先天性房间隔、室间隔缺损的经胸微创封堵治疗

目的评估在食道心脏超声引导下经胸微创封堵先天性房、室间隔缺损的疗效及安全性。方法回顾性分析2013年9月至2015年6月贵阳中医学院第二附属医院收治的44例经胸微创封堵心脏房、室间隔缺损患者的临床资料。所有患者术中经食管超声心动图监测并引导封堵伞的放置,评价手术效果,术后门诊定期随访患者心电图、超声心动图。结果 44例患者中43例先天性间隔缺损(室缺28例,房缺16例,其中1例为室缺合并房缺患者)封堵成功,1例室缺患者中转为心内直视手术。手术时间22~48 min,手术切口2~4.5 cm,术后呼吸机辅助时间1~5 h,术后引流量小于50 mL,术后住院时间2~6 d。所有患者均治愈出院。出院病例随访1~12个月,封堵器位置良好,无残余分流,无封堵术导致的瓣膜返流及心律紊乱。结论在食道心脏超声引导下经胸封堵手术治疗先天性房、室间隔缺损具有微创、简便、安全、恢复快等优点,近期随访疗效满意。     

多平面经食管与经胸超声心动图在感染性心内膜炎诊断中的对比价值

目的探讨多平面经食管与经胸超声心动图在感染性心内膜炎(IE)诊断中的临床价值。方法 109例IE疑似病例均行多平面经食管与经胸超声心动图检查,与"金标准"进行对照分析。结果经食管超声心动图诊断IE的敏感性、特异性、阳性预测值、阴性预测值及诊断准确率显著高于经胸超声心动图(P 0. 05)。经食管超声心动图瓣膜穿孔检出率显著高于经胸超声心动图(P 0. 05)。结论经食管超声心动图检查对IE及并发症诊断价值较高,值得临床应用。     

经食管超声评价微创外科房间隔缺损封堵术中患者心功能及血流动力学

目的运用经食管超声对微创外科房间隔缺损封堵术中患者心功能及血流动力学的变化进行评价,探讨超声在微创外科房间隔缺损封堵术中的应用价值。方法门诊筛查选择适合经微创外科封堵术治疗的房间隔缺损患者50例,于术中及手术前后对患者进行经食管超声和经胸超声心动图检查,分别测量左、右室心功能及血流动力学指标,并对手术前后结果进行对照比较。结果术后左、右房室腔的径线与术前比较明显减小（P〈0．05）,右心室舒张末期容积（RVEDV）、右心室每搏输出量（RVSV）、右心排血量（CO）均较封堵前明显减小,左心室舒张末期容积（LVEDV）、每搏输出量（LVSV）及排血量（CO）均较封堵前增加,两者具有显著差异（P〈0．05）。而左心室收缩末期容积（LVESV）和右心室收缩末期容积（RVESV）以及左室和右室射血分数无显著变化。术后肺动脉瓣上最大血流速度、三尖瓣口E峰流速、三尖瓣反流最大流速及肺动脉收缩压与术前比较均显著减小（P〈0．05）,二尖瓣口E峰流速显著增大（P〈0．05）。结论经食管超声可及时反映微创外科房间隔缺损封堵术前后患者心功能及血流动力学变化,为临床评价手术效果提供参考。     

经胸超声在Amplatzer封堵器介入治疗先天性房室间隔缺损中的临床应用

目的探讨经胸超声在AmpLatzer封堵器介入治疗先天性房间隔缺损、室间隔缺损中的临床应用价值。方法术前应用经胸超声筛选封堵术适应证36例先心病,其中26例房间隔缺损、10例室间隔缺损。术中用经胸超声监测指导释放封堵器,即刻观察疗效。于胸骨旁四腔观、房间隔短轴观、心尖四腔观、心尖五腔观、大动脉短轴观、剑突下四腔心观分别观察封堵器的形态,瓣膜反流及封堵器周围分流情况。术后进行定期复查。结果26例房间隔缺损、10例室间隔缺损封堵成功,总成功率100%。其中16例出现二、三尖瓣反流或残余分流,经调整封堵器的位置和方向后,10例反流即刻消失,6例术后1个月消失。结论经胸超声可用来筛选房间隔缺损、室间隔缺损封堵术病例,术中指导Amplatzer封堵器定位和释放,疗效评估和预后评价方面有不可替代的临床应用价值。     

54例超声心动图引导下先天性心脏病封堵治疗回顾分析

目的 探讨超声引导下房间隔缺损(ASD)和室间隔缺损(VSD)封堵的方法、疗效等临床经验。方法 2010年12月至2019年9月,54例先天性心脏病患者行超声心动图引导下介入封堵手术,其中房间隔缺损30例,室间隔缺损24例。14例ASD采取胸骨右缘第4肋间小切口,经右心房途径封堵;16例ASD通过股静脉穿刺,经血管内途径封堵。24例VSD经剑突下小切口右室前壁途径封堵。结果 经胸封堵24例VSD,均顺利。经胸封堵ASD中,有1例在术后7 h发生封堵器移位,紧急开胸在体外循环直视下取出封堵器,修补ASD。16例经股静脉途径封堵ASD中,手术顺利13例,封堵失败3例,封堵失败后改经胸小切口封堵2例,改体外循环下直视手术1例。46例随访3～103个月,平均(21.3±16.2)个月,未见封堵器移位、脱落、明显残余分流以及其他并发症发生。结论 超声引导下经股静脉途径或经胸小切口房间隔缺损及室间隔缺损封堵安全有效,无射线辐射,操作简单易普及。     

经食管与经胸超声心动图在心房及瓣膜占位病变诊断中的应用价值分析

目的分析经食管与经胸超声心动图在心房及瓣膜占位病变诊断中的应用价值。方法选取心房及瓣膜占位性病变患者44例,均行经食管超声心动图检查(TEE)及经胸超声心动图检查(TTE)。观察超声心动图显示的占位性病变形态、大小、内部结构、病理性质提示。结果 TEE检查对心房及瓣膜占位病变的内部结构、病理性质提示检查结果要优于TTE检查,差异具有统计学意义(P 0. 05); TEE与TTE检查占位病变大小测量结果比较,差异无统计学意义(P 0. 05)。结论心房及瓣膜占位病变诊断中行经食管超声心动图较经胸超声心动图可获得更佳的影像学信息,两者结合可做出明确诊断。     

房间隔缺损经胸超声指导下封堵术50例临床分析

目的探讨经胸超声指导下封堵术在房间隔缺损治疗中的价值。方法回顾分析50例经导管封堵治疗房间隔缺损患儿的疗效。结果 47例成功,3例失败,术后随访1月～2年,无不良并发症。结论经胸超声指导下封堵术治疗房间隔缺损安全,有效,创伤小,操作简单,住院时间短,是一项有发展前景的治疗方法。     

单纯输送鞘法经胸超声引导封堵卵圆孔未闭的临床疗效

目的 探讨单纯输送鞘法行经胸超声引导下经皮卵圆孔封堵手术的临床治疗效果。方法 回顾性分析2020年1月至2022年12月于我院行介入封堵手术或单纯输送鞘法经胸超声引导经皮卵圆孔封堵手术的卵圆孔未闭患者临床资料,分别设为介入封堵组（40例）和单纯输送鞘组（39例）。比较2组患者的手术时间、手术并发症发生率及手术成功率;术后超声评价封堵效果;术后随访6个月,评估患者临床症状缓解情况。结果 单纯输送鞘组手术成功率（100%）高于介入封堵组（90.0%）,差异有统计学意义(P<0.05)。单纯输送鞘组手术时间长于介入封堵组,差异有统计学意义(P<0.05)。介入封堵组1例患者术中出现少量心包积液;单纯输送鞘组2例患者术中出现血压降低、心率减慢,对症处理后症状消失。2组并发症发生率比较,差异无统计学意义(P>0.05)。术后6个月随访,封堵伞位置良好,无残余漏;介入封堵组28例患者头痛、头晕症状消失,8例患者症状明显缓解;单纯输送鞘组30例患者头痛、头晕症状消失,9例患者症状明显缓解。结论 单纯输送鞘法经胸超声引导经皮卵圆孔封堵手术安全可行,疗效满意,手术成功率高,无辐射危害,...     

超声心动图在常见先天性心脏病Amplatzer封堵术中的应用

目的:探讨超声心动图在常见先天性心脏病封堵术中的应用价值.方法:本组先天性心脏病47例中,ASD 31例、PDA 7例及VSD 9例,经胸或/和经食道超声心动图检查符合条件而行经导管以Amplatzer封堵器封堵术治疗.结果:47例中,除2例患者因双孔或单孔ASD最大伸展径较大(＞34 mm)而放弃封堵外,余45例患者在超声指导下以Amplatzer封堵器封堵成功,均无残余分流,成功率为95.75%(45/47).结论:采用Amplatzer封堵器封堵治疗常见先天性心脏病时,超声心动图对于术前病例选择、术中指导监测、封堵器型号的选择以及术后疗效评价等,均有较大的临床价值.     

国产封堵器介入治疗房间隔缺损的疗效及安全性

目的 评价应用国产房间隔封堵器治疗房间隔缺损的疗效及安全性。方法 12例房间隔缺损患者，男性4例，女性8例，年龄18-45岁。对患者均使用经体表超声心动图（TTE）监测。封堵器选用国产房间隔封堵器（北京华圣杰科技有限公司研制）。房间隔缺损封堵术后48h进行TTE复查，术后1、3、6个月随访得查心电图、TTE、X线，并观察疗效及安全性。结果 11例封堵手术成功，即刻手术成功率91.67%，术中及术后48hTTE星移斗转测均无残余分流。术后1、3、6个月随访，原有临床不适症状缓解，TTE显示封堵器位置稳定，房间隔水平无分流。结论 国产房间隔封堵器对房间隔缺损进行介入治疗，临床使用有效、安全。     

Intraoperative echocardiography

Combined echocardiography (uni- and two-dimensional, and Doppler) was used during surgery on an open heart. Technological aspects of such examinations are discussed. A method for tricuspid valve annuloplasty is suggested, monitored and regulated by echocardiography on an open heart. Such monitoring will help assess the efficacy of valve-preserving surgery.     

Intraoperative application of transesophageal echocardiography

Transesophageal echocardiography (TEE) has become a routine monitor in the operating room for cardiac surgery because it provides instantaneous and continuous assessment of cardiac function and anatomy. TEE aids intraoperative management and improves outcome in patients undergoing cardiac valve repairs, complex congenital heart corrections, and high-risk patients undergoing coronary artery bypass graft surgery. Especially in mitral valve repair surgery, it is mandatory to evaluate the results of the surgical procedure after cardiopulmonary bypass during surgery. Multiple investigations have also documented the improved sensitivity of TEE for the detection of myocardial ischemia compared with ECG or pulmonary capillary wedge pressure measurements. Intraoperative TEE is, however, not without risks, so emerging evidence demonstrating the utility of TEE as a diagnostic monitor or to alter the management of patients is required, especially in non-cardiac surgery. TEE is less frequently used in non-cardiac surgery; however, the emergent use of intraoperative or perioperative TEE to determine the cause of an acute, persistent, and life-threatening hemodynamic abnormality is well indicated. A task force of the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists developed guidelines for the appropriate use of TEE, which were evidence-based and focused on the effectiveness of perioperative TEE in improving clinical outcomes. Compliance with the guidelines for basic intraoperative TEE resulted in a marked improvement in intraoperative TEE practice. Technical progress of echocardiographic equipment and the TEE probe will increase the application of intraoperative and perioperative TEE in the future.     

Possibilities and limitations of echocardiography

Echocardiography offers a noninvasive method ideal for the patient and the observer. The exact diagnosis can be established in most of cardiac diseases. We use the technique as a screening method to select patients for invasive procedures, it allows an accurate assignment and timing of catherization.     

Clinical applications of transesophageal echocardiography

Standard transthoracic ultrasound examination of the heart has provided increasingly better images since it was clinically introduced approximately 25 years ago. Although two-dimensional echocardiography is an established tool in clinical cardiology, the image qualities of conventional transthoracic approaches are sometimes unsatisfactory for various reasons, such as obesity, chronic obstructive lung disease, and changes with age in the chest wall. In these patients, transesophageal echocardiography can provide important diagnostic information because chest wall interference and intrathoracic attenuation are eliminated. Furthermore, the close vicinity of the heart and thoracic aorta to the transducer allows the use of higher frequency, near-focused focused transducer, which produces better resolution and improved signal to noise ratio. In this brief review, We discuss the diagnostic possibilities and clinical advantages of transesophageal echocardiography based on its application in more than 1,500 awake patients since 1977 in our department.     

Gabor spectra for Doppler echocardiography

Doppler echocardiography on current ultrasonography machines makes use of short-time Fourier spectrograms (STFTs) to display the patterns of blood vevocities in the heart chamber. From these sonologists infer the functional parameters, such as valve area, that have pathological significance. After mention of the lacuna in such an STFT display, the Gabor transform and associated Gabor spectrogram evaluation techniques are described. Finally, comparative views of ultrasound machine display with PC-based STFT and Gabor displays for two typical patients are shown, with inferences in support of the proposed Gabor display.     

Evaluation of renal artery stenosis by echocardiography

Renovascular hypertension and renal hypertension are two major secondary forms of hypertension due to renal disease. Diagnosis of renovascular hypertension is important because revascularization therapy is an effective treatment for patients with renal artery stenosis. Doppler echocardiogaphy is a useful noninvasive test to detect renal artery stenosis. There are two Doppler echocardiographic methods to detect renal artery stenosis. The first is to measure flow velocity at the stenotic area. Pulse-Doppler and/or continuous Doppler methods are used to measure flow velocity. Significant stenosis is diagnosed by maximum flow velocity (Vmax) at the stenotic area: > 1.5m/sec or > 1.8-2.0m/sec. Flow waves of segmental and interlober arteries are assessed by the pulse-Doppler method. Decreased Vmax, early systolic acceleration, resistive index and pulsatility index indicate decreased renal artery blood flow and hence, renal artery stenosis.