经胸超声心动图与经食管超声心动图对比观察成人多发房间隔缺损

目的 探讨经胸超声心动图(TTE)与经食管超声心动图(TEE)对成人多发继发孔房间隔缺损(MASD)的诊断价值.方法 成人MASD患者30例接受TTE检查,其中25例接受TEE检查,26例接受心导管检查;20例接受MASD封堵术介入治疗,18例封堵成功;4例接受体外循环下开胸修补术.结果 TTE与TEE全部诊断继发孔房间隔缺损,TTE诊断缺损数量准确率60.00%(18/30);TEE诊断缺损数量准确率96.00%(24/25).MASD的彩色多普勒血流显像(CDFI)特征性改变是显示多束过房间隔左向右五彩镶嵌分流束血流信号,即CDFI"漏勺征".结论 TTE对成人MASD诊断有一定难度,TEE有特异性诊断价值.开胸修补术治疗成人MASD行TTE检查即可,行封堵术介入治疗成人MASD必须行TEE检查以明确诊断缺损的数量和位置.     

Cor triatriatum dexter: transesophageal echocardiographic diagnosis and 3-dimensional reconstruction.

Cor triatriatum dexter is an unusual cardiac abnormality with division between the sinus and primitive atrial portions of the right atrium. Three-dimensional echocardiography is a novel technique that defines this entity.     

超声诊断房间隔缺损合并三房心一例

<正>1病例资料患者,女,81岁。两年前劳累后出现心悸气短,休息后好转,无胸闷胸痛及咳嗽症状,未诊治。近日轻微活动即出现心悸气短,并有双踝部水肿,不能平卧收入院。查体:     

Utility of three-dimensional transthoracic echocardiography in diagnosis of intermediate atrioventricular septal defect: report of an adult case

We present the case of a 54-year-old male with an intermediate atrioventricular septal defect (AVSD). He was referred to our institute for treatment of shortness of breath. Two-dimensional transthoracic echocardiography demonstrated an ostium primum defect of the atrial septum, a common atrioventricular valve with mild regurgitations, and an interventricular communication, which are the features of complete AVSD. However, three-dimensional transthoracic echocardiography (3D-TTE) could clearly visualize the tricuspid pouch (i.e., persistence of the tissue in the endocardial cushion), a feature of partial AVSD. 3D-TTE appears to be a useful modality for diagnosis of intermediate AVSD.     

Cor triatriatum with isolated pulmonary venous stenosis in an adult: diagnosis with transesophageal two-dimensional echocardiography

The diagnosis of cor triatriatum in an adult was made from routine two-dimensional transthoracic echocardiography. The findings of aliasing and turbulence in the roof of the left atrium suggested pulmonary venous stenosis. A transesophageal echocardiogram defined both the hemodynamic features of nonobstructing cor triatriatum and the presence of isolated pulmonary venous stenosis. The clinical use of transesophageal echocardiography with color flow Doppler in the elucidation of complex anatomic substrate is demonstrated.     

经胸与经食管超声心动图在房间隔缺损介入治疗中的应用

目的探讨经胸与经食道超声心动图在房间隔缺损（ASD）经皮介入治疗中的应用。方法选择2005年5月至2009年9月期间在本院接受经皮房间隔缺损封堵术的92例患者,所有患者均经过临床、心电图、X线平片及经食管超声（TEE）和／或经胸超声心动图（TTE）检查诊断为继发孔型ASD,并根据超声心动图检查结果选择封堵器大小,均经股静脉途径放置封堵器,患者术后即刻、1周复查1TrE、心电图。结果共有91例患者封堵成功,1例患者因封堵器脱落行急诊手术,经胸与经食管超声对ASD直接测量,差异有统计学意义。结论ASD介入治疗总体有效,术前慎密综合超声心动图检查结果选择适合封堵术患者及选择封堵器直径是保障治疗成功的关键,经食管超声在ASD经皮封堵术治疗中仍有重要的使用价值。     

Fenestrated atrial septal aneurysm: diagnosis by transesophageal echocardiography

The diagnosis of atrial septal defect by transthoracic echocardiography remains difficult in a small subset of patients because of either suboptimal acoustic windows or unusual anatomy, for example, fenestrated defects. We report the case of a 55-year-old woman with a fenestrated atrial septal aneurysm that was incompletely visualized by transthoracic echocardiography. Subsequent transesophageal echocardiography demonstrated three defects within the atrial septal aneurysm with left-to-right shunting across each defect. Normal pulmonary venous connections were also defined. All echocardiographic findings were confirmed at surgery. This case demonstrates the additional diagnostic accuracy of transesophageal echocardiography for detecting disease of the atrial septum.     

Association of atrial tachyarrhythmias with atrial septal defect, Ebstein's anomaly and Fontan patients

The number of adults with congenital heart disease is increasing as medical and surgical palliation for congenital heart lesions improves. With this comes long-term complications of congenital heart disease such as the increased risk of atrial tachyarrhythmias. Atrial septal defect, Ebstein's anomaly and post-Fontan patient subsets are particularly important to focus on due to their unique characteristics and association with atrial tachyarrhythmias. Reviews, randomized controlled trials, and meta-analyses were obtained using electronic search strategies such as Medline and the Cochrane Library. References of electronically obtained studies were then used to obtain additional relevant studies. Sources were deemed relevant if they discussed the relationship between atrial septal defects/Ebstein's anomaly/Fontan procedure and atrial tachyarrhythmias in respect to incidence, mechanism, recurrence or treatment. Selected sources were then stratified on the basis of quality. Patients in these subsets of congenital heart disease are at increased risk of atrial tachyarrhythmias for a variety of reasons when compared with the general population. It is necessary for pediatric and adult cardiologists alike to understand these differences, as well as their implications in diagnosis and management of such occurrences.     

多平面经食道超声心动图诊断继发孔型房间隔缺损的应用价值

目的：探讨多平面经食道超声心动图（MTEE）诊断继发孔型房间隔缺损（ASD）的应用价值。方法：选择本院2007年7月~2009年5月超声诊断ASD患者63例,其中18例行开胸手术修补成功,18例行经皮Amplatzer伞封堵成功。结果：63例ASD患者中,TTE漏诊5例（卵圆孔未闭3例,小型ASD 2例）,全部病例MTEE均清晰显示房间隔回声中断及彩色过隔血流束。18例行开胸手术修补的ASD患者,证实其解剖类型为上腔静脉型4例,筛孔状3例,混合型3例,下腔静脉型3例,中央型5例;TTE除诊断1例上腔静脉型ASD与手术结果一致以外,其余17例均诊断为继发中央孔型ASD;MTEE误将2例下腔静脉型ASD和1例中央型伴底边筛孔状ASD诊断为单纯中央型ASD,其余15例与手术结果一致。结论：MTEE在ASD的解剖分型诊断中具有重要的临床意义,并能评估缺损边缘组织情况,可作为指导治疗的重要依据。     

多平面经食管超声心动图在成人房间隔缺损介入治疗中的应用

探讨多平面经食管超声心动图在成人房间隔缺损介入治疗中的价值。方法应用ＭＴＥＥ行术前筛选、术中监测和术后随访。结果３６例经ＭＴＥＥ诊断为各型ＡＳＤ,１２例符合治疗适应证（３３％）。１８例用球囊导管探测ＡＳＤ大小。ＭＴＥＥ的声像直径和球囊探测的伸张直径高度相关,伸张直径＝１．２１（ＭＴＥＥ声像直径）－０．１３。     

Comparison of left atrial dimensions by transesophageal and transthoracic echocardiography.

Left atrial (LA) size, as determined by transthoracic echocardiography (TTE), predicts the risk of atrial fibrillation and stroke and the success of cardioversion. Transesophageal echocardiography (TEE) is increasingly used in these clinical situations. However, unlike TTE, measurement of LA size by TEE has not been standardized. To validate TEE measurement, we determined LA dimensions in 4 standard views by TTE at the same time in 121 patients undergoing TEE. The mid-esophageal basal short-axis view at the level of the aortic valve (TEE 30-60) was the only view in which complete visualization of a LA axis of measurement could be obtained with an acceptably high yield (97.2%). The measurement from this view provided a value that had the highest correlation between TTE and TEE (r = 0.758, P <.0001, 95% confidence interval 0.68-0.86; bias 0.37 +/- 1 cm). Overall, TEE underestimated the LA dimension by 9% compared with TTE. These results suggest that the short-axis view at the level of the aortic valve is the preferred site for measuring the LA dimension by TEE.     

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.     

经食管超声心动图在经胸微创封堵室间隔缺损术中的应用

目的评价经食管超声心动图(TEE)在经胸微创封堵室间隔缺损病例选择和治疗中的应用价值.方法 2007年1月至2010年10月我中心对164例单纯室间隔缺损患者进行经胸微创封堵手术,其中膜周室间隔缺损138例,肌部室间隔缺损3例,流出道部室间隔缺损23例.采用四腔观、大动脉短轴观、左心室长轴观、五腔观、右心室流入道观等评估患者采用微创封堵的可能性.结果164例患者中152例(92.7%)植入封堵器成功封堵.全部病例随访3个月以上,无Ⅲ度房室传导阻滞和瓣膜并发症.5例存在少量左向右反流者3例自愈.结论 TEE在经胸微创封堵室间隔缺损病例选择术中具有重要价值,选择好适宜手术的病例是手术成功的关键.     

超声诊断三尖瓣缺如合并房间隔缺损1例

病例男,11岁,因活动后口唇青紫7年入院。查体：发育正常,口唇发绀．呼吸略促。心电图提示实性心律,律齐,右心房肥大,该患儿4岁左右开始出现活动后的口唇紫绀,近年来逐渐加蓖,活动后胸闷气急。超声心动图表现：     

超声诊断镜像右位心合并房间隔缺损的三房心1例

患者女,30岁.以"晕厥待查"入院.自幼发现先天性心脏病,1997年于生育后出现乏力症状,外院诊断为"先天性心脏病,房间隔缺损,右位心",行房间隔缺损修补术.查体:心尖搏动位于右锁骨中线内1.5 cm,心率72次/分,律齐,心音低钝,心前区可闻及吹风样杂音.24小时动态心电图:窦性心律;偶发室性期前收缩(时而成对);偶发房性期前收缩(时而成对);ST-T改变.     

超声心动图诊断部分型心内膜垫缺损合并房间隔肿物1例

<正>患者男,60岁,因发作心慌半年余,劳力性气短、胸闷1月余来我院就诊。体格检查:心界稍大,心率70次/min,律齐,P2亢进,胸骨左缘第三四肋间可闻及2～6级收缩期杂音,传导局限。超声心动图检查:于心尖四腔切面见房间隔下部近十字交点连续中断,缺损口大小为1.2 cm,可见自左房向右房血流信号(图1,2)。于房间隔中部卵圆窝处见一大小约1.5 cm×1.1 cm     

超声诊断胎儿心脏继发隔及卵圆瓣缺失致小儿房间隔缺损1例

<正>孕妇,32岁,孕2产1。孕25周来我院行胎儿心脏筛查,超声检查:胎儿心脏位置、四腔心比例、两大动脉走行关系、三血管气管切面及主动脉弓切面均正常,室间隔连续完整。四腔心切面反复扫查未见继发隔及其上的卵圆瓣回声,房间隔回声失落约7 mm(图1)。CDFI:主动脉瓣、二尖瓣及肺动脉瓣未见反流信号,三尖瓣探及少量反流信号(图2),动脉导管及两大动脉血流速度正常,主动脉瓣上血流速度103 cm/s,肺动脉瓣上血流速度