16层螺旋CT检测左心房血栓的临床价值研究

目的研究16层螺旋CT（MSCT）在左房血栓检测方面的临床价值。方法对60例患者（37例心房颤动患者,23例二尖瓣狭窄患者）分别进行16层螺旋CT及经食管超声检查,以经食管超声心动图为金标准,对16层螺旋CT检出左心耳血栓情况进行评价。结果 MSCT检测出7例左房血栓,其中4例TEE确认为左房血栓,另外3例TEE确认为假阳性。MSCT诊断左房血栓的敏感性、特异性、阳性预测值和阴性预测值分别为100.0%、95.4%、70.0%、100.0%。结论 MSCT对检测左房血栓有很高的敏感性,可以作为左心房血栓筛选的影像学方法。     

经食管超声检测房颤射频消融前左房自发性显影和左心耳血栓

目的探讨经食管超声心动图在房颤射频消融治疗前对左房自发性显影和左心耳血栓的诊断价值。方法对26例拟行射频消融的非瓣膜性房颤患者进行常规经胸超声心动图和经食管超声心动图检查,总结分析左房自发性显影和左心耳血栓检出情况。结果 26例房颤患者TTE发现左房自发性显影2例,占7.7%（2/26）,未检出左心耳血栓;TEE发现左心耳自发性显影10例,占38.5%（10/26）,左心耳血栓6例,占23.1%（6/26）。超声图像显示：左心耳扩大;左心耳出现异常团块回声,在心耳壁的附着面较宽大,彩色多普勒二尖瓣上少量、中量或大量反流;左房或左心耳可探及漩涡状或云雾状征象为SEC。结论经食管超声心动图明显提高了左房自发性显影和左心耳血栓的检出率,减少了房颤射频消融治疗的风险。     

经食道超声对射频消融术前房颤患者左房及左心耳血栓的诊断价值

目的探讨经食道超声（transesophageal echocardiography, TEE）对射频消融术前房颤患者左房及左心耳血栓的诊断价值。方法对52例房颤拟行射频消融术患者同时进行经胸超声（transthoracic echocardiography, TTE）和经食道超声检查,比较分析左房和左心耳血栓检出情况。结果52例房颤患者经胸超声检出左房血栓4例(7.69%）,左心耳血栓3例(5.77%）,其中1例假阳性,左心房自发显影（spontaneous echo contras, SEC）2例(3.85%）;经食道超声检出左房血栓8例(15.38%）,左心耳血栓9例（17.31%),左心房SEC 8例（15.38%）,左心耳SEC 6例（11.54%）,两种方法比较均有显著差异性。超声图像显示：左心房及左心耳内可见异常回声团块,附着于心房或心耳内壁,形态不规则,不活动,提示为左房或左心耳血栓形成,左房或左心耳内漩涡状或云雾状回声为血流自发显影现象,提示血流高凝状态。结论经食道超声明显提高了左房及左心耳血栓的检出率,是房颤射频消融治疗前的有效检查手段。     

华法令治疗左房血栓后施行二尖瓣球囊扩张术(附9例报告)

目的 探讨有左房附壁血栓的二尖瓣狭窄患者用药物消融血栓后行球囊扩张的方法与注意事项。方法 对我院收治的15例预备行二尖瓣球囊扩张术（PBMV）的风湿性二尖瓣狭窄（MS）患者以华法令2.5 mg/d治疗3周至1年后复查TEE,其中9例施行了PBMV。结果 最后1次TEE检查时6例附壁血栓完全消失,左心房各壁及左心耳内壁表面光滑;1例尚残留小钙化血栓在左心耳底部;1例左心房周边仍存在纤维化的附壁血栓;1例左心耳外侧壁小机化血栓存在。行PBMV术中1例发生脑栓塞现象,8例无任何动脉栓塞症。结论 口服华法令可消除部分病人的左心房附壁血栓并成功施行PBMV。     

经食道超声分析左心耳功能与风湿性二尖瓣狭窄合并左房血栓的关系

目的　分析左心耳功能在风湿性二尖瓣狭窄中出现左房血栓的预测能力。方法　应用二维多平面经食道超声检查 87例二尖瓣狭窄病患 ,按左房有无血栓分成两组 ,比较分析左心耳的血流。结果　左心耳处缺乏活跃的血流 ,使二尖瓣狭窄患者出现左房血栓的危险性大为升高 (P <0 0 1)。结论　左心耳功能情况与二尖瓣狭窄患者出现左房血栓高度相关。     

多平面经食管超声在二尖瓣球囊扩张术前的应用

目的 探讨经食管超声（TEE）在行二尖辩球囊扩职术（PBMV）前对左房小血栓及浓云雾影的诊断价值。方法 选择拟行PBMV的二尖辩中重度狭窄的患者30例，进行经胸及食管超声检查。结果 经食管超声对左房浓云雾影及左心耳小血栓的敏感度及特异度均达100％。结论 二尖辩球囊扩张术前，行经食管超声检查是可靠、必要的检查手段。     

经食道超声心动图对左房血栓及血栓前状态的评价

风湿性二尖瓣狭窄患者左房血栓形成可显著增加栓塞的发生率,是经皮球囊二尖瓣成形术(PBMV)的禁忌证之一,与左房血栓前状态密切相关。笔者对拟行PBMV的二尖瓣狭窄患者,通过经食道超声心动图(TEE)检查,对其左房血栓及血栓前状态进行了评价,现报告如下。     

MSCT对房颤患者左心耳形态结构的评估及对左心耳血栓的诊断价值

目的 探究多层螺旋CT (MSCT)对房颤患者左心耳形态结构的评估及对左心耳血栓的诊断价值。方法 选取82例拟行房颤射频消融术的患者作为研究对象,并在1周内进行经食管超声心动图(TEE)检查及MSCT检测,以TEE检查结果为参照标准,观察分析MSCT对房颤患者左心耳形态结构评估及对左心耳血栓的诊断效能。结果 经MSCT检查82例患者左心房容积为(120.32±25.21) mL,左心耳容积为(10.21±4.32) mL;左心耳口部面积53.35～500.40 mm2;长径11.34～35.12 mm,短径7.38～29.00 mm;左心耳嵴的长度(23.85±3.41)mm,宽度(3.69±1.24)mm,左心耳基部同冠状动脉左回旋支的距离为1.41～6.69(3.67±0.82) mm。82例患者经TEE检查其中32例发生左心耳血栓,检出率为39.02%,Kappa值为0.80,以TEE检查结果为参照标准,MSCT检查左心耳血栓的检出率为32.93%,Kappa值为0.67,两者左心耳血栓诊断结果比较,差异无统计学意义(P>0.05);MSCT诊断房颤患者左心耳血栓的灵敏度为...     

经食管超声心动图诊断左房血栓的价值

目的：评价经食管超声心动较（TEE）诊断左房血栓的价值。方法：对70例风湿性心脏病二尖瓣狭窄患者进行经胸超声心动图（TTE）和TEE检查，并对2种技术进行分析。结果；在受检的70例中左房血栓检出率TEE为65％，而TTE仅为23％。左房血栓形成与二尖瓣瓣口面积的大小，左房的增大，有无房颤和左房自发显影密切相关，二尖瓣返流的程度对左房附壁血栓的形成有一定的影响。结论：TEE对左房血栓的诊断价值优于TTE。     

多平面经食道超声心动图估测左心耳功能及血栓的评价

目的 评价应用经食道超声心动图(TEE)估测左心耳功能及诊断左房血栓的价值。方法 采用TEE对33例伴有或不伴有房颤患者检测左心耳容量及收缩功能，探测左房和左心耳内有无明确血栓征象。并与经胸多普勒二维超声心动图(TTE)比较。结果 33例患者中左房血栓6例，左心耳血栓6例，排除左房血栓3例。根据左心耳面积测定计算出左心耳射血分数(Efv)与左心耳峰值血流排空速度(Per)相关性良好(r=0．84)。结论 TEE不仅可定性诊断左房血栓，还可测量左心耳射血分数，房颤患者左心耳面积扩大，左心耳射血分数减低，评价左心耳功能较二维超声心动图更为准确。     

经食管超声心动图评估房颤栓塞危险性的临床研究

目的： 评价经食管超声心动图（ＴＥＥ） 在区分心房颤动（ 房颤） 栓塞高危人群中的应用价值。方法：８６例持续性房颤患者同时接受常规经胸超声心动图（ＴＴＥ） 和ＴＥＥ 检查,根据ＴＥＥ 探测到心房血栓的例数分为血栓阳性组和血栓阴性组,分别纪录以下各项指标：左房自发性超声对比现象（ＬＡＳＥＣ） 、左心耳（ＬＡＡ） 血流排空速率、ＬＡＡ 面积、左房内径、左室收缩功能参数、二尖瓣返流（ ＭＲ） 程度。结果：８６ 例中经ＴＥＥ 探测到２２ 例存在左房和／或左心耳血栓,而ＴＴＥ 仅探测到５ 人存在左房血栓（ Ｐ＜ ０ ．０００１） 。对血栓阳性和阴性组各项测值指标进行对比显示,ＬＡＳＥＣ 严重程度、ＬＡＡ 血流速率降低和ＬＡＡ 面积扩大在两组间存在极显著差异（ Ｐ＜ ０ ．０００１ 和０００１） 。ＬＡＡ面积扩大与ＬＡＳＥＣ 严重程度及ＬＡＡ 速率降低密切相关。结论： ＴＥＥ 探测心房血栓具有显著优势,并可测定与血栓形成密切相关的因素,在区分房颤栓塞高危人群方面具有重要价值     

Floating left atrial mass in a patient with mitral stenosis

Mobile masses within the left atrial cavity are commonly caused by organized thrombi or left atrial myxoma. The use of transesophageal echocardiography has provided means for differentiation between the 2 conditions. We report a case of a left atrial mass in a female patient who presented with mitral stenosis and atrial fibrillation, and was diagnosed by transthoracic echocardiography (TTE). The mass appeared freely mobile but did not prolapse between the mitral leaflets due to the tightly stenosed valve orifice. In the presence of mitral stenosis, atrial fibrillation and dilated left atrium, the appearance of the mass was in keeping with mobile thrombus. Consequently, the patient was referred for surgical treatment and the mass removed through left atriotomy. Microscopic examination revealed a highly organized thrombus. We conclude that TTE is still a reliable tool in the diagnosis of large mobile atrial thrombi; TEE is needed when differentiation from atrial myxoma is difficult.     

经食管超声结合X线引导经皮二尖瓣球囊扩张术

目的：研究经食管超声（ＴＥＥ）结合Ｘ线实时引导经皮二尖瓣球囊扩张术（ＰＢＭＶ）的价值。方法：对风湿性心脏病二尖瓣狭窄患者４３例,在食道四腔心平面观察ＰＢＭＶ过程。结果：ＴＥＥ结合Ｘ线,引导了全部患者的球囊扩张过程和２０例患者的穿刺房间过程。１９例房间隔穿刺一 成功,１例第二次穿刺成功。ＴＥＥ发现４矩房钢丝一过性进入左心耳,及时撤出。ＴＥＥＪ列８次球囊导管进入左心室过程中嵌入腱索,及时退出导管,３例     

迷宫术与射频消融联合应用对风湿性心瓣膜病并心房纤颤的治疗

[目的]探讨迷宫术与射频消融结合,在行瓣膜置换术的同时治疗风湿性心瓣膜病并心房纤颤的效果.[方法]对2例风湿性心瓣膜病合并心房纤颤的病人行人工机械瓣二尖瓣置换的同时,在体外循环下右房按迷宫手术方法,左房则按迷宫手术设计用射频消融方法进行心房纤颤的治疗.[结果]开放主动脉后,心脏自动复跳,心房纤颤消失.[结论]迷宫术与射频消融联合应用对风湿性心瓣膜病合并心房纤颤是一种有效的治疗手段.     

术中经食管实时三维超声心动图在二尖瓣置换术中的应用

目的评价术中经食管实时三维超声心动图（RT-3D TEE）在二尖瓣置换术中的应用。方法回顾性分析术中RT-3D TEE监测的52例风湿性心脏病患者,其中单纯性二尖瓣狭窄18例,单纯性二尖瓣关闭不全12例,二尖瓣狭窄合并关闭不全22例。结果 52例行瓣置换术患者中3例于术前发现左心耳血栓,术中行左心耳血栓清除术。2例于心脏复跳后发现较大瓣周漏,即刻对瓣周漏进行修补。结论术中RT-3D TEE监测能显著提高手术成功率,减少术后并发症,避免二次开胸率,对二尖瓣置换术具有重要的指导意义。     

经食管超声对风湿性二尖瓣狭窄患者自发显影的研究

为探讨风湿性二尖瓣狭窄（ＭＳ）患者自发显影（ＳＥＣ）与左心耳功能状态、心房纤颤及血栓形成的关系,作者采用经胸及经食管超声测量了１１７例风湿性二尖瓣狭窄患者的左房径（ＬＡＤ）、二尖瓣口面积（ＭＶＡ）、左心耳最大面积（ＬＡＡ－ａｒｅ）、最大充盈速度（ＬＡＡ－Ｖｐｆ）和最大排空速度（ＬＡＡ－Ｖｐｅ）,并观察了左心房和左心耳血栓及ＳＥＣ程度。结果：该１１７例患者中,窦性心律５７例,房颤６０例;无血栓者９８     

The effect of transient balloon occlusion of the mitral valve on left atrial appendage blood flow velocity and spontaneous echo contrast: a comparison in sinus rhythm and atrial fibrillation patients

Objective To investigate the relationship between spontaneous echo contrast (SEC) and left atrial appendage (LAA) blood flow velocity using transesophageal echocardiography (TEE) during percutaneous balloon mitral valvotomy (PBMV) in patients with atrial fibrillation and sinus rhythm.Methods Thirty-five patients （21 in sinus rhythm and 14 in atrial fibrillation ） with rheumatic mitral stenosis underwent PBMV with intraoperative transesophageal echocardiography monitoring. We measured LAA blood flow velocities and observed the left atrium for various grades of SEC (from 0=none to 4=severe), before and after each balloon inflation. Results Left atrial appendage maximal emptying velocity (LAA MEV) was reduced from 35±14 cm/s to 6±2 cm/s at peak balloon inflation and increased to 40±16 cm/s after balloon deflation. Comparison of the values before balloon inflation and after balloon deflation showed that LAA velocities were significantly lower (P&lt;0.001).During balloon inflation, both maximal emptying velocity (MEV) and maximal filling velocity (MFV) were significantly decreased, compared to those before inflation and after balloon deflation (P&lt;0.01).And both MEV and MFV were significantly higher after balloon deflation relative to those before balloon inflation. Patients with atrial fibrillation had significantly lower MEV and MFV before and during balloon inflation and after balloon deflation than patients with sinus rhythm.At peak balloon inflation, new or increased SEC grades were observed during 54 of 61 (88%) inflations and unchanged during 7 (12%) inflations.SEC grades were reduced after 55 balloon deflations (90%), completely disappeared after 18 deflations (30%) and remained unchanged after 6 deflations (10%). At peak balloon inflation,left atrium spontaneous echo contrast (LASEC) grade 4 was observed during 14 of 27 (93%) inflations in the atrial fibrillation patients, significantly higher than in patients with sinus rhythm (8 of 34, 24%; P&lt;0.05). LASEC completely disappeared after 16 of 34 deflations (47%) in the patients with sinus rhythm, significantly higher than in the atrial fibrillation patients (2 of 27 deflations; P&lt;0.01). The mean time to achieve maximal SEC grade (2.5±1.2 s) correlated with the mean time to trough LAA velocities (2.3±1.1 s ) after balloon inflation. Both the time to lowest LAA velocity and the time to highest LASEC were significantly longer in the patients with sinus rhythm than in the atrial fibrillation patients (2.6±1.1 s vs 1.7±1.0 s, P&lt;0.05 and 2.8±1.4 s vs 1.9±1.3 s, P&lt;0.05, respectively).Upon deflation, the mean time to lowest SEC grade (2.9±1.8 s) correlated with the mean time to achieve maximal LAA velocities (2.7±1.6 s).Both intervals are significantly shorter in the patients with sinus rhythm than in the atrial fibrillation patients (2.0±1.6 s vs 3.5±1.5 s, P&lt;0.01 and 2.2±1.7 s vs 3.6±1.6 s, P&lt;0.05). Conclusion Reducing the blood flow velocity in the human left atrium by balloon occlusion of the mitral valve may enhance SEC, whereas restoring blood flow after balloon deflation would cause enhanced echogenic blood to disappear or decrease in both groups of patients.Patients with atrial fibrillation demonstrate more severe blood stagnation of the left atrial body and appendage during transient balloon inflation at mitral valve orifice and slower recovery from the stagnation, decreasing to a lesser extent after balloon deflation, when compared to patients with sinus rhythm.     

CHA2DS2-VASc评分及MDCT对非瓣膜性房颤患者左心房/左心耳血栓预测价值的临床研究

目的：探讨CHA2DS2-VASc评分及MDCT对Nonvalvular AF预行消融术患者左房/左心耳(LA/LAA)血栓形成预测价值。方法整群选取2012年1月—2014年12月期间预行射频消融术房颤患者233例,进行CHA2DS2-VASc评分,经食道心脏彩超及左心房MDCT检查以排除左心房血栓。线性趋势χ2检验分析CHA2DS2-VASc评分与LA/LAA血栓发生率关系。McNemar法χ2检验验证左心房MDCT与传统TEE技术一致性。结果233入选病例中LA/LAA血栓形成13例,CHA2DS2-VASc评分0分组1例,1分组2例,2分组3例,3分组3例,≥4分组4例。0~1分组血栓发生率2.16%,3分以上为16.28%。线性趋势χ2检验分析提示CHA2DS2-VASc评分与LA/LAA血栓形成有明显统计学意义,P=0.001。 TEE法检出血栓8例,左心房MDCT发现3例,McNemar法χ2检验P=0.062,提示两种方法一致性。结论 CHA2DS2-VASc评分与LA/LAA血栓形相关,评分越高血栓形成风险趋大,伴高血压病、充血性心力衰竭是血栓形成主要危险因素。 CHA2DS2-VASc 0分、1分低危组预行消融术患者LA/LAA血栓形成发生率极低。左心房MDCT技术与传统TEE检查有较好一致性。