超声心动图在经皮二尖瓣缘对缘修复术中的应用进展

目前,经皮二尖瓣缘对缘修复术是治疗二尖瓣关闭不全的有效方式之一。超声心动图检查在该手术前可对二尖瓣病变的程度准确评估,对具体病变的部位做准确定位;在术中,可对导丝引导、钳夹装置释放等进行指导,并实时监测左心室壁运动及左心功能;在术后,可对手术近远期疗效进行评价。近年来,随着临床介入治疗的开展与提高,超声心动图在二尖瓣结构病变的介入治疗过程中发挥了一定的作用,具有重要的价值。     

超声心动图用于风湿性心脏病二尖瓣狭窄的临床分析

目的 研究超声心动图用于风湿性心脏病二尖瓣狭窄中的价值。方法 回归分析2017年1月~2018年1月在我院诊治的46例风湿性心脏病二尖瓣狭窄患者临床资料,研究其超声心动图临床特点。结果 46例患者中轻度狭窄19例（41.30%）、中度狭窄23例（50.00%）、重度狭窄4例（8.69%）。结论 采用超声心动图诊断风湿性心脏病二尖瓣狭窄,不仅对患者无创伤,而且操作简单、方便。同时可以判断出病情的严重程度,对临床诊治风湿性心脏病二尖瓣狭窄具有重要的价值。     

经胸超声心动图诊断心脏黏液瘤

目的：探究经胸超声心动图检查诊断心脏黏液瘤的价值。方法选取2009年6月~2014年9月我科诊断的心脏黏液瘤35例，均经本院或外院手术及病理证实，对患者进行资料的回顾性分析。结果35例黏液瘤均为经胸超声心动图检出，其中右房黏液瘤7例，左房粘液瘤26例，左、右室粘液瘤各1例，大部分患者都有特征性的超声表现。结论超声心动图不仅能对心脏粘液瘤作出定位及定性诊断，并能对其引起的心脏血流动力学改变进行分析，给临床手术提供帮助。     

经会阴高频超声联合经直肠腔内超声在肛肠疾病诊断中的应用探讨

目的 探讨经会阴高频超声联合经直肠腔内超声在诊断肛肠疾病中的应用价值.方法对54例肛肠疾病患者(22例肛瘘,14例肛周脓肿,12例直肠癌,6例肛门直肠周围间隙感染)行经会阴高频超声和,或经直肠腔内超声检查.并将检查结果与手术所见及病理结果相对照.结果 除4例肛瘘患者未能明确瘘管内口位置,1例直肠癌患者超声未能明确诊断外,其余超声检查结果均与临床诊断相符合.结论 应用经会阴高频超声联合经直肠腔内超声检查,对肛瘘的走行及内口的定位、肛周脓肿的定位、直肠癌的浸润范围及盆腔淋巴结情况有非常高效的临床诊断价值.     

彩色多普勒超声心动图诊断右冠状动脉右室瘘的价值

目的 彩色多普勒超声心动图诊断右冠状动脉右室瘘时,对临床手术具有指导价值.方法 两例心前区双期杂音的患者,经彩色多普勒超声心动图检查.结果 两例手术证实右冠状动脉右室瘘.并且痿口的部位和数目与彩超诊断吻合.结论 说明彩色多普勒超声心动图诊断右冠状动脉右室瘘准确性,并且能明确瘘口的数目和部位,对手术切口位置的选择有重要意义.     

超声心动图对诊断双腔右心室的价值

目的 探讨超声心动图对诊断双腔右心室（DCRV）的价值；方法 总结1995年1月-2001年5月间经手术证实为双腔右心室的12例住院病例资料，分析其超声心动图特点，并与手术结果进行对照；结果 超声心动图上右心室腔内室上嵴至右心室游离壁见粗大肌束横跨，中央孔狭窄，将右心室分成高压腔及低压腔，彩色多普勒血流显像（CDFI）在中央孔示五色镶嵌的湍流，CW估测中央孔狭窄压差来判断病变程度；12例患，超声心动图诊断DCRV与手术符合10例，符合率为83.3%；DCRV以合并室间隔畸形最为常见；结论 超声心动图在诊断DCRV及其合并心脏畸形等方面具可靠价值，已成为临床上术前正确诊断及术后疗效评价重要手段。     

四维经食管超声心动图在二尖瓣成形术中的应用

目的 探讨四维经食管超声心动图(4D-TEE)技术在二尖瓣成形术(MVP)中的应用价值。方法 回顾性分析2019年2-7月安徽医科大学第一附属医院行MVP的25例二尖瓣反流患者的临床资料,其中男15例、女10例,年龄(55.56±14.40)岁。患者MVP术前均行4D-TEE检查,精准评估二尖瓣反流的病因及病变分型、病变位置和反流程度,测量左-右纤维三角间距离、收缩期瓣环前外侧至后内侧直径(DAlPm)、瓣环前后径(DAP)、瓣叶各个分区(将二尖瓣前叶和后叶的外、中、内部分别命名为A1~A3和P1~P3)的高度等参数,依据检测结果制定手术方案。术中探查对术前超声检测结果进行验证,并选择合适的成形环尺寸,完成MVP操作后,利用亚甲蓝染色直视下测量瓣叶对合高度。心脏复跳后再次行TEE检查,测量瓣叶对合高度,即刻评估手术效果。21例MVP患者术后3个月行经胸超声心动图(TTE)检查,再次评估二尖瓣反流程度。(1)观察术前通过4D-TEE诊断的二尖瓣反流的病因和病变分型、病变位置、反流程度,以及与术中探查结果的一致性;(2)比较术前4D-TEE所得的二尖瓣各参数与手术最终使用的成形环尺寸的相关性;(3)比较心脏复跳后利用TEE测得的对合高度与术中术者在直视下利用亚甲蓝染色测量的对合高度的相关性等;(4)分析术后3个月反流程度的影响因素。结果 术前4D-TEE的检查结果与术中探查的结果对比,25例患者病因和病变分型诊断的准确率为96.0%(24/25)。对病变部位发生在瓣叶的单一区域或某两个区域诊断的准确率为14/14,对交界区病变及多个区域联合病变诊断的准确率分别为2/3、4/5。术前4D-TEE评估二尖瓣反流程度2级6例、3级2例、4级17例,与术中探查结果一致。通过术前4D-TEE测得的各指标对术中成形环尺寸的逐步多元线性回归分析显示,DAP(X₁)、左右纤维三角距离(X₂)两个参数进入回归模型,建立多元线性方程:成形环尺寸^Y=10.506+0.230X₁+0.395X₂,模型有统计学意义(P＜0.01),R²为0.613,提示模型拟合的效果良好。DAP的标准化偏回归系数为0.486,左-右纤维三角间距离的标准化偏回归系数0.450,提示二者对成形环尺寸的预测均有较大意义。以心脏复跳循环稳定即刻TEE测量的A1-P1、A2-P2、A3-P3的对合高度及三个对合缘的平均对合高度与术中亚甲蓝染色直视下测量的对合高度进行Pearson相关性分析,四组相关系数分别为0.838、0.916、0.951、0.953,均呈正相关(P值均＜0.01)。分析术后3个月反流程度的影响因素,进行逐步logistic回归分析结果显示,平均对合高度≤7 mm为术后反流的危险因素,比值比为30.0(P＜0.05),提示平均对合高度≤7 mm的患者术后更容易出现反流再次加重。结论 4D-TEE不仅可以在MVP术前精准地判定二尖瓣反流的病因和病变分型、病变位置及反流程度,并根据测量的定量参数预测术中实际使用的成形环尺寸,协助外科医生手术方案的决策,而且可以在术中实时评估手术疗效,提高手术的成功率;另外,它提供的参数对术后早期的成形效果也起到了一定的预测价值,具有相当重要的临床应用前景。     

经胸超声心动图无创性评价先天性主动脉瓣病变

目的 评价经胸超声心动图在诊断先天性主动脉瓣病变中的应用价值.方法 临床确诊的先天性主动脉瓣病变患者43例,其中男性25例,女性18例;年龄4～46岁,平均年龄234岁.纯合子家族性高胆固醇血症(HoFH)患者7例,主动脉瓣二叶畸形(BAV)患者35例,罕见的主动脉瓣下移畸形1例.回顾分析经胸超声心动图检查结果,并与彩...     

高低频超声对阑尾病变的病理-影像学对比研究

目的探讨阑尾病变的超声图像特征及超声对阑尾病变的诊断价值.方法应用低频超声(简称低频)及高频超声(简称高频)对87例可疑阑尾病变进行检查并诊断,全部经手术与病理证实.结果阑尾病变的超声诊断符合率:低频为42.3%,高频为94.1%.结论高频对阑尾病变的显示率明显高于低频,其对阑尾病变的直观显示可为临床提供客观的诊断依据.     

超声心动图对冠心病诊断的特异性、敏感性和ROC曲线分析

目的: 对超声心动图诊断冠心病的特异性、敏感性和ROC曲线进行分析,评价其诊断价值。方法: 对114例临床诊断标准为冠心病的患者进行超声心动图检查,观察有无室壁运动异常及其部位,并测量左室射血分数、左室舒张末期内径、左室收缩末期内径、二尖瓣舒张早期峰值流速(E)和舒张晚期峰值流速(A),计算E/A比值。上述患者进行冠脉造影检查,观察3支冠状动脉有无病变、狭窄及狭窄程度,狭窄≥50%诊断为冠心病。结果: 114例中经冠脉造影明确为冠心病患者96例。冠心病超声心动图表现为:节段性室壁运动减弱、消失或矛盾运动。超声心动图诊断冠心病的敏感性为79.2%,定位准确率为75.0%。以左室室壁运动评分≥4为截点,诊断冠心病的敏感性为82.2%,特异性为100%,ROC曲线下面积为0.95(0.89-0.98)。结论: 超声心动图是诊断冠心病首选的无创性诊断方法。利用室壁节段性运动评分诊断冠心病具有较高的特异性和敏感性。     

Butterfly修复技术应用于二尖瓣后叶严重脱垂患者外科修复的中远期疗效分析

目的:探讨二尖瓣Butterfly修复技术应用于二尖瓣后叶严重脱垂患者外科修复的中远期疗效。方法:回顾性分析2016年7月—2019年10月南京大学医学院附属鼓楼医院34例行外科瓣膜修复的二尖瓣后叶严重脱垂患者的临床资料。其中男21例、女13例,年龄33～73岁。患者均在浅低温体外循环下完成二尖瓣Butterfly修复...     

A critical analysis of minor cardiovascular criteria in the diagnostic evaluation of patients with Marfan syndrome.

PURPOSE: The prevalence of most minor cardiovascular manifestations in Marfan syndrome (MFS) is unknown. We assessed the prevalence of minor cardiovascular manifestations in MFS to evaluate their usefulness in a diagnostic setting. METHODS: Seventy-seven patients with MFS (aged 4 months to 55 years) underwent echocardiography to assess the presence of mitral valve prolapse and the diameter of the main pulmonary artery. A subset of 29 adult patients with MFS also underwent magnetic resonance imaging evaluation of the diameters of the thoracoabdominal aorta. RESULTS: Mitral valve prolapse was encountered in 66% of patients with MFS, with an equal distribution of classic and nonclassic mitral valve prolapse. The main pulmonary artery diameter was significantly larger in patients with MFS at all ages when compared with controls. In the adult group (> or = 14 years), we were able to provide a cutoff value of 23 mm to define pulmonary artery dilatation. The descending aorta was enlarged, but with substantial overlap with controls, thus precluding the use of a cutoff value. CONCLUSIONS: Mitral valve prolapse and main pulmonary artery dilatation are common findings in MFS patients at all ages and are easy to assess with echocardiography. Cutoff values to define dilatation of the descending aorta are hard to define, making them of limited value in the diagnostic evaluation. We recommend echocardiographic evaluation of mitral valve prolapse and main pulmonary artery diameter in patients referred for cardiovascular diagnostic assessment for MFS.     

Aortic root dilatation and mitral valve prolapse in the fragile X syndrome

Forty patients with fragile X [fra(X)] or Martin-Bell syndrome, confirmed by chromosome analysis, underwent full cardiac evaluation including physical examination, chest film, electrocardiography (ECG), and M-mode and 2-dimensional echocardiography. Thirty-four males and six females were studied. Although all patients were asymptomatic, seven males were found to have mild aortic root dilatation. All seven also had evidence of mitral valve prolapse. Twenty-two (55%) of the study patients had mitral valve prolapse with either a click or murmur heard on physical examination and confirmation by M-mode echocardiography. The frequency of mitral valve prolapse was the same in males and females, but 80% of males older than 18 years had mitral valve prolapse. These findings support the hypothesis of a connective tissue dysplasia in the fra(X) syndrome.     

Prevalence of mitral valve prolapse in hypertension

Mitral valve prolapse was found in one of 133 patients with hypertension (0.75 percent) studied by two-dimensional echocardiography. This rarity may be related to the presence of hypertrophied papillary muscles that probably pull the chordae tendinae and mitral valve leaflets away from the left atrium in systole, thus preventing their eversion and prolapse.     

Cardiac disease in patients with reversible cerebral ischemic events

The establishment of a possible association between ischemic cerebral attacks and prolapsing mitral valve has been studied in 45 consecutive patients aged 60 years or less with transient cerebral ischemic attacks and reversible ischemic neurological deficits. The study comprised cardiac history, auscultation, electrocardiography and echocardiography. We found only one patient (2%) with mitral valve prolapse but 19 patients (42%) with cardiac abnormalities. Two of the patients with cardiac abnormalities had a flail posterior mitral leaflet, one had ventricular septal defect and one had sclerotic aortic valves. We conclude that all patients with transient cerebral ischemic attacks should be subjected to heart examination, if possible including echocardiography.     

Cardiovascular findings in congenital contractural arachnodactyly: Report of an affected kindred

Three generations of a kindred had a history and physical findings consistent with congenital contractural arachnodactyly (CCA) segregating in an autosomal-dominant manner. Six of the seven affected patients we examined had mitral valve prolapse (MVP) diagnosed clinically or by echocardiography. The family members without CCA did not have MVP. This association of cardiac involvement with CCA further lessens the distinction between CCA and the Marfan syndrome. The indication for ophthamologic and echocardiographic follow-up of patients carrying the diagnosis of CCA is stressed.     

Cardiovascular manifestations in Fabry's disease

Cardiovascular manifestations of Fabry's disease were studied clinically in 10 hemizygous males and 13 heterozygous females. Mitral valve prolapse was found in 5 of 9 hemizygotes and in 5 of 13 heterozygotes examined by echocardiography. Ordinary medical examinations revealed cardiomyopathy in some asymptomatic females, and the diagnosis of the Fabry heterozygote was established by demonstration of specific inclusion bodies in the biopsied myocardium and low a-galactosidase activity in leukocytes. Renovascular hypertension of juvenile onset and thromboembolism were also found in 7 patients. It was concluded that Fabry's disease should always be considered in cases of mitral valve prolapse, cardiomyopathy, renovascular hypertension and thrombosis of unknown etiology, and that the Fabry patients should be followed carefully for the early detection of cardiovascular involvements in this disease.     

Sudden cardiac death owing to pseudoxanthoma elasticum: a case report

A 26-year-old woman collapsed and died suddenly while dancing. Autopsy findings included the cutaneous lesions of pseudoxanthoma elasticum (PXE), a rare genetic disease with autosomal dominant and recessive inheritance patterns. Pathologic findings of PXE (degenerated elastic fibers) were seen in the stenotic epicardial coronary arteries, the intramyocardial arterioles, the subendocardium, the mitral valve, and the blood vessels of other viscera. The mitral valve was slightly myxoid. Intramyocardial arteriolar involvement has not been previously described in PXE. The other cardiac findings have only been described in a few cases. Although mitral valve prolapse in PXE has been shown echocardiographically, it is unclear whether or not the mitral valve findings in this case represent the substrate for this condition. It is important that autopsy pathologists search carefully for the pathognomonic skin lesions of PXE in cases of sudden death associated with coronary disease, mitral valve prolapse, or endocardial lesions. Recognition of this disease is essential for proper genetic counseling of surviving family members.     

An investigation into the frequency of mitral valve prolapse in von Willebrand disease

The reported extremely high incidence of mitral valve prolapse in von Willebrand patients (60%) in combination with multiple signs of mesenchymal dysplasia points to a hitherto unknown pleiotropic effect of the von Willebrand gene and needs further confirmation. Therefore, we looked for the presence of mitral valve prolapse in 19 patients with classical von Willebrand disease. While 58% of these patients had one or more physical findings which could be interpreted as symptoms of mesenchymal dysplasia, we found only one patient with a mitral valve prolapse (5.3%), comparable to the 6% incidence in the normal population. Therefore, we must conclude that there is no association between mitral valve prolapse and von Willebrand disease.     

Mitral valve prolapse and aortic dilatation in the fragile X syndrome

Four patients with the fragile X syndrome including 3 males and one woman, were evaluated for cardiological abnormalities. One patient had an obvious murmur. All 4 were shown to have mitral valve prolapse by echocardiography. Two male patients also demonstrated mild dilatation of the ascending aorta. We recommend thorough cardiological evaluations of all fragile X patients.