超声心动图评价新生儿窒息的左心功能

应用超声心动图（ＵＣＧ）对３５例窒息新生儿进行左心功能测定，显示：窒息儿心内结构测定结果明同于正常对新生儿；窒息儿左室功能测定结果明显低于正常新生儿，将小于正常新生儿测的下限数作为判定左室收缩功能降低的标准，则窒息新生儿左室收缩功能降低的检出率为ＬＶＳＶ７８．５７％，ＬＶＥＦ１００％ＳＶＩ７１．４３％△Ｄ％１００％，结果表明应用ＵＣＧ评价新生儿窒息的左心功能是敏感而实用的监测手段之一。     

超声心动图评价新生儿窒息的左心功能

应用超声心动图（ＵＣＧ）对３５例窒息新生儿进行左心功能测定。显示：窒息儿心内结构测定结果明显高于正常新生儿；窒息儿左室功能测定结果均明显低于正常新生儿。将小于正常新生儿测值的下限数作为判定左室收缩功能降低的标准，则窒息新生儿左室收缩功能降低的检出率为ＬＶＳＶ７８．５７％，ＬＶＥＦ１００％，ＳＶＩ７１．４３％，△Ｄ％１００％。结果表明应用ＵＣＧ评价新生儿窒息的左心功能是敏感而实用的监测手段之一。     

急性心肌炎左室功能的超声心动图评价

急性心肌炎由于心肌炎性病变 ,左室的收缩和舒张功能会受到不同程度的损害。随着心肌炎症的逐步修复 ,左室的收缩和舒张功能渐恢复。但有关心肌的收缩和舒张功能在恢复过程中的不同演变情况 ,文献报道尚少。本文应用超声心动图评价 32例急性心肌炎患儿左室功能的恢复情况。资料与方法一、病例选择　临床诊断为急性心肌炎[1] 32例 ,男 11例 ,女 2 1例 ,年龄 6～ 14岁 ,平均年龄 9岁。二、方法　应用德国产西门子中狮王彩色多谱勒诊断仪 ,探头频率为 2 .5ＭＨｚ,自住院起分别于ｄ1、ｄ10、ｄ15～ 30、ｄ30～ 6 0进行超声心动图检查评价左室功…     

负荷多普勒超声技术评价川崎病患儿左心功能的临床研究

目的 探讨双嘧达莫负荷多普勒超声技术在川崎病患儿左心储备功能评价方面的临床应用价值.方法 选择超声检查均提示有冠状动脉增宽的川崎病患儿21例,根据99Tcm-甲氧基异丁基异腈心肌断层扫描检查结果 将患儿分为2组,核素分布稀疏组(A组)14例,核素分布正常组(N组)7例.分别于双嘧达莫负荷前后测量左室射血分数(LVEF)、心脏指数(CI)、射血前时间/左室射血时间(PEP/LVET)、短轴缩短率(FS)、二尖瓣环处舒张早期最大峰值流速(Emax)及舒张晚期最大峰值流速(Amax).结果 负荷试验前,A组与N组各项指标比较差异无显著性(P>0.05).负荷后,A组CI明显降低(P<0.05);PEP/LVET明显增高(P<0.05).负荷后1?h时,A组与N组CI和PEP/LVET恢复到负荷前水平.结论 心肌断层扫描核素分布异常的川崎病患儿左室收缩储备能力下降.双嘧达莫负荷超声心动图技术操作简便、安全,可连续性评价患儿的心功能,便于随访.     

重度窒息新生儿左心功能的动态研究

正常新生儿24例,重度窒息新生儿53例,应用二维脉冲多普勒超声心动图,在生后24,48、72小时内以及1周时连续测定心率(HR)、每搏心输出量(SV)、每分心输出量(CO)、升主动脉峰值血流速度(PFV_(AO))。发现1周内两组新生儿SV无明显差异,但出生3天内,重度窒息新生儿HR,CO,PFV_(AO)均高于正常新生儿,1周时相似。提示重度窒息新生儿左心泵血功能未见明显损害,经过治疗,1周左右其血液动力学指标与正常相似。     

超声心动图对评价新生儿窒息时缺氧性肺动脉高压左心功能减低的意义

目的 探讨超声心动图对评价新生儿窒息时缺氧性肺动脉高压左心功能减低的意义.方法 新生儿窒息患者108例,均符合新生儿缺氧性肺动脉高压(hypoxic pulmonary hypertension,HPH)的诊断标准,其中轻度HPH组76例和中度HPH组32例.68例正常出生新生儿作为对照组,行常规超声心动图检查测量左心房内径(left atrium,LA)、左心室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、左室后壁厚度(left ventricular posterior wall,LVPW)、舒张末期室间隔(interventricular septum,IVS)、右心室舒张末期内径(right ventricular end diastolic dimension,RVEDD)、左心室射血分数(ejection fraction,EF)、动脉血流加速时间(pulmonary artery velocity,TPV)、右心室射血时间(right ventricular ejection time,RVET)以及Tei指数.结果 中度HPH组LA较对照组明显增大,差异有统计学意义(P＜0.01),LVEDD明显减小(P＜0.01),而IVS增厚不明显.中度HPH组E/A、EF、TPV/RVET均较对照组减低(P＜0.05),但中度HPH组与轻度HPH组间差异无统计学意义(P＞0.05).与对照组、轻度HPH组比较,中度HPH组Tei明显增加,与前两者比较,差异有统计学意义(P＜0.01).Tei指数与EF之间呈负相关(γ=-0.37,P＜0.05).结论 超声心动图可以无创地早期检测新生儿窒息时左心功能,Tei指数为反映左心室功能的较好指标,对临床判断病情及估计预后有重要意义.     

多普勒超声心动图评价小儿心肌炎左室收缩及舒张功能

应用多普勒超声心动图对２０例心肌炎患儿治疗前后的左室收缩及舒张功能进行检测,旨在寻求评价小儿心肌炎疗效的定量指标。结果显示主动脉瓣口的血流状态,心输出量,射血分数和二尖瓣口血流的Ｅ、Ａ波比值及充盈分娄筠 能定量评价其左室收缩及舒张功能变化,尤其是主动脉瓣口血流的最大流速,平均加速度,二尖瓣口血流的Ｅ、Ａ波充盈分类更为可靠。     

小儿扩张型心肌病左室舒张功能研究

２７例小儿扩张型心肌病左室舒张心肌病患者分初次住院治疗１７例为甲组,治疗１年以上１３例乙组。甲组主要为舒缓障碍,Ｅ峰降低,Ａ峰代偿性增高,Ｅ峰消失３例。其余为限制充盈型,Ｅ峰异常增高变窄;Ａ峰降低,Ｅ／Ａ增大。乙组大部分为假性正常型,恢复正常２例。舒张功能各指标参数与正常值比较,差异非常显著,Ｐ〈０．００１,而两组间非限制型外均无差异,Ｐ〉０．０５。     

Echocardiographic evaluation of cardiac functions and left ventricular mass in children with malnutrition

OBJECTIVE: This study was undertaken to assess the left ventricular mass (LV Mass) and systolic and diastolic functions of the left ventricle in children with protein energy malnutrition (PEM). METHODOLOGY: Thirty children, aged between 2 months and 2 years with PEM (four kwashiorkor, seven marasmic- kwashiorkor, 19 marasmus), and 17 healthy, age-matched children, using Doppler echocardiography were studied. RESULTS: The mean LV Mass in the patients was lower than that in the controls (14.5 +/- 5.2 vs 19.8 +/- 4.7 g, P < 0.05). However, the LV Mass/body surface area was not different in the patients with PEM and in the control group (52 +/- 9.2 vs 53.9 +/- 8.2g/m(2), P > 0.05), indicating that LV Mass was reduced in proportion to decrease in body size in malnutrition. Left ventricular septal and posterior wall thickness in PEM were also lower than that in the controls, and the most significant reduction in the LV Mass, septal and posterior wall thickness were found in the kwashiorkor group. Cardiac output was reduced in proportion to decrease in body size in the patient group (1.6 +/- 0.5 vs 2.1 +/- 0.8 L/min, P < 0.05), therefore cardiac index was not significantly different between the patients and the control subjects (5.9 +/- 1.4 vs 5.7 +/- 1.6 L/min/m(2), P > 0.05). Systolic function indices including ejection fraction, fractional shortening, and diastolic function indices were not significantly different in the groups. CONCLUSIONS: We demonstrated that LV Mass and cardiac output were reduced in proportion to decrease in body size in patients with PEM, and LV systolic and diastolic functions were preserved in atrophic hearts.     

Echocardiographic assessment of left ventricular function during the injection of adriamycin.

Echocardiography was used to evaluate left ventricular function in 8 children treated with adriamycin for malignant disease. Preejection period (PEP), left ventricular ejection time (LVET) and percent change in left ventricular internal dimension with systole (delta LVID) were measured before, during and immediately after 22 injections of adriamycin as well as 14 injections of other cytotoxic drugs and physiologic saline. No immediate effects on left ventricular function could be discerned. When functional parameters were evaluated longitudinally in patients with relatively higher cumulative doses of adriamycin, percent change in left ventricular internal dimension with systole showed some tendency to decrease, while the other parameters remained essentially unchanged.     

Longitudinal assessment of cardiac status by echocardiographic evaluation of left ventricular diastolic function in thalassaemic children

Cardiac disease is the primary cause of death in patients affected by thalassaemia major. In most cases diastolic dysfunction precedes the onset of systolic impairment at a time when appropriate therapy can prevent progression of cardiac damage. We have assessed the pattern of left ventricular filling by Doppler echocardiography in six transfusion-dependent thalassaemic patients. They were re-evaluated 5 y after the first observation, after additional blood transfusions and consequent iron load. We registered a significantly impaired relaxation pattern in all of them. A state of cardiac anoxia has been hypothesized.     

Echocardiographic assessment of left ventricular size and function in normal children from infancy to adolescence: acoustic quantification in comparison with traditional echocardiographic techniques

The purpose of this study was to establish normal left ventricular acoustic quantification (AQ) reference values for children from infancy to adolescence and to compare AQ-derived parameters with traditional M-mode and Doppler indices. We studied 150 normal, healthy children aged 2 days to 14 1/2 years. Left ventricular parasternal end diastolic area and left ventricular end diastolic volume calculated by AQ were linearly related to the body surface area to the 1.1 and 1.4 powers. AQ parasternal peak filling rate and atrial fractional area change in the neonatal period were 140% and 142% of the adolescent's values, respectively, and decreased to 110% and 112% by 36 months of age. The duration of the rapid filling phase and the rapid filling contribution, as identified by AQ, was shorter or lower than that measured by the Doppler method. Interobserver variability of AQ parameters ranged from 8.1% for the ejection fraction to 18.2% for the peak filling rate. Manual biplane determinations of volumes were slightly higher than AQ calculations with highly significant correlations (p <0.001). Our data permit the determination of normal ranges of AQ parameters in relation to body surface area or age.     

Echocardiographic assessment of cardiac function and morphology in patients with generalised lipodystrophy

Because cardiomegaly has been observed in lipodystrophic patients we studied cardiac morphology and function with one- and two-dimensional echocardiography in addition to general cardiologic examination in a series of seven patients. Muscular hypertrophy with increased chamber size and myocardial indentations were found. Two patients had asymmetrical septal hypertrophy (ASH), and two patients demonstrated systolic anterior movement (SAM) of the mitral valve. Wall motion analysis showed anomalities in four patients during contraction, in three during the early relaxation phase. Since pathological findings, probably increasing with age, were made in the majority of the patients, these findings add an additional unfavourable aspect to the syndrome.Abbreviations ASH asymmetrical septal hypertrophy - SAM systolic anterior movement - CGL congenital generalised lipodystrophy - ATL acquired total lipoatrophy - LA/Ao left atrial/aortic ratio - NRDD normalised rate of diameter decrease - NRID reduced rate of increased diameter - HOCM hypertrophic obstructive cardiomyopathy - VCF velocity of circumferencial fiber shortening     

Echocardiographic assessment of cardiac function during respiratory syncytial virus infection

Respiratory syncytial virus infection has been associated with increased morbidity and mortality in infants with underlying cardiac and pulmonary disease. To understand better the cardiopulmonary interaction in patients with acute respiratory syncytial virus bronchiolitis, we performed M-mode echocardiograms and pulsed Doppler assessment of pulmonary arterial flow in 19 patients with structurally normal hearts during acute illness. Studies were repeated in 11 of these patients following complete recovery. Based on severity of respiratory compromise, patients were grouped into those with severe illness (ten patients) or mild illness (nine patients). Left ventricular dimensions and shortening fraction were used to assess left ventricular function. Right ventricular systolic time intervals and specific Doppler flow velocity measurements were used to assess right ventricular function and elevation of pulmonary artery pressure. Comparisons were made between patients with severe and mild illness and between acute and follow-up studies. No statistically significant differences in left ventricular function, right ventricular systolic time intervals, or Doppler flow measurements were observed. We conclude that in patients with structurally normal hearts, respiratory syncytial virus bronchiolitis is not associated with significant depression of cardiac performance or elevation in pulmonary resistance.     

多普勒超声心动图对先天性心脏病合并肺动脉高压儿童左室形态与功能的评价

目的：探讨多普勒超声心动图对先天性心脏病（CHD）儿童肺动脉高压（PAH）的诊断价值及PAH对左室重塑和舒张功能（LVDF）的影响。方法：对彩色多普勒超声心动图证实的45例继发肺动脉高压的先天性心脏病患儿的超声心动图和多普勒血流资料与22例无PAH的先天性心脏病患儿（对照组）对比分析。结果：PAH组及对照组的左室舒张末内径分别为18.24±1.71 mm vs 16.28±0.52 mm、右室内径 12.23±2.14 mm vs 8.14±0.73 mm、肺动脉内径 11.20±1.35 mm vs 7.92±0.21 mm。两组比较差异有显著性（P<0.05）；VTR 流速增快（2.56±0.46）m/s及PASP压力（40.23±4.56）mmHg升高 ，与对照组相比差异亦有显著性（P<0.05）；室间隔增厚与对照组相比差异不明显。对照组、PAH组的二尖瓣口血流多普勒频谱A峰流速分别为94.56±31.45 m/s vs 51.17±26.67 m/s、A峰流速速度时间积分为10.89±2.73 s vs 4.94±1.85 s及AV/EV为1.79±0.32 vs 0.59±0.19、AVTI/EVTI为1.61±0.49 vs 0.45±0.21 两组比较差异有显著性(P<0.01)。左室等容舒张时间分别为119. 86±54.62 s vs 52.31±28.06 s。PAH组明显延长(P<0.05)。E峰流速、E峰流速速度时间积分及E峰减速时间两组无明显改变(P>0.05)。而增高的肺动脉压与二尖瓣口血流频谱AV/EV比值呈正相关,相关系数 r=0.4 456， P<0.01。结论：多普勒超声心动图不仅是先天性心脏病儿童合并肺动脉高压最重要的诊断方法之一，还可提供肺动脉高压对左室重塑和舒张功能受损的指标，对临床判断病情轻重及预后有重要价值。［中国当代儿科杂志，2007，9（5）：422-424］