心肌对比超声心动图

随着冠状动脉造影的广泛开展,人们逐渐认识到,心外大的传导动脉(conducting arteries)与心肌内的阻力冠脉(resistance arteries)对心肌的血供可不一致。如完全闭塞的大冠脉,所属心肌由于得到充分的侧支循环供应而能长期存活;急性心肌梗死经溶栓或PTCA使相关冠脉再通后,所属心肌由于微血管损伤可呈现无血流状态。越来越多的证据表明,心肌内微血管对冠状循环的影响在心肌的血供中起     

超声心动图诊断左心房恶性肿瘤3例

心脏肿瘤以良性肿瘤最常见,且多为黏液瘤,多位于左心房。超声心动图对于检出心脏肿瘤具有决定性的意义,对于肿瘤的性质,有一定的指导意义,但是不能完全确诊。现将我院近两年收治的3例左心房恶性肿瘤报告如下。     

心肌炎超声心动图表现

目的本文旨在探讨超声心动图对心肌炎的诊断价值.方法通过对112例心肌炎患者进行常规心电图和实时超声心动图检查,将其检查结果进行总结分析.结果112例心肌炎患者二维超声心动图大部分病例出现心脏形态和结构的改变.结论超声心动图可以实时的观察心脏结构和形态变化,能给心肌炎的临床诊断提供较多的信息和客观依据.     

二维超声心动图的心脏运动分析

本文研究与探讨了一种基于速度场计算的自动分析二维超声心动图的心脏运动的方法。该方法不需要复杂的心内边缘提取算法，也不需要各向同性、均匀的假设。通过对超专心动图速度场及其统计规律的分析，提高心脏的诊断质量。实验证明这是一种有效的方法。     

心脏瓣膜退行性病变的超声心动图检查

目的：评价超声心动图检查在心脏瓣膜退行性病变诊断中的应用价值。方法：回顾性分析258例经超声心动图诊断心脏瓣膜退行性病变的声像图表现,并测定心功能。结果：病变主要累及的部位依次为主动脉瓣环、二尖瓣环及瓣叶,少数累及二尖瓣前组腱索及前组乳头肌,病变特点为瓣环、瓣叶回声增强、增厚,活动僵硬;随着病程进展,瓣膜区可出现返流、狭窄,造成心脏结构改变及心脏功能受损,其中心脏舒张功能减退患病率较高。结论：超声显像能实时了解瓣膜退行性变,确定病变部位、程度、判断有无瓣膜狭窄或关闭不全,以及了解心脏功能情况,为该病的诊断提供了一种无创伤性以及敏感性、特异性均高的检查方法。     

超声心动图在早期妊娠胎儿心脏检查中的应用

目的探讨超声心动图在检查妊娠11~14+6周内正常胎儿心脏结构和血流情况的应用价值。方法对150例孕妇在妊娠11~14+6周时进行常规经腹超声检查,观察胎儿心脏各切面结构和血流并进行测量,同时在各切面对3种超声方法[二维超声、彩色血流显像及增强型血流成像技术(e-flow)]的显像满意率进行对比分析。结果二维超声检查中胎儿心脏各切面显示率不同,其中四腔心切面显示率最高。妊娠13周以后胎儿心脏结构超声可清晰显示。妊娠11~12周e-flow血流显像较二维超声和彩色血流显像各切面的显示满意率高。结论由于在妊娠13周以后胎儿心脏结构能够清晰显示,e-flow血流显像超声方法有助于优化超声显像,因此,可以将胎儿心脏筛查时间提前至妊娠早期,有利于胎儿严重先天性心脏畸形的早期诊断。     

最小的经食道超声心动图传感器

在2009年6月召开的第20届美国超声心动图技术（ASE）年会上，展出了飞利浦公司iE33智能超声心动图系统，其中最主要的经食道超声心动图（TEE）传感器microTEE，是目前世界上最小的专用于新生儿患者心脏成像的传感器。它为小儿心脏病诊断提供了良好的成像工具。     

扩张型心肌病超声心动图诊断价值

目的?探讨扩张型心肌病患者二维超声心动图及多普勒超声心动图的表现.方法?选取30例扩张型心肌病患者行超声检查的超声表现资料进行分析.结果?扩张型心肌病超声心动图可见心腔扩大、普遍性弥漫性室壁运动减弱、瓣膜反流、射血分数下降,偶见心腔内血栓.结论?正确评估病变的程度、心功能状态、疾病的预后和治疗效果.     

超声心动图新技术在心衰患者同步化治疗中的应用

心力衰竭患者普遍存在不同程度的心室内或心室间的不同步化运动,心脏再同步化治疗(CRT)越来越受到人们的重视。超声心动图尤其是各种新技术在心脏再同步化治疗中具有重大作用。本组详细介绍了组织多普勒、二维应变、三维全容积和速度向量成像等超声新技术在评价心脏同步性、CRT患者筛选、指导起搏器置放、优化起搏程序、评价疗效以及术后随访观察等方面的进展和应用。     

Viable myocardium revealed by contrast echocardiography

In patients with acute ischemic syndrome left ventricular dysfunction may indicate necrotic myocardium as well as viable tissue. Among the well known non-invasive techniques like dobutamine echocardiography, rest-redistribution thallium scintigraphy or positron emission tomography a new method, contrast echocardiography is evolving. In the presented case stunning resulting in left ventricular aneurysm formation was confirmed after intravenous injection of contrast agent and the use of intermittent harmonic imaging in the acute phase of ischemia. The negative coronary angiography and the complete restoration of the left ventricular function confirmed the results of contrast echocardiography. With the development of new second generation contrast agents and new techniques contrast echocardiography will become a feasible method for detection of viable myocardium after intravenous injection.     

Evaluation of myocardial perfusion using intravenous contrast echocardiography

The aim of the study was to assess the accuracy of rest myocardial contrast echocardiography (MCE) in detecting perfusion abnormalities after intravenous contrast administration in chronic coronary artery disease. In 21 patients (mean age 49 years) contrast agent was injected intravenously. ATL HDI 5000 ultrasound machine was used. Triggering every fifth cardiac cycle in end-systole apical 2-chamber, 3-chamber and 4-chamber views were used. All patients underwent thallium scintigraphy on the same day and coronary angiography was performed within 24 hours. Second harmonic imaging and power Doppler were used in assessing presence or absence of perfusion, localization and extent of perfusion defects, and their relation with wall motion. In the first group all the 13 patients after myocardial infarction had akinetic segments on echocardiography in accordance with the coronary occlusion detected by coronary angiography. In the second group none of the 8 patients without previous myocardial infarction had wall motion abnormality. Group I: dividing the left ventricle into 16 segments out of 208 segments 44 were akinetic. Perfusion defect was detected by MCE in 29 segments. In 12 segments with wall motion abnormality the normal myocardial perfusion was consistent with viable myocardium, 2 inferior akinetic segments could not be evaluated due to contrast attenuation and in one inferior segment MCE in contrast to the thallium scintigraphy showed no perfusion defect. Group II: good contrast effect was detected in all 128 segments except one inferior segment in which there was a fixed perfusion defect also by thallium scintigraphy and coronary angiography revealed occluded right coronary artery. In conclusion MCE and second harmonic triggered imaging is comparable with thallium scintigraphy in detecting fixed perfusion abnormalities. MCE may contribute to the detection of viable myocardium.     

心肌声学造影用心脏程控触发装置的研制

介绍了一种用于持续静脉滴注声学造影剂定量心肌血流测量研究的、基于单片机的心脏程控触发装置，及其硬件电路设计和基于Keil C51的软件设计流程。该装置运行稳定可靠，为持续静脉滴注声学造影剂定量心肌血流测量研究提供了技术支持。     

SonoVue声学造影剂及心肌声学造影的研究新进展

六氟化硫等高分子低溶性气体有各种材料核膜包裹的造影剂，以SonoVue为代表，由于SonoVue内含高分子低溶性惰性气体，又以磷脂等多种表面活性物质成薄而柔软的壳膜，有极好的稳定性，因此也称其为第二代新型造影剂。由于其特殊的药理学及声学特性，结合特殊的超声检测技术，产生了一种新的显像模式一对比增强超声（CEUS）^[1]。它可明显提高心血管疾病的检查技术水平，应用价值可与核医学、对比增强CT和MRI相当。     

右心声学造影诊断合并肺动脉口狭窄的房间隔缺损应用价值

目的探讨右心声学造影对合并肺动脉口狭窄（PS）的房间隔缺损（ASD）的诊断价值。方法应用经胸超声心动图（TTE）技术和右心声学造影技术分析出15例合并PS的ASD患者的声像图表现。结果TTE和右心声学造影对合并PS的ASD的检出率分别是66％和100％。结论右心声学造影有助于合并PS的ASD的诊断。     

右心声学造影诊断合并肺动脉口狭窄的房间隔缺损应用价值

目的探讨右心声学造影对合并肺动脉口狭窄(PS)的房间隔缺损(ASD)的诊断价值。方法应用经胸超声心动图(TTE)技术和右心声学造影技术分析出15例合并PS的ASD患者的声像图表现。结果TTE和右心声学造影对合并PS的ASD的检出率分别是66%和100%。结论右心声学造影有助于合并PS的ASD的诊断。     

冠心病支架植入术后超声心肌灌注显像的初步研究

目的初步探究实时超声心肌造影(MCE)评价经皮冠状动脉介入(PCI)术后心肌灌注情况的应用价值。方法 8例因胸痛就诊的临床诊断为冠心病或疑似冠心病患者纳入此项研究。结果 7例患者确诊冠心病,并行PCI治疗。8例患者共记录图像清晰的有效节段为51个,其中7例确诊为冠心病的患者共记录43段。1例患者MCE检查发现2个节段灌注欠佳,但心肌酶谱及心电图检查为阴性,未行PCI治疗。以CAG为标准,MCE对LAD病变的检出率为100%,对LCX病变的检出率为60.0%,对RCA的检出率为66.7%。结论①MCE可以客观的反映PCI术后心肌的再灌注情况;②冠脉造影显示狭窄血管腔<50%的冠脉分布区,也会出现心肌灌注异常,进一步证明实时超声心肌造影可以补充冠脉造影的不足,准确地反映心脏微循环。     

Detection of myocardial viability with venous contrast echocardiography immediately after reperfusion therapy in patients with acute myocardial infarction

INTRODUCTION: After reperfusion therapy of acute myocardial infarction not only the patency of infarct related artery (IRA) but uncompromised myocardial perfusion are essential for recovery of myocardial contractile function. AIM: The authors sought to evaluate the relation between the status of myocardial microvasculature early after successful mechanical reperfusion therapy of AMI and contractile function at rest two weeks later. METHODS: Sixty-three patients with first acute myocardial infarction underwent venous myocardial contrast echocardiography (VMCE) 3 hours after successful percutaneous coronary intervention. The myocardial contrast intensity of akinetic segments was evaluated according to a semiquantitative score (1 = normal; 2 = moderate contrast defect; 3 = serious contrast defect; 4 = no contrast at all). Two weeks later the resting contractile function of previously akinetic segments (n = 218) was re-evaluated. RESULTS: The semiquantitative contrast score was significantly different between differential functional groups observed after two weeks: normokinesia (1.21 +/- 0.47); hypokinesia (1.65 +/- 0.77); akinesia (2.75 +/- 0.85). Sensitivity and the specificity of semiquantitative venous myocardial contrast echocardiography for early prediction of functional recovery is 90% and 69%, respectively (chi 2 = 76.2; p < 0.001). The global wall motion score index improved in contrast positive patients (more than 50% of initial akinetic segments show score 1 or 2) (1.607 +/- 0.30 vs. 1.295 +/- 0.25; p < 0.001), but did not change in the contrast negative patients (1.702 +/- 0.38 vs. 1.603 +/- 0.33; p = NS). CONCLUSION: Functional recovery after AMI can be predicted with VMCE immediately after successful reopening of IRA. The post-PTCA contrast intensity of an infarcted segment is closely related to its subsequent functional status.