超声心动图诊断胎儿心律失常的声像表现

目的 :探讨超声心动图诊断胎儿心律失常的声像表现。方法 :应用彩色多普勒超声诊断仪对孕妇年龄 2 0～ 32岁、胎龄 17～ 4 0周、临床疑有胎儿心律失常或伴其他异常妊娠史的 32 5例胎儿进行超声心动图检查。通过分析超声心动图特征 ,明确房室激动顺序和时相关系 ,分类诊断胎儿心律失常。对出生后仍有心律失常的新生儿进行超声心动图与心电图同步检查验证。结果 :32 5例高危胎儿中产前超声心动图诊断胎儿心律失常 5 5例 ,其中房性早搏 2 9例 ,室性早搏 9例 ,心动过缓 7例 ,窦性心动过速 4例 ,室上性心动过速 2例 ,房室传导阻滞 2例 ,房性早搏合并窦性静止 2例。出生后仍有心律失常的 4例新生儿进行超声心动图与心电图同步检查证实结果一致。结论 :超声心动图能诊断多种类型的胎儿心律失常 ,具有重要的临床意义     

新生儿三尖瓣下移畸形合并B型预激综合征1例

本文报道1例新生儿三尖瓣下移畸形合并B型预激综合征。患儿胎龄39周娩出, 生后2 d诊断三尖瓣下移畸形合并B型心室预激, 经内科治疗后好转出院。追溯产前超声检查, 胎龄20周胎儿超声心动图未提示异常, 但38周因胎心率过快行M型超声检查诊断室上性心动过速。三尖瓣下移畸形的心脏解剖结构异常不仅导致血流动力学的改变, 而且会引起快速性心律失常。因此对于产前心脏超声检查到室上性心动过速或者出生后心电图检查到B型预激综合征的患儿, 应当在心脏超声检查中仔细扫查三尖瓣, 以免漏诊。     

4例心室肌致密化不全患儿超声心动图诊断及临床分析

目的探讨儿童心室肌致密化不全的临床特点。 方法2002年9月至2004年11月新乡医学院第三附属医院心内科4例男性心室肌致密化不全患者，年龄5~14岁。均采用东芝PV6000,vivid7彩色多普勒超声心动图仪进行检查，探头频率2~4MHz。 结果4例均出现不同程度心功能不全和心律失常，未见栓塞。超声心动图均可见多发突入心室腔内的肌小梁和与心室腔交通深陷的小梁间隙。 结论儿童心室肌致密化不全是一种少见的先天性心肌病，易合并其他心脏畸形。临床主要表现为心功能不全和心律失常。超声心动图是可靠的诊断方法。     

小儿左冠状动脉起源于肺动脉所致心脏扩大22例误诊分析

摘要：目的　探讨小儿左冠状动脉起源于肺动脉（ALCAPA）所致心脏扩大病例的误诊原因,总结诊断经验。 方法　回顾性分析1996年7月至2009年1月广东省心血管病研究所22例小儿ALCAPA所致心脏扩大的误诊病例。均行心电图、X线胸片、超声心动图检查,8例行心脏CT检查,14例行心导管检查及造影,21例进行了外科手术治疗。 结果　≤ 1岁患儿10例中,6例误诊为心内膜弹力纤维增生症,3例误诊为扩张型心肌病,1例误诊为先天性二尖瓣脱垂并关闭不全。 > 1岁患儿12例中,4例误诊为扩张型心肌病,3例误诊为心内膜弹力纤维增生症, 2例误诊为先天性二尖瓣脱垂并关闭不全,1例误诊为右冠状动脉右心室瘘,1例误诊为川崎病,1例误诊为动脉导管未闭。 结论　小儿ALCAPA所致心脏增大病例容易误诊为心内膜弹力纤维增生症、扩张型心肌病、先天性二尖瓣脱垂等疾病,左冠状动脉起源于肺动脉后方偏右的病例更易误诊。提高对ALCAPA的认识、超声或CT检查中仔细探查冠状动脉及其起源对避免误诊至关重要。     

心电图在小儿过敏性紫癜合并心肌损害中的应用价值

目的探讨心电图在小儿过敏性紫癜合并心肌损害中的应用价值。方法在郑州市儿童医院儿科接受治疗的过敏性紫癜合并心肌损害患儿80例,随机分为观察组和对照组各40例。对照组采用常规心电图进行检测。观察组采用动态心电图进行检测。比较两组患儿心电异常检出情况及过敏性紫癜合并心肌损害检查率。结果观察组ST-T改变、QT间期延长、窦性心动过缓、二度窦房传导阻滞窦性检出情况明显高于对照组,差异有统计学意义(P0.05);两组心动过速、左室高血压、房性早搏、右束支阻滞、一度房室阻滞、总心电图改变检出情况比较差异无统计学意义(P0.05)。观察组过敏性紫癜合并心肌损害阳性检出率为97.5%(39/40),高于对照组72.5%(29/40),差异有统计学意义(P0.05)。结论动态心电图能提高小儿过敏性紫癜合并心肌损害的检出率,诊断阳性率较高,能有效判断患儿是否合并心肌损害,可作为临床诊断的重要指标。     

胎儿心律失常的诊断和治疗进展

胎儿心律失常发病机制尚未明确.通过胎心听诊、超声检查、连续胎心监护以及胎儿超声心动图检查,可准确地诊断胎儿心律失常,并进行相应处理.对于胎儿心动过速者,行胎儿超声心动图检查后,通常可继续监测;药物可用于控制持续性胎儿心动过速.对出现持续心动过缓胎儿,免疫抗体检测阳性妊娠妇女应进行密切监测,需要除外胎儿心脏畸形;对出现不规则心律胎儿,可临床随诊,药物治疗效果有限.大多数心律失常胎儿预后好,心脏畸形发生率很低.     

胎儿超声心动图的研究与应用进展

胎儿心脏异常是所有胎儿先天性畸形中最常见的一种,胎儿心脏超声是胎儿超声检查中最重要且最复杂的一项工作.近年采用胎儿超声心动图技术探索新检查途径、摸索新方法,使胎儿超声心动图在胎儿心脏畸形的产前诊断中获得较高的临床评价.通过对胎儿超声心动图新技术、新途径、新方法的认识与学习,对胎儿心脏畸形的产前诊断水平将会有所提高.     

小儿房间隔缺损40例临床分析

目的:对小儿房间隔缺损进行临床分析。方法:回顾2008年3月-2010年8月来我院治疗小儿房间隔缺损的患儿40例,其中,男患儿14例,女患儿26例。年龄在2～14岁,平均年龄10.5岁。体重9～42kg,平均体重32.5kg。经心电图、X线片、超声心动图确诊为房间隔缺损,采用介入治疗对小儿房间隔缺损进行临床分析。结果:40患儿介入封堵术全部成功,手术时间20～50min,平均40min,术后3～7d出院,出院前对患儿进行进行心脏超声、心电图检查以及X线片检查,患儿有明显改善。封堵器位置准确安全,无并发症以及残余分流发生。结论:对小儿房间隔缺损及时确诊和治疗,防止并发症发生。     

热毒宁继续医学教育园地——思考病例系列（4）答案

（病例见本刊2010年第4期彩页）  　　应做检查包括：（1）心肌酶谱、血沉、C反应蛋白（CRP）、ASO;（2）病原学检测：柯萨奇病毒抗体,梅毒抗体检测;（3）心电图及超声心动图;（4）胸部正侧位片;（5）心脏CT检查。 　　患者检查结果如下：心肌酶谱、血沉、CRP、ASO、柯萨奇病毒抗体及梅毒抗体检测结果均为阴性。心电图示窦性心律,左室高电压。超声心动图示：左室舒末内径增大（LVDd 36 mm）,左室射血分数（LVEF）降低（35%）,左心室内膜增厚3.4 mm,主动脉（瓣环9 mm）瓣增厚,回声增强,仍为三叶瓣,最大开瓣距离4.5 mm,CW测最大前向血流速度4.5 m/s,PG 71 mmHg。胸部正侧位片提示：心胸比例0.62,心影增大。心脏CT检查提示：同超声心动图,无其他心脏及大血管畸形。 　　诊断：先天性心脏病,主动脉瓣狭窄诊断明确。诊断依据为患儿听诊胸骨左缘第2肋间可闻及2/6级收缩期杂音,超声心动图及心脏CT提示：主动脉瓣狭窄（重度）。 　　鉴别诊断：应注意与心内膜弹力纤维增生症（EFE）、病毒性心肌炎、扩张型心肌病、风湿性心脏炎等加以鉴别。 　　（1）本症不支持EFE诊断要点：患儿先天性心脏病,主动脉瓣狭窄诊断明确。鉴别焦点：① EFE为一独立疾病,与先天性心脏病,主动脉瓣狭窄并存,发生概率较低;②EFE继发于先天性心脏病,主动脉瓣狭窄,但心内膜增厚少见。该患儿入院后行主动脉瓣成形术,术后14 d复查超声心动图示LVDd 26 mm及LVEF 58%均正常,左心室内膜3.2 mm,支持先天性心脏病,主动脉瓣狭窄诊断,为主动脉瓣狭窄继发EFE。 　　（2）本症不支持病毒性心肌炎诊断要点：①发病前无前驱感染史;②柯萨奇病毒抗体、心肌酶谱检查阴性;③心电图检查无心律失常。 　　（3）本症不支持扩张型心肌病诊断要点：①患儿发病年龄小;②心脏彩超无全心扩大的表现;③无慢性心功能不全表现。 　　（4）本症不支持风湿性心脏炎诊断要点：①无发热;②无环形红斑及皮下小结;③血沉、CRP、ASO阴性;④心电图无P-R间期延长、T波及ST段改变;⑤心脏彩超无心内膜炎及心包炎。 　　治疗：（1）纠正心力衰竭治疗;（2）避免剧烈哭闹;（2）手术治疗。 （清华大学第一附属医院小儿心内科 李小梅）     

胎儿超声心动图的研究与应用进展

胎儿心脏异常是所有胎儿先天性畸形中最常见的一种，胎儿心脏超声是胎儿超声检查中最重要且最复杂的一项工作。近年采用胎儿超声心动图技术探索新检查途径、摸索新方法，使胎儿超声心动图在胎儿心脏畸形的产前诊断中获得较高的临床评价。通过对胎儿超声心动图新技术、新途径、新方法的认识与学习，对胎儿心脏畸形的产前诊断水平将会有所提高。     

Intrapartum fetal cardiac arrhythmias.

Fifteen cases of fetal cardiac arrhythmia were detected by direct fetal electrocardiogram (FECG) during intrapartum fetal monitoring. The frequency of arrhythmia of 12.4/1000 monitored births. Thirteen of the arrhythmias were supraventricular. Atrial bigeminy was the most commonly observed arrhythmia, followed by atrial trigeminy. Two cases of ventricular arrhythmia were noted, one of which was a case of ventricular tachycardia. Arrhythmias were not related to drug treatment or to stage of labor. Variable decelerations occurred in association with arrhythmias in 73% of the cases. There were no nuchal cords seen at delivery, nor were there any instances of intrapartum fetal distress, fetal acidosis, or low Apgar scores associated with any arrhythmia. All arrhythmias resolved spontaneously without treatment. The neonatal course was uncomplicated in all cases. Intrapartum fetal arrhythmia is best detected by direct FECG. Appropriate management should include close observation for ominous fetal heart rate (FHR) patterns and fetal acid-base-studies. At present, there is no indication for drug treatment of intrapartum arrhythmia.     

小儿经皮室间隔缺损封堵术后非阵发性 室性心动过速临床意义分析

目的　总结小儿经皮室间隔缺损（VSD）封堵术后非阵发性室性心动过速（AIVR）的发生情况,探讨其临床意义及可能的发生机制。方法　2002年10月至2011年5月,1179例VSD患儿在广东省心血管病研究所心儿科行经皮VSD封堵术（室缺封堵组）,术后检出AIVR 17例。在我院门诊进行动态心电图检查的1392例非介入治疗患儿（非介入组）以及在我院行房间隔缺损封堵术的患儿988例（房缺封堵组）作为对照。比较室缺封堵组与对照组间AIVR的检出情况。对室缺封堵组9例患儿进行治疗,并对17例患儿进行随访。结果　室缺封堵组术后动态心电图AIVR检出率高于非介入组,差异有统计学意义（P < 0.05）;次日常规心电图AIVR检出率高于房缺封堵组（P < 0.05）。室缺封堵组所有AIVR患儿封堵术后1个月动态心电图均无AIVR,随访中无不良事件发生,随访心电图无AIVR。结论　室缺封堵组封堵术后AIVR检出率高于对照组,其发生与VSD封堵有关。该病多无自觉症状,预后良好,可能无须治疗。     

Prediction of postnatal arrhythmia in fetuses with cardiac rhabdomyoma

Objectives: Fetal cardiac rhabdomyomas are rare but well-known to be associated with arrhythmia or conduction abnormalities. However, since in utero electrophysiological information is quite limited, it remains unclear which type of rhabdomyoma will develop arrhythmia after birth. The aim of this study is to identify factors that predict postnatal arrhythmia requiring therapy in fetuses with cardiac rhabdomyoma.

Study design: A retrospective review of infants prenatally diagnosed with cardiac rhabdomyoma was performed at our tertiary pediatric cardiac center between 1990 and 2016. Fetal arrhythmia was diagnosed using fetal echocardiography and magnetocardiography. We compared the characteristics of cases with and without antiarrhythmic therapy after birth. Cases without antiarrhythmic therapy after birth consisted of those who had postnatal arrhythmia but did not require antiarrhythmic therapy and those who had no postnatal arrhythmia.

Results: A total of 20 fetuses with cardiac rhabdomyoma were included in this study. Ten cases (50%) were confirmed as having tuberous sclerosis after birth. The mean gestational week at diagnosis and delivery were 32.1?±?2.7 and 37.6?±?2.8 weeks, respectively. Mean cardiac tumor size in utero was 21?±?11?mm (range, 7–54?mm) in diameter. Fetal arrhythmia was found in six cases; three resolved in utero with transplacental antiarrhythmic therapy. Postnatal arrhythmia or conduction abnormalities were found in 12 cases; 7 required antiarrhythmic therapy. Cases with antiarrhythmic therapy after birth had larger cardiac tumor in utero than those without therapy (29.6?±?12.8?mm versus 16.3?±?5.8?mm, p?30?mm in diameter predicted postnatal arrhythmia requiring therapy with sensitivity of 57.1% and specificity of 100%. Location and number of cardiac tumor and presence of arrhythmia or conduction abnormalities in utero were similar between the two groups.

Conclusions: Cardiac rhabdomyomas >30?mm in diameter are associated with postnatal arrhythmia requiring therapy regardless of number and location.     

儿童支气管结核的临床特点

目的探讨儿童支气管结核的临床特点。方法 2007年3月至2013年3月沈阳市胸科医院结核内科收治支气管结核患儿32例,分析其临床资料,总结支气管结核的临床特点、诊断、治疗及预后。结果 (1)年龄7~14岁儿童支气管结核32例。确诊前误诊32例,误治时间2周至1年。确诊15例,临床诊断性抗结核治疗17例。(2)临床表现:发热21例,肺部闻及哮鸣音7例。(3)X线片异常32例;肺CT检查发现支气管淋巴结结核10例;发现支气管形态异常9例。(4)纤维支气管镜检查发现支气管结核32例。(5)病原学检查阳性率37.5%(12/32)。(6)病程中结核菌素试验阳性率达59.4%(19/32)。(7)接受抗结核治疗32例,治愈30例,失访2例。结论儿童支气管结核的临床表现不典型,诊断困难,误诊、漏诊率高,疗程长,治疗依从性差等因素直接影响结核病愈后。早发现、早诊断、及时治疗对控制结核病的进展,减少支气管结核的发生,减轻支气管结核患儿的临床症状,减少或防止并发症的发生,提高治愈率及改善预后起到至关重要的作用。     

Results of Senning operation for transposition of great arteries.

We report our results with 10 infants and children who underwent atrial repair using the Senning operation between 1985 and 1990. All cases had abdominal situs solitus, levocardia and atrio-ventricular concordance (D-bulboventricular loop). Nine patients had simple D-transposition of the great arteries without ventricular septal defects (VSD) or left ventricular outflow tract obstruction. The other patient had a double outlet right ventricle with subpulmonic VSD and pulmonary hypertension (PHT) and underwent a palliative Senning procedure. All patients had a balloon atrial septostomy (BAS) before surgery, except for one with Taussig-Bing syndrome. One patient had a Blalock-Hanlon operation after BAS. The age at the time of surgery ranged from two months to four years seven months (mean: 22 months) and weight ranged from 4.3-12 kg. There were two hospital mortalities including the patient with VSD and PHT. All of the patients had echocardiographic examinations and six of the eight survivors received cardiac recatheterization four to 19 months (mean: 7.4 months) postoperatively. No baffle leaks were noted in the survivors. Two patients had both mild tricuspid regurgitation and slightly decreased right ventricular contractility, and one patient had a pressure gradient of 6 mmHg between the superior vena cava and neo-right atrium. The clinical follow-up interval was eight to 64 months (mean: 31.4 months). All survivors showed a sinus rhythm on their latest electrocardiogram and were participating in normal daily activities without medication.     

Tako-Tsubo cardiomyopathy caused immediately following cesarean section delivery of triplets: a case report

The name 'tako-tsubo' cardiomyopathy was initially used to describe a unique 'short-neck round-flask'-shaped form of left ventricular apical ballooning, resembling a Japanese tako-tsubo, a jar (tsubo) used for capturing octopus (tako). Tako-tsubo cardiomyopathy exhibits acute onset, transient left ventricular apical wall motion abnormalities with chest symptoms and minimal myocardial enzymatic release, mimicking acute myocardial infarction in patients without angiographic stenosis on coronary angiography. There have been few case reports on tako-tsubo cardiomyopathy, and this disorder is especially rare in pregnant women. A 30-year-old woman who was pregnant with triplets, and had been treated with ritodrine hydrochloride for 12 weeks for threatened premature delivery, underwent cesarean section with spinal anesthesia at 30 weeks' gestation. Three hours later, she complained of acute chest pain, dyspnea and episodes of unconsciousness. She was transferred to the intensive care unit and intubated for ventilatory support. We diagnosed heart failure due to tako-tsubo cardiomyopathy based on heart ultrasonography, blood tests, chest X-ray, electrocardiogram and myocardial scintigraphy. She was extubated from the ventilator after 3 days of catecholamine, furosemide and carperitide administration. She was discharged from the hospital on day 53 without symptoms.     

Echocardiographic assessment of total anomalous pulmonary venous connections in pediatric patients.

BACKGROUND AND PURPOSE: Cardiac catheterization can be superfluous and risky for sick babies, infants, and young children with total anomalous pulmonary venous connection (TAPVC). This study assessed the accuracy of echocardiography in the clinical assessment of pediatric patients with TAPVC before cardiac surgery. PATIENTS AND METHODS: A total of 15 consecutive patients with TAPVC treated between July 1, 1993, and December 31, 1999, were included in this retrospective study. Patients with TAPVC with heterotaxy syndrome were excluded. We assessed this cardiac anomaly preoperatively using plain chest roentgenograms, echocardiography, and magnetic resonance imaging. A combination of suprasternal, parasternal, subcostal, and apical four-chamber views and their tilting scans were employed for diagnosis and to trace the course of the anomalous pulmonary venous connection. RESULTS: Interatrial right-to-left shunt via atrial septal defects were documented by two-dimensional echocardiography with color Doppler mapping in all 15 patients. Patent ductus arteriosus was found in six patients. Cardiomegaly with enlargement of the right atrium and the right ventricle could be seen on plain chest roentgenograms and by echocardiography in all but two patients with infracardiac TAPVC. In all patients, the left innominate vein, coronary sinus or right atrium, and portal vein were the draining sites of supracardiac, cardiac, and infracardiac TAPVC, respectively. A pattern of continuous flow without phasic variation, which is suggestive of stenosis of the pulmonary vein, was found in two patients with infracardiac TAPVC with obstruction. The surgical findings were reviewed and correlated well with those of the echocardiography. CONCLUSIONS: In infants and children with TAPVC, the drainage sites and flow profiles of the pulmonary veins can be exactly determined by Doppler echocardiography preoperatively, which makes cardiac catheterization and angiocardiography unnecessary.     

Cardiovascular disease and arrhythmias: unique risks in women

Women have higher risks for symptomatic arrhythmias and sudden death than men. A significantly higher resting heart rate and longer QT interval on electrocardiogram may be factors that predispose women to a serious form of ventricular arrhythmia known as torsades de pointes. Recent studies have demonstrated hormonal effects on the expression of cardiac potassium and calcium ion channels, indicating their possible regulatory role in the modulation of cardiac repolarization and QT interval. These results demonstrate a need for greater awareness and further research into the mechanistic differences between men and women with respect to arrhythmia and cardiovascular disease.     

Apical hypertrophic cardiomyopathy: clinical, echocardiographic and angiographic features in 3 Chinese patients

We present 3 cases of apical hypertrophic cardiomyopathy. The presenting symptoms were dyspnea on exertion in 2 of 3 patients, typical anginal pain in 1 patient, atypical chest pain in 1 patient, and fatigue in 1 patient. One patient was asymptomatic with an abnormal electrocardiogram. Sustained apical impulse was noted in all patients, Grade 1/6 systolic murmur was audible in 2 patients. Electrocardiogram showed T wave inversion in the left precordial leads in all patients with amplitudes of 1.4, 0.8 and 2.0 mV, respectively. Isolated apical hypertrophy was noted in all patients. Two-dimensional echocardiogram and the left ventriculogram revealed a "spade-shaped" configuration of the left ventricular cavity at endo-diastole in only one patient. Left ventricular end diastolic pressures were elevated and coronary angiograms were normal in all 3 cases. We conclude that this disease entity should be considered in patients whose electrocardiogram shows a large inverted T wave in the left precordial leads, either accompanied by symptoms such as dyspnea on exertion or chest pain, or even when asymptomatic. Echocardiogram is the most useful screening tool in the diagnosis of apical hypertrophic cardiomyopathy.