经胸超声心动图在急诊冠状动脉介入术的应用价值

目的探讨经胸超声心动图(TTE)在急诊冠状动脉介入术(PCI)的应用及其价值。方法92例胸痛患者,临床怀疑急性心肌梗死(AMI),在行急诊冠状动脉造影(CAG)之前,采用TTE从不同切面和角度,探测观察有无节段性室壁运动异常(RWMA)及其范围。对行急诊PCI的患者,术后定期复查,观察RWMA范围的变化及改善程度。结果TTE检查提示,89例存在RWMA,经急诊CAG均证实其相关冠状动脉完全或不完全闭塞,符合率100%,且其RWMA的区域与相关冠状动脉闭塞的部位及闭塞程度也明显相关。结论TTE可作为AMI诊断的可靠指标之一,也是选择适合患者作CAG、PCI以及评价急诊PCI后治疗效果的一个重要依据。     

经食管三维超声心动图临床应用的新进展

经食管三维超声心动图（three-dimensional transesophageal echocar diography,3D—TEE）于上世纪90年代初期问世并应用于实验室及临床检查。由于探头位置的改变,它能由后向前,近距离扫查心脏深部结构,有效排除肺气干扰、肥胖、胸廓畸形和肋间隙狭窄的影响,明显改善超声图像的清晰度及分辨率。     

超声心动图在心血管病介入治疗中的应用

近年来,随着心血管病介入与微创治疗应用范围的拓展,新的治疗术式不断创新,各种超声心动图技术包括常规经胸超声(TTE)、经食管超声(TEE)、心腔内超声(ICE)、血管内超声(IVUS)、超声声学造影(MCE)以及三维超声心动图等,在心血管病介入     

经胸与经食管超声心动图应用的对比分析

目的 :为获取高质量的心脏及大血管超声心动图像。方法 :对比分析北京协和医院 5年来 363例在经胸超声心动图 ( TTE)检查的基础上行经食管超声心动图 ( TEE)的检查结果。结果 :363例检查指征分为心腔内血栓、主动脉夹层、感染性心内膜炎、主动脉瓣膜病变及主动脉粥样硬化等。 TTE仅有 2 2 .3%的病例获得诊断 ,而有 TEE76%的病例可获得明确诊断 ,增加信息量5 3.7%。结论 :TEE检查结果对改进或决定临床处理对策产生了不同程度的影响。     

超声心动图临床应用研究的现状与展望

自 1 95 5年Ｅｄｌｅｒ首次提出超声心动图以来 ,已经 40余年。此项技术已在临床上得到了广泛的应用 ,随着声学基础理论研究的深入和计算机技术的飞速发展 ,二维及彩色多普勒图像的质量有很大提高。目前 ,成熟应用于临床的超声心动图技术主要有Ｍ型和二维超声心动图、彩色和频谱多普勒显像、心腔和心肌声学造影、经食管超声心动图、血管腔内超声等。这些技术的综合应用通常能对心脏的形态结构与功能作出准确的评价。为推进这一技术的发展和应用 ,本期集中选载了几篇有关超声心动图的文稿。侯传举等对 344例先天性心脏病大动脉右转位的二维超…     

超声心动图发展概要

影像学检查通过人体脏器的扫查,提供重要的解剖学信息,而超声心动图能够实时评价心脏解剖结构、功能以及血流动力学信息。三维超声心动图、应变成像等定量评估方法以及超声增强显影不再是纸上谈兵,已经广泛应用于临床并且为患者的诊断和预后提供了丰富信息。本文主要通过超声心动图新技术在心脏移植等新领域的应用来阐述其重要性,从而指导治疗。     

侵入性超声心动图检查的概况

侵入性途径扩大了常规超声心动描记方法的临床应用范围。对比超声心动图已广泛用于临床,各种新型对比剂和心肌对比超声心动检查的研究目前相当活跃。经食管超声心动描记术提供了不受胸壁和肺组织干扰的探查途径,并能较好地评价左右心房、房间隔和左室前壁等结构。经静脉心腔内超声心动图和手术过程中心外膜超声心动图检查也均有一定价值。     

超声心动图检查在冠状动脉疾病中的应用(二)

正1负荷超声心动图评估存活心肌负荷超声心动图检查对于冠心病患者具有重要的诊断和预后意义。负荷超声心动图常用负荷方法包括运动负荷和药物负荷。负荷超声心动图的综合敏感性、特异性及预测值80%。其中多巴酚丁胺负荷超声心动图是公认的检测存活心肌的方法之一。对比观察负荷超声心动图静息状态和负荷状态的室壁反应类型,可以推测相应的临床状况:1没有冠心病或可能性很小;2心肌缺血;3心肌梗死,没     

超声心动图检查在冠状动脉疾病中的应用(一)

<正>超声心动图具有极佳的性价比和出色的安全性,方便灵活快捷,是目前临床工作中重要的无创性检查方法。特别是在冠心病心肌缺血和心肌梗死的诊断治疗中,超声心动图可以评价患者心腔的大小,瓣膜、室壁运动的情况,心脏的收缩和舒张功能,局部心肌灌注情况,冠状动脉的结构和血流,心腔内压力和血流动力学参数以及预后等。最新公布的心肌梗死全球统一定义提出:心肌生化标记物升高或升高后降低,至少有1次数值超过正常上限,同时     

急慢性肺栓塞心电图及超声心动图的对比

目的：了解在急慢性肺栓塞中常规十二导联心电图及超声心动图的表现及其不同之处。方法：回顾性研究从2001年1月到2007年3月53例住院肺栓塞患者的资料，对象被分为急性肺栓塞组（24例）及慢性肺栓塞组（29例）；分析急、慢性肺栓塞的心电图及超声心动图（包括右房右室大小，肺动脉压力，左房左室大小等）表现。结果：两组病人中绝大多数病人均有心电图的异常，急性组病人更多见SⅠ、QⅢ（P均〈0．05）。而慢性组心房颤动发生率明显高于急性组（P〈0．01），且RⅥ增高，RⅥ〉1．0mV例数增多（P均〈0．05）；两组病人超声心动图表现不同程度的肺动脉压力升高，慢性组右房、室扩大更为明显（P〈0．01，〈0．05）。结论：常规心电图，超声心动图在急慢性肺栓塞中表现不同，具有诊断价值。     

Outcomes of emergent cardiac catheterization following pediatric cardiac surgery

Background: Although there is agreement of the importance of cardiac catheterization, especially interventional procedures, cardiac catheterization in postoperative critical care unit (CCU) period is often debated. The focus of this study was to explore the indications for and determinants of outcome after cardiac catheterization in this setting. Methods: Between March 2004 and October 2006, 49 children (2.8% of cardiac surgeries) underwent 62 catheterizations before discharge from the CCU. Morphological, surgical, and catheterization data were accrued and analyzed using parametric competing risks models and multivariable risk‐hazard analysis. Results: Median age at surgery was 167 days (0–13.5 years) and time to catheterization was 8.5 (0–84) days following surgery. Catheterization procedures were either interventional (n = 35) or noninterventional (n = 27). Children who required a more urgent investigation following initial surgery more often had deployment of a stent at catheterization (P = 0.01) or subsequent surgical pulmonary artery augmentation (P < 0.01). Surgical reoperation was required following 23 (37%) catheterizations and was more common following index surgery involving a cavopulmonary shunt. Overall mortality was high (43%). Delayed invasive investigation beyond 2–3 weeks (P = 0.04) or a splinted sternum (P < 0.001) were risk factors for death. In addition, reoperation after a noninterventional catheterization predicted worse survival (P < 0.001). Conclusions: The need for invasive investigation in the immediate CCU period is associated with a poor outcome, especially when the investigation is delayed or an intervention is not possible. Identification of at‐risk patients may improve outcomes. Best outcomes follow expedient catheterization with definitive management (often stent deployment or pulmonary artery augmentation). © 2009 Wiley‐Liss, Inc.     

心脏淀粉样变患者的心电图和心脏超声特点

目的 总结心内膜心肌活检(EMB)证实原发型心脏淀粉样变(CA)患者的心电图和心脏超声特点,为临床医师能够早期识别和诊断CA提供帮助.方法 自2006年9月至2009年10月收治临床怀疑CA患者共20例(其中男性7例),平均年龄(50±12)岁,进行EMB检查.11例(55%)患者诊断为CA,血清和(或)尿检查示游离单克隆轻链(λ)明显升高,确诊为原发型CA.分析该11例心电图和心脏超声的特点.结果 心电图分析发现,11例患者的6个肢导联电压均较低,均值为0.33～0.51 mV,其中肢导联低电压和假性梗死波形发生率均为45%.心脏超声检查结果分析发现,11例患者室壁呈向心性增厚和左心室腔容积正常,绝大多数患者可见左心房扩大(10例,91%)、心肌内可见颗粒样强回声(9例,82%)、中至大量心包积液(7例,64%)以及左心室收缩功能受损(8例,73%).结论 对于临床原因不明的心力衰竭,心脏超声示向心性肥厚且左心室腔容积不大,伴心肌内颗粒样强回声或心包积液,而心电图示肢导联低电压或假性梗死波形者,高度疑似原发型CA的可能性,应进一步行EMB和血清(尿)生化检查,以便早期明确诊断和及时治疗.     

Left atrial myopathy in cardiac amyloidosis: implications of novel echocardiographic techniques.

AIMS: To assess left atrial (LA) function and determine the prevalence of LA dysfunction in AL amyloidosis (AL) using conventional and strain echocardiography. METHODS AND RESULTS: LA ejection fraction, LA filling fraction, LA ejection force, peak LA systolic strain rate (LAsSR), and LA systolic strain (LA epsilon) were determined in 95 AL patients (70 with and 25 without echocardiographic evidence of cardiac involvement, abbreviated CAL and NCAL, respectively), 30 age-matched controls (CON), and 20 patients with diastolic dysfunction and LA dilatation (DD). Peak LAsSR >2 standard deviations below mean CON value was used as the cut-off for normal LA function. LA ejection fraction was lower in CAL when compared with CON (40.4+/-13.6 vs. 67.0+/-6%, P=0.01). Left atrial septal strain rate and strain were lower in CAL (0.8+/-0.5 s(-1) and 5.5+/-4%, respectively) compared with CON (1.8+/-0.8 s(-1) and 14+/-4%, respectively, P=<0.0001), NCAL (1.6+/-0.8 s(-1) and 13+/-7%, respectively, P<0.0001) and DD (1.3+/-0.4 s(-1) and 10+/-2%, respectively, P<0.0001). Based on peak LA systolic strain rate criteria, the cut-off values for normal LA function were -1.1 s(-1) and -1.05 s(-1) for lateral and septal walls. Using these criteria, LA dysfunction was identified in 32% (lateral LA criteria) and 60% (septal LA criteria) of CAL patients. Lateral and septal LAsSR were lower in CAL patients with vs. those without symptoms of heart failure. Inter- and intra-observer agreement was high for LA strain echocardiography. CONCLUSION: LA function assessment using strain echocardiography is feasible with low intra- and inter-observer variability. LA dysfunction is observed in AL patients without other echocardiographic features of cardiac involvement and may contribute to cardiac symptoms in CAL.     

The echocardiographic assessment of donor heart function prior to cardiac transplantation.

Received 3 August 2004; received in revised form 12 October 2004; accepted after revision 25 October 2004.^* Corresponding author. Tel.: +44 121 472 1311; fax: +44 121 627 2543. E-mail: rajamiyer.venkateswaran@uhb.nhs.uk     

Role of intraoperative transesophageal echocardiography in pediatric cardiac surgery

Background

Intraoperative transesophageal echocardiography (TEE) has a major role in detecting residual lesions during and/or after pediatric cardiac surgery.

Methods

All pediatric patients who underwent cardiac surgery between July 2001 and December 2008 were reviewed. The records of surgical procedure, intraoperative TEE, and predischarge transthoracic echocardiograms were reviewed to determine minor and major residual cardiac lesions after surgical repair.

Results

During the study period, a total of 2268 pediatric cardiac patients were operated in our center. Mean age was 21 months (from 1 day to 14 years). Of these patients, 1016 (48%) had preoperative TEE and 1036 (46%) were evaluated by intraoperative echocardiography (TEE or epicardial study). We identified variations between TEE and preoperative transthoracic echocardiography in 14 patients (1.3%). Only one surgical procedure was cancelled after atrial septal defect exclusion. The other 13 patients had minor variation from their surgical plan. Major residual lesions requiring surgical revision were detected in 41 patients (3.9%), with the following primary diagnoses: tetralogy of Fallot in 12 patients (29%), atrioventricular septal defect in seven patients (17%), ventricular septal defect in seven patients (17%), double outlet right ventricle in two patients (5%), Shone complex in two patients (5%), subaortic stenosis in two patients (5%), mitral regurgitation in two patients (5%), pulmonary atresia in two patients (5%), and five patients (12%) with other diagnoses.

Conclusion

Intraoperative TEE has a major impact in pediatric cardiac surgery to detect significant residual lesions. Preoperative TEE has a limited role in case of a high quality preoperative transthoracic echocardiography. We recommend routine use of intraoperative TEE during and/or after intracardiac repair in children.     

慢性心力衰竭患者心脏标志物水平及超声心动图特点

目的分析慢性心力衰竭(CHF)患者心脏标志物水平及超声心动图特点。 方法选取2017年4月至2018年3月在泰兴市第二人民医院收治的82例CHF患者设为CHF组,选择同期24例健康体检者为对照组。将CHF患者根据心功能分级分为4个CHF亚组：CHF 1级23例、CHF 2级25例、CHF 3级21例和CHF 4级13例。检测外周血脑钠肽(BNP)和生长分化因子－15(GDF－15)水平,采用超声心动图测定室间隔舒张末期厚度(IVSTD)、左室后壁舒张期厚度(LVPWTD)、左心室舒张末期内径(LVDD)、左房收缩末期内径(LAD)。采用Simpson公式计算左室射血分数(EF)、心输出量(CO)、心脏指数(CI)。从心尖四腔切面获得二尖瓣血流频谱,收集舒张早期最大流速(E峰),舒张晚期最大速度(A峰),E/A、舒张早期快速充盈分数(RFF)、左心室重量指数(LVMI)、相对室壁厚度(RWT),并对两组结果进行比较。 结果与对照组比,CHF组患者外周血BNP和GDF－15均明显增高(P<0.05),在CHF组中,随着心功能降低,外周血BNP和GDF－15也增高(P<0.05),与对照组比,CHF组的IVSTD、LVPWTD、LVDD、LAD、LVMI、RWT、CO和A明显增高(P<0.05),CI、EF、E/A和RFF明显减少(P<0.05),在CHF组中,随着心功能降低,IVSTD、LVPWTD、LVDD、LAD、LVMI、RWT、CO和A也明显增高(P<0.05),CI、EF、E/A和RFF也明显减少(P<0.05)。 结论CHF心脏标志物BNP和GDF－15明显增高,超声心动图各指标异常,异常集中表现为左心功能衰竭。     

超声心动图诊断急性肺动脉栓塞的价值

目的 :分析评价床旁超声心动图 (ECHO)在急性肺动脉栓塞 (APE)诊断中的实用价值。方法 :采用经胸ECHO对临床怀疑APE的 5 8例患者在 4～ 6h内行床旁ECHO检查。结果 :超声直接检出主肺动脉及左右肺动脉主干近端血栓者 4例 ,均被外科手术或肺动脉造影证实。本组具有典型右心负荷过重超声征象者 15例 (其中包括具有超声直接征象的 4例 ) ,核素肺灌注 通气扫描提示为双肺多发性大面积栓塞。仅右房、右室轻度增大或肺动脉轻度增宽者 19例 ,ECHO无改变者 2 4例 ,但核素肺灌注 通气扫描均提示为肺段或亚段栓塞。结论 :ECHO能够发现主肺动脉、左右肺动脉干内附壁血栓直接提示肺动脉栓塞 ,或根据右室负荷过重表现间接提示肺栓塞的可能 ,但对肺段或亚段栓塞者超声不能作出或排除诊断。