彩色多普勒超声心动图诊断房间隔膨出瘤的临床意义

目的:通过应用彩色多普勒超声对房间隔膨出瘤的诊断,总结其在临床诊断及治疗方面的价值。方法:应用彩色多普勒超声诊断仪进行多切面扫查,认真观察房间隔膨出瘤的基底宽度,突起的凸度,有无合并房间隔缺损,流出道的梗阻及血栓的形成等。结果:12例房间隔膨出瘤患者膨出瘤均位于房间隔中部,其中8例瘤体膨向右房侧,2例膨向左房侧,2例于左右心房之间往返,膨出度(10mm,基底直径>15mm(成人)或膨出度>25%左或右房横径(小儿)。结论:超声诊断房间隔膨出瘤为临床的诊断和治疗提供可靠的依据。     

超声心动图诊断单纯性房间隔膨胀瘤1例

1　病历报告患者 ,女 ,2 1岁。无心悸、胸闷、口唇发绀及腹胀、下肢水肿等症状 ,活动不受限 ,发育正常。于 2个月前体检时发现心脏杂音来院就诊。查体 :心率 84 /ｍｉｎ ,律齐 ,于心底部闻及轻微喀喇音。超声心动图检查示 :各房室大小正常 ,房间隔中段菲薄 ,呈线性回声 ,连续性良好 ,但活动度明显增大 ,随心脏的缩舒活动在两房间左右摆动 (见图 1) ,左右向最大活动幅度为 2 .2ｃｍ。彩色多普勒未见该处异常分流。超声诊断 :单纯性房间隔膨胀瘤。2　讨论房间隔膨胀瘤是一种较为少见的心脏畸形 ,可能继发于房间压差的异常 ,也可能仅是一种原发…     

彩色多普勒超声心动图诊断房间隔瘤2例

房间隔瘤是一种少见的心脏结构异常，尸解发病率为 1％ [1]。我院自 1999年 4月至 2000年 6月运用威曼 800型彩色多普勒超声仪诊断房间隔瘤 2例。现报道如下： 例 1：患者女， 60岁。反复胸闷、气促十 a余，加重伴下肢浮肿半 mo。门诊以“风心病、心房纤颤”申请彩超检查，心尖四腔心切面显示左房 53mm× 85mm，右房 66mm× 86mm，左室 70mm，右室 49mm。全心扩大，室壁运动普遍减低。 LVEF： 0.45， Fs： 18％。 CDFI：各瓣膜口均见返流信号。房间隔中部呈薄壁囊袋状向右房侧膨出，膨出高度 41mm，基底长度 18mm(图 1见封三 )。 CDFI：房间隔水平未见穿隔血流束。舒张期右房内红色血流信号绕过房间隔瘤而呈囊状充盈缺损。超声心动图诊断：扩张型心肌病，心功能不全；房间隔瘤。     

经胸超声心动图检查在房间隔膨出瘤诊断中的应用价值

目的探讨经胸超声心动图检查在房间隔膨出瘤诊断中的临床应用价值。方法对13例房间隔膨出瘤患者的经胸超声心动图检查资料进行回顾性分析。结果二维超声见13例房间隔膨出瘤均位于卵圆窝处,膨出深度8～17mm,基底部长度为13～19mm;彩色血流显像12例未见明显异常血流信号,1例发现房间隔中部穿隔血流。结论经胸超声心动图检查对房间隔膨出瘤有特异性诊断价值,操作简单,安全无创,已成为临床首选的检查方法。     

房间隔膨胀瘤的超声诊断

在本院行多普勒二维超声心动图检查的３２００例门诊及住院患者中共检出房间隔膨胀瘤７例，检出率为０．２５％，均为原发性，本文就该病的病因，发病机理，超声心动图表现及临床意义进行了讨论。     

房间隔膨胀瘤彩色多普勒超声心动图诊断及临床意义

目的：探讨彩色多普勒超声心动图诊断房间隔膨胀瘤（ASA）的诊断价值和临床意义。方法：应用彩色多普勒超声诊断仪对36例ASA患者进行多切面检查,对ASA基底部宽度、最大膨出深度、膨出方向、瘤体内有无血栓以及有无合并房间隔缺损、流出道梗阻等其他心脏疾病的情况进行观察,探讨其诊断要点,提高其超声诊断和鉴别诊断价值。结果：根据彩色多普勒超声心动图特征对于36例ASA全部做出正确诊断,声像图均清晰显示房间隔中部卵圆窝处变薄,其中25例膨向右房侧。5例膨向左房侧,6例于左右房之间往返。成人：膨出度〉10mm,基底部〉15mm。小儿：膨出度〉25％左房或右房横径。结论：彩色多普勒超声心动图诊断ASA为临床的诊断和治疗提供可靠的根据。     

房间隔瘤的超声心动图表现(附3例报告)

房间隔瘤是房间隔的一部分呈瘤样扩张．菲薄的房间隔可突入左房。亦可突入右房，严重时可引起房室瓣口部分梗阻。2006年3月-2007年2月我院发现3例房间隔瘤患者，现报告如下。     

成年患者中房间隔膨出瘤的超声心动图特点分析

目的 探讨房间隔膨出瘤（atrial septal aneurysm,ASA）超声心动图参数特点。方法 回顾性收集经胸超声心动图（transthoracic echocardiography,TTE）检查确诊为ASA的患者129例及无ASA的129例患者为对照组。获取患者的一般临床资料、有无卒中及心律失常;应用常规心动图检查获取左房前后径、升主动脉内径、左室舒张末期前后径,观察有无二尖瓣反流和主动脉瓣反流,有无合并先天性心脏病。比较两组的超声心动图参数差异,并采用二元logistic回归分析ASA发生的相关危险因素。结果二尖瓣反流和卵圆孔未闭（patent foramen ovale,PFO）发生率在ASA患者中显著高于对照组,差异有统计学意义（均P<0.001）;ASA组较对照组升主动脉内径宽,差异有统计学意义（P<0.05）;此外,ASA组患者主动脉瓣反流和房间隔缺损（atrial septal defect,ASD）的发生率也高于对照组,差异有统计学意义（均P<0.05）。二元logistic回归分析显示,二尖瓣反流、PFO和ASD是ASA发生的独立危险因素,均...     

老年房间隔瘤二例

<正> [病例1] 患者,黄某,女,60岁。因胸痛气短二十余天而就诊,既往无活动后心悸气短病史。查体:发育营养良好,心前区无隆起,心浊音界不大,心律整,各听诊区未闻及杂音,胸透心肺无异常。心电图示窦性心动过缓,Ⅱ、Ⅲ、avF、V_4、V_5、V_6。导联T波低平。二维超声心动图检查,左房内径38mm,右室、左     

超声心动图在精河地区房间隔膨出瘤诊断中的应用价值

先天性房间隔膨出瘤（atrial SePtaI aneurysm,ASA）是指房间隔卵圆窝区呈瘤样向任一侧一心房突出的原发性或继发性心脏结构异常。本病是在心脏负荷因素的作用下向低压侧膨隆而形成气球样的瘤洋膨出,亦可随心动周期变化在左右心房之间摆动。随着二维及彩色多普勒超声心动图在各临床上的广泛应用,使得房间隔膨出瘤的检出率明显提高。我们对精河地区近5年内经体检确诊的房间隔膨出瘤患者的二维及彩色多普勒超声心动图进行分析,探讨二维及彩色多普勒超声心动图对房间隔膨出瘤的诊断价值。     

Value of the Ratio of Occluder Versus Atrial Septal Length for Predicting Arrhythmia Occurrence after Transcatheter Closure in Children with Ostium Secundum Atrial Septal Defect

Background:

Transcatheter occlusion has been applied to treat ostium secundum atrial septal defect (OS ASD) since 1997. During the clinical practice, several postoperative complications including arrhythmia have been reported. This study aimed to evaluate the value of the ratio of atrial septal occluder (ASO) versus atrial septal length (ASL) for predicting arrhythmia occurrence after transcatheter closure in children with OS ASD.

Methods:

Six hundred and fifty-one children diagnosed with OS ASD underwent occlusion procedures after completing routine examinations. The onsets and types of arrhythmia both during and after the occlusion procedures were monitored. Treatments were given based on the individual types of arrhythmia. The binary logistic regression analysis and receiver-operating characteristic (ROC) curve were used in the analysis of value of the ratio of ASO/ASL for predicting postoperative arrhythmia occurrence.

Results:

Transcather occlusions were conducted in 651 children, among whom 7 children had different types and degrees of arrhythmia, with an incidence of 1.1%. The types of arrhythmia included sinus bradycardia, atrial premature beats, bundle branch block, and different degrees of atrioventricular block. Normal electrocardiograph findings were resumed in these 7 patients following active therapies such as corticoids, nutrition, and surgeries. The binary logistic regression and ROC analysis suggested that the ratio of ASO/ASL exhibited an intermediate predictive value for predicting arrhythmia occurrence after occlusion procedures. A cut-off value of 0.576 in the ratio provided a sensitivity of 87.5% and a specificity of 76.2% with an area under the ROC curve of 0.791 (95% confidence intervals, 0.655–0.926; P < 0.05) in predicting arrhythmia occurrence after the closure procedures.

Conclusions:

The ratio of ASO/ASL might be a useful index for predicting arrhythmia occurrence after closure procedures in children with OS ASD.     

彩色多普勒超声心动图评价房间隔缺损封堵术后右心形态和功能改变

目的评价房间隔缺损(ASD)患者Amplatzer封堵术后右心房、右心室形态及功能的变化。方法25例继发孔型房间隔缺损患者,男9例,女16例;均行右心导管封堵术,封堵器为Amplatzer式封堵器或国产类似AmplatzerASD封堵器。术前、术中、术后3天、术后3个月分别经胸彩色多普勒心脏检查,观察右心房、右心室大小、三尖瓣反流、肺动脉压力、右室射血分数及左室射血分数。结果25例房间隔缺损患者封堵术后,封堵器位置良好,未见偏移。CDFI:术后3天1例患者封堵器旁见3mm的分流信号,此例患者术后1月复查未见分流信号。余24例术后3天均未见穿隔分流信号。右心房(上下径、左右径)、右心室前后径、长径、横径较术前明显减小。(P<0.05～0.01);三尖瓣反流及肺动脉压力明显降低,(P<0.01);左室射血分数有所升高。3个月后复查右心房、右心室的大小基本恢复正常。结论ASD患者经封堵术后不仅消除了异常分流,而且使右心室的高动力状态得以纠正,也改善了左室收缩功能,彩色多普勒超声心动图能评价心脏的恢复情况。     

Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

Background:

Permanent atrial fibrillation (AF) is the most common form of dysrhythmia associated with atrial septal defects (ASDs) in patients older than 40 years. However, little is known about cardiac remodeling after transcatheter closure in patients with permanent AF. This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients.

Methods:

Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively. Of them, 63 patients with permanent AF were assigned to the case group, and the other 226 patients without permanent AF were assigned to the control group. Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups.

Results:

Patients in the case group were significantly older than those in the control group. The right ventricular (RV) volume and right atrial (RA) volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001). The left atrial dimensions, left ventricular end-systolic dimensions, left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups. Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P = 0.005 and P < 0.001). The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period.

Conclusions:

The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.     

颅内破裂动脉瘤的诊断研究

目的探讨颅内破裂动脉瘤的临床诊断方法.方法对203位颅内破裂动脉瘤患者进行了DSA和(或)CTA检查,再对CTA和DSA,2D-DSA和3D-DSA等检查结果进行比较研究.结果在动脉瘤检出数方面,CTA与DSA动脉瘤检出数无显著差异,2D-DSA与3D-DSA也无显著差异,但在瘤颈显示方面,3D-DSA清晰率较2D-DSA清晰率则差异有统计学意义(P<0.01).结论 3D-DSA是目前最可靠的颅内动脉瘤诊断方法,CTA则因其独特的优点,是诊断颅内动脉瘤的重要补充方法.     

经胸超声心动图在房间隔缺损封堵术中的应用

目的探讨经胸超声心动图(TTE)在房间隔缺损封堵术中的应用价值。方法在经胸超声和数字减影血管造影监测下,对44例继发孔型房间隔缺损用伞形封堵器封堵。结果44例全部封堵成功。最长随访12个月,均见封堵器位置正常,稳定,无合并症。结论经胸超声心动图在房间隔缺损封堵术前、术中、术后随访中有重要作用。     

超声心动图检出心包积液的临床意义探讨

本文报告了应用超声心动图诊断心包积液54例。其中大量积液15例,中等量积液25例,小量积液14例。54例当中有17例作了两维超声心动图检查,从左室长轴和短轴切面观,均清晰地显示了心包积液的空间分布。在上述54例当中仅27例是通过体检、心电图和X线检查诊断的。因此,应用超声心动图能够大大提高心包积液的检出率。在估计心包积液的量方面,特别是在很小量积液时,超声心动图检查也是有显著的价值。并且认为当慢性风湿性瓣膜病患者有肯定的心包积液存在时,超声心动图检查是确定风湿活动的一项有价值的诊断指标。     

原发性高血压发生心房颤动的危险因素

目的探讨原发性高血压发生心房颤动的危险因素。方法306例符合纳入标准的单纯性原发性高血压病人整群随访5年,由专科医师进行降压治疗的同时记录随访结果。终检标准:心房颤动。影响心房颤动事件的因素用Cox风险比例模型鉴定。结果5年中,发生心房颤动86例(28.1%),平均年发生率5.6%,Cox回归分析显示年龄(HR=1.095,p=0.024)、左室重量指数(HR=1.137,p=0.000)、左房内径(HR=1.232,p=0.000)是原发性高血压发生心房颤动的独立预报因子。结论年龄、左室重量指数、左房内径是原发性高血压发生心房颤动的危险因素。     

探讨超声心动图对诊断甲状腺功能亢进性心脏病的意义

目的应用彩色多普勒超声心动图检测甲亢患者的心脏形态及心功能的变化,并与20例正常人超声心动图作对比。方法采用超声诊断仪测量甲亢心患者（38例）以及正常人（20名）心脏各房室的大小值,计算心功能指标,并比较2组之间的差异。彩色血流观察二尖瓣、三尖瓣反流程度。结果甲亢心患者以左室增大为主,部分合并瓣膜反流,心功能测值部分参数低下,与正常人对照组相比,有显著性差异（P〈0.01）,甲亢心检出率明显高于X线及EKG检查。结论彩色多普勒超声心动图是甲亢性心脏病诊断及随访的简单、无创性检查方法。     

门静脉瘤的CT和MRI诊断

目的探讨门静脉瘤(PVA)在多层螺旋CT(MSCT)、MRI中的表现。材料和方法搜集经MSCT、MRI平扫和动态增强扫描诊断为PVA15例患者的资料,采用多平面重组(MPR)、容积再现重组(VR)等进行血管重建,分析其表现。结果 15例PVA中,11例行CT检查,4例行MRI检查。MRI平扫呈血管流空信号,CT平扫表现为等或稍低密度,动态增强扫描动脉期无强化,门静脉期和延迟期呈持续血管样强化。肝内型5例,发生于门静脉左支3例,右支2例,1例合并肝动脉-门静脉瘘,1例合并门静脉-肝静脉瘘。肝外型8例,发生于门静脉主干4例,肠系膜上静脉1例,脾静脉3例。混合型2例,1例发生于脾静脉和门静脉右前支,1例发生于网膜静脉和门静脉左支。3例PVA附壁血栓形成。结论 CT、MRI动态增强扫描结合血管后处理重建,能准确诊断PVA。