先天性左心室憩室二例

先天性左心室憩室 (ＬＶＤ)是极为罕见的心脏畸形 ,我院左心室造影检查诊断ＬＶＤ已有二例 ,现报告如下。例 1　 6 8岁女性 ,因反复夜间前胸烧灼感 1周入院。否认高血压病史。查体 :心肺腹无阳性体征。心电图检查 :无病理性Ｑ波 ,Ⅱ、Ⅲ、ＡＶＦ、Ｖ1～ 6导联Ｔ波倒置且无动态变化 ;常规心脏超声心动图检查未发现心脏形态、结构及室壁运动异常 ;常规心肌核素扫描检查未见放射性核素分布稀疏或缺损区 ;正位胸片示左心缘突出。左心室造影显示 :左室前壁近间隔侧有限局性瘤样膨出 ,膨出瘤体有收缩和舒张运动 ,瘤壁肌小梁清晰可见 ,呈典型的左心…     

左心室憩室1例及文献复习

左心室憩室是一种在成人较为罕见的心脏畸形。本文报道了一例36岁左心室憩室患者,超声心动图提示左室侧壁及后侧壁自瓣环水平至心尖部可见一附加腔隙,与左室较大沟通,伴有收缩活动减弱。患者于我院行心憩室切除及左室成形术。通过文献整理复习,本文进一步总结超声心动图在诊断心脏憩室中的意义,并讨论心脏憩室的手术治疗方式。     

儿童左心室憩室一例

患儿男．9岁8个月。反复咳喘4年余，再发1周就诊。入院查体发现，两肺呼吸音粗，可闻及喘鸣音及少量细湿罗音。诊断为“支气管哮喘及肺部感染”。体格检查未发现心脏的阳性体征，心率90次／min，律齐，心音有力，各瓣膜听诊区未及病理杂音。胸片示：支气管肺炎、心影左心缘下延。心电图示：窦性心律不齐，左室高电压，     

左心室憩室的产前超声诊断及出生后随访病例3例

<正>心室憩室是一种罕见的心脏畸形,最早于1816年被提出[1]。其主要解剖表现为心脏室壁的局部膨出,可伴发其他先天性胸腹畸形、心血管畸形或遗传综合征,亦可孤立发生,以左心室憩室（left ventricular diverticulum,LVD）较为常见[2]。一项国外超声研究发现LVD的发病率约0.04%[3]。由于目前诊断手段多样化,越来越多关于孤立性LVD的诊断或治疗的病例被报道,对孤立性左心室憩室的认识不断增加。本文对广东省妇幼保健院心脏中心产前诊断胎儿LVD并出生的3例病例,就其临床及超声资料报道如下：     

成人孤立性左心室肌型憩室的多普勒超声心动图特点

目的：探讨多普勒超声心动图对诊断左心室肌型憩室的意义。　　方法：对２ 例经左心室造影和（或）心脏核磁共振成像（ＭＲＩ）和超高速计算机断层摄影术（ＵＦＣＴ）诊断为先天性孤立性左心室肌型憩室患者,行多普勒超声心动图检查对比。　　结果：多普勒超声心动图发现左心室壁局限性瘤样膨出,其颈部明显小于扩张的瘤体和左心室腔,瘤颈处室壁异常突出,酷似心脏破裂的室壁残端,其改变与ＭＲＩ或ＵＦＣＴ相符。但是多普勒于瘤颈处可探及收缩晚期出和舒张期入瘤体的血流频谱,说明瘤体有主动收缩和舒张功能,非室壁破裂所致,从而构成了左心室肌型憩室的特征性改变。　　结论：左心室肌型憩室的多普勒超声心动图所见与心脏ＭＲＩ和ＵＦＣＴ影像结果一致。而多普勒技术对显示血流频谱特征性改变上有其诊断价值。     

中国人成人先天性孤立性左室憩室物临床和影像诊断特点

目的 总结成人先天性左室憩室的临床影像特点。方法对４例左室造影或（和）超高速确诊为成人先天性左室憩室患者的临床和影像特点进行分析。结果 临床无症状，然而无益工有冠心病，经左室造影确诊为先一性孤立性左室肌型憩室，其中２例需ＵＦＣＴ和ＭＲＩ补充诊断：二维超声心动图不仅与左室造影、ＭＲＩ和ＵＦＣＴ的影像特征一致，可弥补左室造影中因右室影像重叠而对憩室观察缺陷的不足，而且其独特的多普勒血流频谱，可与真、假     

先天性心室憩室的研究进展

先天性心室憩室是一种少见的心脏畸形。大部分为左室憩室,右室憩室较少,也可发生在两个心室。心室憩室常伴有其他的异常。先天性心室憩室多见于婴幼儿和儿童,但亦可见于各年龄组人群。现对先天性心室憩室的研究进展做一综述。     

成人巨大右心房憩室1例

患者,女,59岁,反复发作胸闷、头晕、四肢乏力20余年,再发加重1周。体检:心律不齐,心率80次/min,血压130/80 mmHg(1 mmHg=0·133kPa),心界向双侧扩大,各瓣膜听诊区未闻及杂音。胸片示:左右心室明显扩大。心电图示快速率心房颤动伴室内差异性传导,频发室性期前收缩伴成对室性期前     

先天性左心室憩室合并房间隔缺损一例

左心室憩室一种非常少见的心脏畸形,早期的研究显示尸检中左心室憩室的检出率为0.4%,经左心室造影发现的患者有0.76%[1]。左心室憩室合并房间隔缺损(ASD)则更为罕见。患者女,20岁。因发现"心脏杂音"入住中南大学湘雅二医院。既往无特殊病史。查体仅提示胸骨左缘2～3肋间可闻及收缩期3/6级杂音,无震颤。心电图提示逆钟向转位。     

症状性十二指肠憩室的临床特点分析

目的探讨症状性十二指肠憩室病例的临床、内镜及影像学表现、治疗方法,并分析其临床意义。方法回顾性分析武汉大学人民医院2008年1月-2011年1月症状性十二指肠憩室病例,分析其临床表现、内镜及影像学表现、治疗方法等临床资料。结果共35例患者诊断为症状性十二指肠憩室,其中腹痛者15例、呕吐者2例、呕血或黑便者12例、黄疸患者6例,腹痛患者4例有反复发作史、黑便患者2例。所有病例中并发十二指肠憩室炎5例、急性胰腺炎1例、胆总管结石6例、肠梗阻1例、上消化道出血12例。35例症状性十二指肠憩室分别位于十二指肠球部9例、降部22例、水平部4例,其中单发25例、多发10例。经由消化道钡餐检查发现十二指肠憩室13例、胃镜9例、经内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)7例,双气囊小肠镜2例、腹部CT检查4例。结论十二指肠憩室症状不典型,对于不明原因上腹痛、消化道出血及胰腺炎患者,需考虑此病因,可行相关检查明确,治疗上除内科保守外还可以进行内镜下或者手术治疗。     

Asymptomatic isolated congenital left ventricular muscular diverticulum in an adult: a case report

Congenital ventricular diverticulum is a very rare malformation in adults. We describe a 21-year-old male with a congenital muscular left ventricular diverticulum in the inferior wall. The lesion was suspected on two-dimensional transthoracic echocardiography; transesophageal echocardiography allowed clear detection of the diverticulum as well of mild mitral valve prolapse. The diagnosis was confirmed by cardiac catheterization. There were no other thoracoabdominal or cardiac anomalies, the patient was asymptomatic, and surgery was not deemed necessary.     

Congenital left ventricular diverticulum: Multimodality imaging evaluation and literature review

Congenital ventricular diverticulum is a rare cardiac malformation. We present the case of a 57-year-old man who underwent cardiac catheterization for suspected unstable angina. No coronary artery disease was diagnosed and a left ventricular diverticulum was incidentally found. Coronary CT and cardiac MRI were performed in order to confirm the diagnosis of a muscular type diverticulum and to exclude a post-ischemic aneurysm.     

Electrophysiological characteristics of left atrial diverticulum in patients with atrial fibrillation: Electrograms,impedance and clinical implications

Background

Left atrial diverticulum (LAD) is not rare in patients with atrial fibrillation (AF). Recent reports focused on its morphology however data on its electrophysiological characteristics are lacking. Our study aims to investigate the electrogram and impedance features of LAD.

Methods

This study included 24 patients (mean age, 58.5 ± 10.7 years) with LAD undergoing catheter ablation for AF and 24 gender-and-age-matched individuals without LAD as controls. A bipolar LAD electroanatomic map was acquired in sinus rhythm from all study participants. Points were acquired for diverticulum in the LAD group and for corresponding areas in the control group. Electrogram deflections were counted, bipolar voltage and impedance were measured for each point, and average ?impedance and highest ?impedance were calculated.

Results

A total of 234 points were collected in the two groups. In the LAD vs. control group, median (Q1, Q3) of electrogram deflections was 6 (5, 7) and 4 (4, 5) (P < 0.0001), respectively, voltage was not significantly different (1.58 ± 0.68 mV vs. 1.28 ± 0.65 mV, P = 0.10), and average ?impedance was significantly higher in the LAD group (19.5 ± 9.0 Ω vs 3.9 ± 1.7 Ω, P < 0.0001). A cut-off value of 9.5 Ω for ?impedance predicted LAD with sensitivity, specificity, and positive and negative predictive values of 83.5%, 92.8%, 92.1% and 84.9%, respectively.

Conclusions

Electrogram was more fractionated and impedance was higher at LAD than in corresponding areas without LAD, which might help to differentiate LAD during catheter ablation for AF.     

中国人成人先天性孤立性左室憩室的临床和影像诊断特点

目的　总结成人先天性左室憩室的临床 (和 )影像特点。方法　对 4例左室造影或 (和 )超高速CT(UFCT)、MRI确诊为成人先天性左室憩室患者的临床和影像特点进行分析。结果　临床无症状 ,然而均合并有冠心病 ,经左室造影确诊为先天性孤立性左室肌型憩室 ,其中 2例需UFCT和MRI补充诊断 ;二维超声心动图不仅与左室造影、MRI和UFCT的影像特征一致 ,可弥补左室造影中因左室影像重叠而对憩室观察缺陷的不足 ,而且其独特的多普勒 (Doppler)血流频谱 ,可与真、假室壁瘤鉴别 ,对憩室有确诊价值。结论　 (1)中国成人先天性左室憩室多为孤立性肌型憩室 ;临床多无症状 ,多合并有冠心病 ,甚至心肌梗死 ;左室造影有确诊价值 ,但有时需UFCT或MRI补充。 (2 )超声心动图不仅与MRI和UFCT影像特征一致 ,而且其独特的Doppler血流频谱 ,对左室肌型憩室有确诊价值。     

Bedside ultrasonography screening for congenital renal anomalies in children with congenital heart diseases undergoing cardiac repair

Introduction

Ultrasound (US) assessment of renal anomalies in children requiring pediatric cardiac surgery is not a standard practice. This study is highlighting the role of bedside US performed by intensivist to detect occult renal anomalies associated with congenital heart disease (CHD).

A case of congenital left ventricular diverticulum in an adult patient

Congenital left ventricular diverticulum (CL.koVD) refers to a localized cystic protrusion of the ventricular wall that interacts with the heart cavities through a narrow channel and is a rare heart malformation. In recent years, many cases of this disease involving infants and children have been reported, while few cases involving adults have been described. The case of an adult with CLVD who underwent successful surgery was retrospectively evaluated. The echocardiography examination indicated that the apical myocardium of the left ventricle was thin and bulging outward and that the contractile movement was significantly reduced. During the surgery, it was observed that the left ventricle was enlarged, and a left ventricular diverticulum structure was observed on the left side of the apex. A bovine pericardial patch of the corresponding size was used to continuously suture and repair the internal orifice of the diverticulum. The postoperative pathology revealed that the resected sample was composed of full myocardial tissue. This report focused on the imaging characteristics of left ventricular diverticula to improve the understanding of CLVD. With its simple, economical, and noninvasive characteristics, echocardiography presents the best option for diagnosing a ventricular diverticulum.     

Clinical and diagnostic features of pulmonary valve endocarditis in the setting of congenital cardiac malformations

We studied the clinical and diagnostic features of 5 cases of pulmonary valve endocarditis where morphologic documentation was available. All patients had congenital cardiac disease as thee predisposing factor and the infectious process involved only the pulmonary valve. None of the patients was addicted to drugs. Absence of systemic emboli, lack of pulmonary symptoms, acute course and high frequency of sterile cultures made the clinical recognition difficult and was possible only in three cases. The clinical picture of pulmonary valve endocarditis was characterised by fever, right-sided congestive cardiac failure and pulmonary incompetence. Echocardiography assumes a specific diagnostic role in such cases and cross-sectional echocardiography provides more information than M-mode echocardiography. Pulmonary valve endocarditis carries a high mortality and 3 patients died. Two patients underwent successful surgery of their underlying defect and excision of the pulmonary valve. Staphylococcus aureus was the organism grown from autopsy or surgical material in 3 cases.