主动脉窦瘤破裂的超声心动图诊断

目的评价主动脉窦瘤破裂(rupturedaorticsinusaneurysm,RASA)的超声心动图价值。方法复习文献,回顾性分析经手术证实的9例主动脉窦瘤的超声心动图特征。结果超声心动图可以准确显示窦瘤的形态、部位、破入心腔方向、血流动力学及并发症。结论超声心动图可于手术前及时、准确的诊断本病。     

主动脉窦瘤破裂超声心动图诊断及误诊原因分析

目的：探讨彩色多普勒超声心动图对诊断主动脉窦瘤破裂的临床价值及提高诊断率的方法。方法：将14例主动脉窦瘤破裂患者声像图表现与手术结果进行对比分析。结果：12例主动脉窦瘤破裂患者，彩色多普勒超声心动图显示瘤体形状、破口大小及数量与手术结果基本相符，误诊2例．结论：彩色多普勒超声心动图对主动脉窦瘤破裂有特异性诊断价值．综台分析二维图像特征和频谱特点，可提高主动脉窦瘤破裂的诊断率。     

主动脉窦瘤的超声心动图诊断

对３７例经超声心动回检查（包括两维超声、频谱多普勒、彩色多普勒、声学造影及经食道超声心动图）诊断为主动脉窦瘤患者进行手术对照研究。结果表明：超声心动图能准确显示主动脉窦瘤的形态、起源、突入腔室及破裂状况，并能基本正确评估其合并的右室流出道狭窄、主动脉瓣脱垂及返流、心包积液等病损。文中尚对窦瘤是否破裂、是否并发室间隔缺损等鉴别诊断进行了讨论。     

彩色多普勒亏声检查主动脉窦瘤破裂的价值

目的 对２１例经彩色多普勒超声心动图检查诊断为主动脉窦瘤破裂患者进行手术对照研究,结果：彩色多普勒超声心图能准确显示主动脉窦瘤的形态、起源、破入腔室的状况。本文２１例患者在超声诊断后即行手术,无一例作心导管检查,而窦瘤破裂诊断符合率达１００％,合并症诊断符合率９５％以上,因此我们认为彩色多普勒超声心动图是诊断主动脉窦瘤破裂的一种首选、无创、准确、重复性强的检查方法。对合并症也有较好的检出能力。     

彩色多普勒超声心动图诊断主动脉窦瘤破裂

彩色多普勒超声心动图诊断主动脉窦瘤破裂张玉金，任卫东，杨军，王晓丽，张玉华，龚传斌本文总结我科１９８９～１９９３年应用彩色多普勒超声心动图诊断主动脉窦瘤破裂２０例。现就应用彩色多普勒超声心动图检测结果与手术结果进行对照分析。资料与方法本文２０例主动脉...     

彩色多普勒超声检查主动脉窦瘤破裂的价值

目的 对21例经彩色多普勒超声心动图检查诊断为主动脉窦瘤破裂患者进行手术对照研究,结果:彩色多普勒超声心图能准确显示主动脉窦瘤的形态、起源、破入腔室的状况。本文21例患者在超声诊断后即行手术,无一例作心导管检查,而窦瘤破裂诊断符合率达100％,合并症诊断符合率95％以上,因此我们认为彩色多普勒超声心功图是诊断主动脉窦瘤破裂的一种首选、无创、准确、重复性强的检查方法,对合并症也有较好的检出能力。     

主动脉窦瘤破裂封堵的超声心动图应用

目的探讨超声心动图在主动脉窦瘤破裂封堵术中的应用。方法2例单纯主动脉窦瘤破裂入右房患者,应用超声心动图经导管封堵术前观察窦瘤破口位置、大小、与周围结构的关系及有无合并其他畸形,术中定位和指导封堵器释放,术后评估疗效和随访观察。结果2例患者成功封堵。超声心动图术前判断手术适应证准确,术中正确指导封堵器释放,术后评估效果满意。结论超声心动图可用于主动脉窦瘤破裂经导管封堵患者的术前筛选、术中指导和术后随访。     

20例主动脉窦瘤破裂的外科治疗

目的：总结主动脉窦瘤破裂的外科治疗经验。方法：主要脉窦瘤破裂20例,合并室间隔缺损11例（55％）,合并主动脉关闭不全5例（25％）,行单纯窦瘤切除修补4例,窦瘤切除加室缺修补11例,窦瘤切除修补加主动脉瓣置换5例。结果：全组无手术死亡,无残余分流。结论：心脏超声对主动脉窦瘤破裂诊断准确率高。窦瘤破裂心功能影响严重,一经确诊,宜尽早手术。窦瘤破口直径≥1．0cm宜有补片修补,缝合或修补窦瘤时进针方向要与主动脉长轴平行。     

超声心动图对主动脉窦瘤破裂的诊断价值

本追踪了11例临床怀疑主动脉窦瘤破裂患的临床表现及超声心动图结果，与手术结果对比，探讨超声检查对主动脉窦瘤的诊断及鉴别诊断的价值。[第一段]     

先天性主动脉窦瘤破裂的影像诊断(附6例分析)

本文报道6例先天性主动脉窦瘤破裂病例，均经手术证实，窦瘤全部起于右冠状窦并破入右室。6例皆有普通X线照片，主动脉造影及超声心动图检查。本文对临床资料及各种检查方法进行了讨论，认为平片有明显的诊断价值，超声心动图作为无创检查不仅可明确提示诊断，而且能指出窦瘤的部位、破口大小及有无合并心内畸形。术前行胸主动脉造影能更详确的做出诊断。     

经食管超声心动图引导经胸微小切口封堵主动脉窦瘤破裂的可行性

目的 探讨经食管超声心动图（TEE）引导经胸微小切口封堵主动脉窦瘤破裂（RASA）的可行性。方法 回顾性分析30例接受TEE引导经胸微小切口封堵治疗的RASA患者的资料。对右冠状动脉窦瘤破裂者,准确测量破口与冠状动脉开口之间的距离,术中以TEE准确引导导丝及鞘管顺利进入窦瘤破口,术后仔细评估封堵伞位置、稳定性及对瓣膜的影响。对右冠窦瘤破裂患者,确保封堵器未遮挡冠状动脉开口。结果 30例RASA患者中,TEE引导下成功封堵20例,其中右冠窦瘤破裂10例（破入右心室7例、破入右心房3例）;无冠窦瘤破裂10例（破入右心房8例、破入右心室2例）。封堵成功患者各项生命体征平稳,心腔结构未发生明显改变,心功能正常。术后多次复查,封堵器位置正常,主动脉瓣启闭运动正常,未见狭窄及反流信号,也未检测到残余分流。结论 TEE可较为准确地诊断RASA,并引导术者准确放置封堵器;单纯TEE引导下经胸微小切口封堵RASA是一种可行的方法。     

经食管超声心动图在儿童复杂性先天性心脏病手术治疗中的应用价值

目的探讨经食管超声心动图(TEE)对儿童复杂性先天性心脏病(CHD)手术治疗的价值。方法复杂性CHD患者95例,年龄0.3～15.6岁(平均4.3岁),均在体外循环前后进行TEE检查。结果术前TEE首要诊断与手术诊断符合率100%,其中仅7例(7.4%)TEE次要诊断与手术诊断不符。TEE对经胸超声心动图诊断做出补充或修正9例(9.5%),其中6例(6.3%)由于TEE的发现而作出手术方案改变或相应处理。术后TEE成功显示率95.8%(91/95),在91例显示成功患者中,达到预期效果且无残余问题63例(69.2%),发现残余问题28例(30.8%),其中2例(2.2%)由于TEE的发现立即予以处理。结论术前TEE可准确诊断儿童复杂性CHD,有助于制定手术方案,术后TEE可及时发现残余问题,有助于提高手术成功率。     

RASA1 maintains the lymphatic vasculature in a quiescent functional state in mice

RASA1 (also known as p120 RasGAP) is a Ras GTPase-activating protein that functions as a regulator of blood vessel growth in adult mice and humans. In humans, RASA1 mutations cause capillary malformation-arteriovenous malformation (CM-AVM); whether it also functions as a regulator of the lymphatic vasculature is unknown. We investigated this issue using mice in which Rasa1 could be inducibly deleted by administration of tamoxifen. Systemic loss of RASA1 resulted in a lymphatic vessel disorder characterized by extensive lymphatic vessel hyperplasia and leakage and early lethality caused by chylothorax (lymphatic fluid accumulation in the pleural cavity). Lymphatic vessel hyperplasia was a consequence of increased proliferation of lymphatic endothelial cells (LECs) and was also observed in mice in which induced deletion of Rasa1 was restricted to LECs. RASA1-deficient LECs showed evidence of constitutive activation of Ras in situ. Furthermore, in isolated RASA1-deficient LECs, activation of the Ras signaling pathway was prolonged and cellular proliferation was enhanced after ligand binding to different growth factor receptors, including VEGFR-3. Blockade of VEGFR-3 was sufficient to inhibit the development of lymphatic vessel hyperplasia after loss of RASA1 in vivo. These findings reveal a role for RASA1 as a physiological negative regulator of LEC growth that maintains the lymphatic vasculature in a quiescent functional state through its ability to inhibit Ras signal transduction initiated through LEC-expressed growth factor receptors such as VEGFR-3.     

超声对主动脉窦瘤破裂的瘤体形状及合并室间隔缺损频谱特点的研究

目的：探讨超声显像对主动脉窦瘤破裂的瘤体形状与破口大小和数量的关系,以及合并室间隔缺损声像图特点。方法：28例主动脉窦瘤破裂患者,其中12例合并室间隔缺损,将其声像图表现与手术结果进行对比分析室间隔缺损患者,二维超声心动图测量的缺损大小明显低于手术所见,二维超声结合频谱多普勒能准确鉴别有无室缺,结论：超声显像能根据窦瘤形状判断破口大小和数量,通过血流频谱特点。能确定是否合并室间隔缺损。     

Stimulation of activin A expression in rat aortic smooth muscle cells by thrombin and angiotensin II correlates with neointimal formation in vivo.

Vasoactive GTP-binding protein-coupled receptor agonists (e.g., angiotensin II [AII] and alpha-thrombin) stimulate the production of mitogenic factors from vascular smooth muscle cells. In experiments to identify mitogens secreted from AII- or alpha-thrombin-stimulated rat aortic smooth muscle (RASM) cells, neutralizing antibodies directed against several growth factors (e.g., PDGF and basic fibroblast growth factor [basic FGF]) failed to inhibit the mitogenic activity of conditioned media samples derived from the cells. In this report, we found that polyclonal neutralizing antibodies directed against purified human placental basic FGF reduced the mitogenic activity of AII-stimulated RASM cell-conditioned media and in immunoblot experiments identified a 26-kD protein (14 kD under reducing conditions) that was distinct from basic FGF. After purification from RASM cell-conditioned medium, amino acid sequence analysis identified the protein as activin A, a member of the TGF-beta superfamily. Increased activin A expression was observed after treatment of the RASM cells with AII, alpha-thrombin, and the protein kinase C agonist PMA. In contrast, PDGF-BB or serum caused only a minor induction of this protein. Although activin A alone only weakly stimulated RASM cell DNA synthesis, it demonstrated a potent comitogenic effect in combination with either EGF or heparin-binding EGF-like growth factor in the RASM cells, increasing DNA synthesis by up to fourfold. Furthermore, in a rat carotid injury model, activin A mRNA was upregulated within 6 h after injury followed by increases in immunoreactive protein detected in the expanding neointima 7 and 14 d later. Taken together, these results indicate that activin A is a vascular smooth muscle cell-derived factor induced by vasoactive agonists that may, either alone or in combination with other vascular derived growth factors, have a role in neointimal formation after arterial injury.     

Comparison of image quality between a narrow caliber transesophageal echocardiographic probe and the standard size probe during intraoperative evaluation.

BACKGROUND: Transesophageal echocardiography (TEE) has become an integral part of the evaluation and monitoring of patients during cardiac operation. Until recently, the smallest TEE probe with multiplane imaging measured 13 mm in diameter. This size is now standard for adult TEE probes. Recently, a new TEE probe has become available (MiniMulti TEE probe, Philips Medical Systems, Andover, Mass), which has a diameter of 8 mm. Although using a smaller probe is attractive, the quality of images it generates when used in adults has not yet been examined. OBJECTIVE: The purpose of this study was to compare TEE studies done with both probes. METHODS: After informed consent was obtained, full intraoperative TEE studies were performed in 20 patients with a small pediatric probe. The study was then repeated using a standard adult probe. The studies were read in random order by two experienced echocardiographers blinded to probe used. For each study, 18 anatomic cardiac structures and 5 Doppler patterns were subjectively graded as excellent (1), good (2), fair (3), or poor (4) in quality. The average score for each structure or Doppler profile was computed for each probe. RESULTS: The average score for all findings was lower (better) for the adult TEE probe (1.4 +/- 0.4 vs 1.7 +/- 0.4; P =.003). When each finding was compared separately, several cardiac structures (left ventricle [LV], pericardium, right ventricle [RV], interatrial septum, left atrium, left atrial appendage, mitral valve, aortic valve) had better scores with the adult probe, and the differences for the LV and RV were larger than those for the other findings (LV scores differed by 0.7, P =.0004; RV scores differed by 0.5, P =.01). There was no significant difference between probes when evaluating venous structures (coronary sinus, superior vena cava, pulmonary vein), the thoracic aorta, or the right atrium or tricuspid valve. In addition, Doppler patterns were not significantly different with the two probes. There were two findings that were missed with the small probe and seen with the adult probe (one aortic plaque and one left atrial appendage thrombus). CONCLUSIONS: In the adult, the larger probe provides better images, particularly of the RV and LV. In addition, important findings may be missed with the smaller probe. However, if the adult probe cannot be passed, the pediatric probe is a reasonable alternative.     

Traumatic subarachnoid hemorrhage visualized with transesophageal echocardiography

Computed tomography (CT) is the current standard for the early diagnosis of traumatic subarachnoid hemorrhage (tSAH). It is, however, not feasible when a patient is hemodynamically unstable. We report a novel method of visualizing tSAH with transesophageal echocardiography (TEE). The spinal cord was visualized through the intervertebral disc with the transducer directed posteriorly in the esophagus. TEE findings of the spinal cord in three patients with tSAH were compared with those of 19 patients without it. In the former, fibrin-like mobile images were present, the ratio of diameter of spinal cord to internal diameter of spinal canal was significantly larger (0.59 +/- 0.07 vs. 0.45 +/- 0.04, p = 0.0070) and the pia mater was significantly thicker (1.41 +/- 0.12 mm vs. 0.66 +/- 0.15 mm, p = 0.0001). Our findings suggest that TEE may be an alternative way of diagnosing early tSAH at bedside in patients in which CT is not feasible.     

Use of transesophageal contrast echocardiography for excluding left atrial appendage thrombi in patients with atrial fibrillation before cardioversion

Transesophageal echocardiographic (TEE) guidance of cardioversion in patients with atrial fibrillation is an alternative method to conventional anticoagulation. Although TEE is considered the gold standard for excluding left atrial (LA) thrombi, in some patients dense spontaneous echo contrast (SEC) and artifacts may hamper the identification or exclusion of LA thrombi. Often those patients are refused cardioversion. The purpose of this study was to determine whether the application of echo contrast (Optison, Mallinckrodt, San Diego, Calif) facilitates the exclusion of LA appendage thrombi in this patient group and allows for safer cardioversion. Forty-one patients with atrial fibrillation and dense SEC or inconclusive TEE findings were given echo contrast. Fourteen patients with sinus rhythm served as control participants. Echo contrast completely reduced artifacts in 13 of 22 patients. In 12 of 19 patients with SEC, the LA appendage was completely filled after the application of echo contrast and, thus, SEC was completely suppressed. In 13 of 41 patients, it was filled incompletely and in 9 of 41 patients, a new mass resembling a thrombus was detected. In total, of 25 of 41 patients with inconclusive TEE findings an atrial thrombus was definitively excluded. Those patients underwent cardioversion. None of those patients had a cerebral embolic complication as assessed by cranial magnetic resonance imaging. Thus, the application of echo contrast may facilitate the TEE exclusion of LA appendage thrombi and, hence, improve the safety of TEE-guided cardioversion. (J Am Soc Echocardiogr 2002;15:1256-61.)     

实时三维经食管超声心动图在二尖瓣成形术中的应用研究

目的 探讨术中实时三维经食管超声心动图(RT-3D TEE)判断二尖瓣病变区域的准确性,以及评价二尖瓣成形术效果的价值.方法 19例因二尖瓣反流(MR)拟接受二尖瓣成形术患者,采集术前、术后RT-3D TEE图像,将术前所见与术中发现进行比较,并在术后即刻评价手术疗效.结果 RT-3DTEE诊断二尖瓣叶病变与术中发现完全相符16例,3例不符合,其中1例术前诊断前叶中间段、后叶中间段脱垂,术中仅发现瓣环扩大,瓣膜黏液退行性变;1例术前诊断后叶后内段脱垂,术中发现后叶中间段及后内段腱索断裂;1例术前提示瓣环扩大,术中发现后叶中间段脱垂.2D TEE诊断二尖瓣病变与术中发现完全相符仅10例,且对二尖瓣脱垂患者难以明确脱垂的确切瓣区和范围.术后即刻观察成形术效果,其中18例RT-3DTEE显示微量至少量二尖瓣反流,1例术后仍为中重度反流,改行二尖瓣置换术,二尖瓣成形术的成功率为94.7%.结论 RT-3D TEE明显提高了二尖瓣反流病因及病变部位定位的诊断准确性,在二尖瓣成形术手术方案制定及疗效的即刻评估方面发挥了非常重要的作用.