰值血流速度达4.2m/s.超声考虑为先天性心脏病,右冠状动脉近端扩张,右冠状动脉右室瘘.后经北京阜外医院手术证实.     

Doppler color flow imaging in detection and mapping of left coronary artery fistula to right ventricle and atrium

Two patients who had left coronary artery fistulas that drained into the right ventricle (case 1) and right atrium (case 2) were studied with combined two-dimensional echocardiography and Doppler color flow imaging. The origin of the fistulas from the left coronary artery, their course, and drainage sites were readily identified. These cases illustrate the enhanced identification of left coronary artery fistulas and the drainage sites with the addition of Doppler color flow imaging to two-dimensional echocardiography.     

Doppler Echocardiographic Features of Coronary Artery Fistula: Report of 8 Cases

Coronary artery fistula is a rare congenital anomaly in which the involved coronary artery empties into a cardiac chamber, pulmonary artery, or other structure. Its diagnosis can be made noninvasively by finding a dilated coronary artery by 2-dimensional (2D) echocardiography, and its drainage can be detected by color flow mapping. We describe features of coronary artery fistulas in 8 patients whose condition was prospectively diagnosed by Doppler echocardiography with color flow mapping. The right coronary artery was involved in 4 cases and the left coronary artery in 4. Four fistulas drained to the right ventricle, 2 to the right atrium, and 2 to the pulmonary artery. In 1 patient who had left and right coronary fistulas to the pulmonary artery, only the first was diagnosed noninvasively. The diagnosis of coronary fistulas can usually be made by 2D echocardiography with color flow mapping. However, fistulas to the pulmonary artery may be more difficult to detect by 2D echocardiography because the coronary artery may be of normal size and the shunt small. (J Am Soc Echocardiogr 1999;12:149-54.)     

Precise evaluation of a complex coronary arteriovenous fistula: the utility of transesophageal color Doppler

The transesophageal color flow Doppler appearance of coronary artery fistulas have not been described previously. We present a patient with a fistulous connection between the right coronary artery and the right atrium with an additional connection to the coronary sinus. The fistulous connection to the coronary sinus, confirmed at operation, was only diagnosed with transesophageal color flow Doppler and missed on both transthoracic echocardiography and cardiac catheterization. In addition, intraoperative transesophageal echocardiography was extremely useful in confirming closure of both these fistulas, thus confirming a successful operative result.     

冠状动脉瘘的超声诊断与临床对照分析

目的 进一步探讨超声心动图诊断冠状动脉瘘的价值。方法 对18例冠状动脉瘘患者的超声心动图表现与手术所见进行对比分析。结果 18例冠状动脉瘘有17例首先由超声诊断，采用彩色多普勒血流显像诊断的6例右冠状动脉瘘和4例左冠状动脉瘘的诊断符合率为100%，8例单发瘘的诊断符合率为100%，2例多发瘘病例，手术前未提示多个瘘口，5例左室瘘的二维超声心动图显示瘘口特征非常清楚。10例右室瘘和3例右房瘘超声虽然提示了瘘入腔室，但有6例未提示具体引流部位。结论 研究冠状动脉瘘的具体引流部位和多发瘘是超声工作者需要进一步做的工作。     

彩色多普勒超声心动图诊断冠状动脉起源异常的价值

目的　探讨彩色多普勒超声心动图在诊断冠状动脉起源异常中的价值。方法　应用彩色多普勒超声心动图对 6例患者进行检查 ,观察左、右冠状动脉主干的起源部位、走行、血流方向 ,测量冠状动脉主干内径、左室射血分数 (LVEF) ,观察合并的其他心血管畸形及瓣膜反流情况 ,并与冠状动脉造影、手术结果进行对比。结果　 4例左冠状动脉主干起源于肺动脉 ,1例左前降支起源于肺动脉 ,1例副冠状动脉起源于肺动脉。主要合并的心血管畸形有室间隔缺损、房间隔缺损、完全性心内膜垫缺损等。超声心动图诊断结果与冠状动脉造影及手术探查结果完全符合。超声心动图测量的左、右冠状动脉内径和LVEF与冠状动脉造影测值间高度相关(r分别为 0 .94、0 .96、0 .89,均 P <0 .0 1) ,两种方法测值间差异无显著性意义 (P >0 .0 5 )。结论　彩色多普勒超声心动图可明确诊断冠状动脉起源异常 ,为手术治疗提供可靠依据     

Assessment of transmural coronary blood flow with intraoperative transesophageal color Doppler echocardiography during coronary revascularization.

Intraoperative color Doppler transesophageal echocardiography with a 4- to 7-MHz transducer was performed on 28 consecutive patients who underwent coronary artery bypass grafting to image and evaluate the transmural coronary blood flow before and after cardiopulmonary bypass. The transmural coronary flow was visualized in 26 (92.8%) of 28 patients in the inferior wall and in 13 (46.4%) of 28 patients in the lateral wall. The peak diastolic flow velocity of the transmural coronary artery in the inferior and lateral wall was significantly increased after coronary revascularization in patients with a successful bypass graft to the right coronary artery (from 34.0 +/- 19.7 to 64.9 +/- 30.9 cm/s, P <.001, n = 10) and to the left circumflex coronary artery (from 35.1 +/- 18.6 to 62.1 +/- 21.1 cm/s, P <.001, n = 10). No significant changes were observed in patients with no bypass graft to the right or left circumflex coronary artery. Coronary blood flow can be mapped and the velocity measured with Doppler transesophageal echocardiography with a high-frequency (4- to 7-MHz) transducer. Assessment of the transmural coronary flow may provide valuable information and aid in decision making during surgical revascularization.     

Rupture of the coronary artery after blunt nonpenetrating chest wall trauma detected by color Doppler echocardiography: a case report.

We report a rare case of a ruptured papillary muscle of the anterior leaflet of the tricuspid valve and the rupture of the septal branch of the left anterior descending coronary artery with drainage into the right ventricle after blunt nonpenetrating chest wall trauma. Both abnormalities were detected by transthoracic 2-dimensional and color Doppler echocardiography, and the septal branch rupture was confirmed by coronary angiography. The leading echocardiographic sign of the rupture of the coronary artery was intramyocardial mosaic-colored flow, representing the turbulent high-velocity flow in the ruptured coronary artery. Hypokinesis of the anteroseptal myocardial segments and the presence of Q waves in leads V1 through 4 on the electro-cardiogram were suggestive of anteroseptal myocardial infarction. We conclude that the history of chest trauma, the electrocardiographic changes, and wall motion abnormalities should be stimuli for a careful color Doppler flow "mapping" of the myocardium for possible identification of a coronary artery rupture.     

肺静脉血流频谱评价冠心病患者左心室舒张功能的价值

目的：应用彩色多普勒超声心动图研究冠心病患者肺静脉血流频谱对左心室舒张功能的价值。方法：用彩色多普勒超声心动图检测冠心病患者和相同年龄组正常人各45例的右上肺静脉血流频谱峰值（Sp、Dp、ap）及其速度时间积分（Si、Di、ai），与所检测的二尖瓣口血流频谱峰值（Ep、Ap)、速度时间积分（Ei、Ai)及等容舒张时间相比较，将结果对比分析。结果：冠心病组ap、ai较正常组显著增大，Si、Dp、Di和Dp/ap、Di/ai值明显减小，ap、ai增大幅度与左室舒张功能明显相关。二尖瓣口血流频谱测值一般反映了左室舒张功能状态，但对几例出现的“伪正常”频谱表现难以明确评价。结论：肺静脉血流可直观反映冠心病患者左心房内的压力状态，其频谱特征与二尖瓣口血流频谱结合评价左室舒张功能较用二尖瓣口血流频谱一种方法更加准确可靠。     

Anomalous origin of the right coronary artery from the left sinus of valsalva: transthoracic echocardiographic diagnosis.

Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital defect that can be difficult to diagnose by echocardiography. We describe an infant with a ventricular septal defect that was diagnosed prospectively by transthoracic echocardiography as an anomalous origin of the right coronary artery from the left sinus of Valsalva. Subcostal imaging and Doppler color flow mapping were instrumental in the echocardiographic diagnosis of this unusual coronary abnormality.     

Two-dimensional and Doppler transesophageal echocardiographic delineation and flow characterization of anomalous coronary arteries in adults.

OBJECTIVES: The purpose of this study was to examine the use of transesophageal echocardiography (TEE) in the identification and flow characterization of congenital coronary anomalies. BACKGROUND: Congenital coronary anomalies in adults are rare but may cause serious cardiac complications. The use of TEE in evaluation of this entity has not been well defined. Very little is known regarding flow patterns in anomalous coronaries assessed by Doppler TEE. METHODS: A total of 32 consecutive adult patients were studied using TEE to define the origin, course, and proximal flow pattern of suspected coronary anomalies. RESULTS: Coronary anomalies identified using TEE included anomalous origin from the pulmonary trunk (n = 2), right sinus (n = 18), left sinus (n = 9), single coronary (n = 2), and left main coronary fistula (n = 1). Multiplane TEE performed in 20 cases simplified the delineation of more complex coronary anomalies. The origin was identified in all patients, proximal course delineated in 31, and proximal flow pattern characterized by pulsed Doppler in 23 of 32 patients. In 16 anomalous left main, left anterior descending, or left circumflex coronary arteries, an abnormal systolic flow pattern (ie, systolic/diastolic time-velocity integral ratio >1) occurred exclusively (P <.001) when the anomalous artery had an intermediate (100%; 5/5) versus anterior or posterior course (0%; 0/11) relative to the aortic and pulmonary artery trunks. A systolic flow pattern was also evident in 4 (80%) of 5 patients with an anomalous right coronary artery with an intermediate course. CONCLUSIONS: TEE, particularly with a multiplane probe, has an important complementary role to coronary angiography in delineating the proximal course and pattern of flow in anomalous coronaries. Predominant systolic flow pattern in anatomically left proximal anomalous coronaries signifies an intermediate course between the aorta and the pulmonary trunk and may be clinically useful for risk stratification.