房间隔完整并部分肺静脉异位引流的外科治疗

房间隔完整并部分肺静脉异位引流的外科治疗１１００１５沈阳沈阳军区总医院李新民，张仁福，朱洪玉关键词心间隔；肺静脉；畸形中国图书资料分类号Ｒ６５４．２房间隔完整并部分肺静脉异位引流较少见，因其血流动力学改变与房间隔缺损时相似，故临床诊断上极易被混淆。现...     

超声心动图诊断小儿三房心的价值

目的:探讨超声心动图诊断小儿三房心的价值.材料和方法:对32例经手术证实为三房心的患者行超声心动图检查.从胸骨旁、心尖、剑突下多个切面,尤其是心尖四腔及剑下心房长轴切面,观察左房内隔膜,隔膜上是否存在交通口,房间隔缺损的部位和分流方向,测量正、副房间的血流速度,三尖瓣返流速度估测肺动脉压,了解并发畸形.结果:超声符合30例,见左房内异常隔膜将左房分为2个腔,近端的副房接受肺静脉血流,远端的真房与二尖瓣相连,出现副房大,真房小的特征性表现,当真、副房间存在交通口时,彩色多普勒可显示真、副房间交通的五彩血流束,合并房间隔缺损者可根据房间隔缺损部位显示真、副房与右房间的过隔血流信号;2例分别误诊为完全性肺静脉异位引流、房缺和冠状静脉窦扩张.结论:心尖四腔和剑下心房长轴切面是左房内隔膜检出的较好切面.超声心动图是诊断小儿三房心的首选方法.     

肺栓塞肺动脉血流波形的观测

目的　了解肺动脉血流波形的变化在肺栓塞诊治中应用意义。方法　利用多普勒超声检测了 7例经计算机体层摄影术、发射计算机体层摄影及肺动脉造影证实的肺动脉栓塞患者的肺动脉血流 ,并对这些患者治疗前、后的肺动脉血流波形的改变进行比较分析。结果　轻、中度肺动脉高压 5例 ,重度 2例。多普勒超声检出了收缩早期突然加速 ,加速肢上升陡直 ,流速峰值前移 ,而后提前减速的肺动脉血流频谱 7例 ,即频谱波形呈“手指状” ,其中 2例可见收缩晚期第二个较低的峰 ,峰值流速明显减低 <80cm/s5例 ,1例室缺患者的流速在正常范围 ;溶栓治疗 4 8h后 ,“手指状”肺动脉频谱波形逐渐消失 ,1周后恢复正常倒等腰三角形肺动脉血流波形 5例 ,室缺 1例和慢性下肢深静脉血栓 1例的肺动脉血流波形治疗前、后变化不明显 ,但室缺患者的肺动脉内栓子明显缩小。结论　多普勒超声观测肺动脉血流波形的变化 ,不单可用于肺栓塞的诊断 ,在肺栓塞治疗疗效评价方面也可成为客观的影像学指标用于肺栓塞的诊断 ,在肺栓塞治疗疗效评价方面也可成为客观的影像学指标。     

原位移植肝术后监护期的超声图像和血流变化观察

目的探讨原位肝移植术后监护期内的超声图像特征和血流动力学变化。方法2例同种原位肝移植术后当天至12天每天定期超声检查，观察肝实质回声、捡测肝动脉、右肝静脉、门静脉多谱勒血流、观察其演变过程，以峰值血流速度时间变化曲线表示。结果（1）肝内回声：第1例术后3。7天肝实质回声显示增强，第8天回声开始恢复，至第12天回声恢复正常。另1例无明显回声改变。（2）肝动脉血流：肝动脉峰值血流速度在整个监护期较对照组测值慢。例1在术后1—6天、例2在术后3天内肝动脉峰值血流时间变化曲线处于高流速状态，后期的曲线较稳定；血流较高时频谱收缩期波峰相对高尖，曲线上升支较陡直，舒张期血流克盈良好，频谱无中断，血管阻力指数无明显异常改变。稳定期频谱形态似三角形。（3）门静脉血流速度变化较小。右肝静脉血流在第2天和第6天有降低，其余观测时间内血流较稳定。结论原位移植肝回声接近正常或有波动性增强。主要与排异反应有关。监护期肝动脉峰值血流速度较正常对照组减慢，但术后1-6天内峰值血流时间演变曲线处于较高流速状态。可能与肝动脉吻合口情况和排异反应有关。肝静脉、门静脉血流变化不明显或偶有波动性降低。     

肺静脉血流频谱的临床研究

肺静脉血流频谱的临床研究于富军，卫亚利，贺江勇，宁佩萸，杜静波０５００８２石家庄解放军白求恩国际和平医院中国图书资料分类号Ｒ５６３．９常规经胸壁心脏超声显示肺静脉困难。作者以经食道心脏超声（ＴＥＥ）技术研究了肺静脉超声学特点，并就其脉冲多普勒血流频谱...     

超声心动图监测房间隔缺损封堵术后血流动力学改变的研究

目的:应用超声心动图观察房间隔缺损(ASD)封堵术后血流动力学变化。方法:对成功实施ASD封堵术的30例患者行超声心动图检查,分别于术前24h、术后48h及术后3个月记录三尖瓣口及肺动脉瓣口多普勒血流频谱,测量三尖瓣口舒张早期及舒张晚期血流速度(E峰、A峰),及肺动脉瓣口血流峰值、平均流速和速度时间积分。结果:ASD封堵治疗术后三尖瓣口E峰、A峰峰值速度及肺动脉瓣口血流速度、积分和压力阶差显著降低。结论:超声心动图能够方便检测ASD封堵治疗术前后右心血流动力学改变,反映右心功能改变,为临床评价掌握ASD术后的恢复情况提供有用信息。     

CT在房间隔缺损合并肺静脉异位引流中的诊断价值

【摘要】目的：评价 CT对房间隔缺损（ASD）合并肺静脉异位引流（APVC）的诊断价值。方法：回顾性分析我院 CT检查的24例ASD合并APVC的病例,观察房间隔缺损的位置、大小,异位肺静脉引流的位置、形态及其异位连接,并与经胸心动超声（TTE） 比较,以手术或心导管造影所见为参考标准,评价CT检查诊断的准确性。结果：24例ASD合并APVC的病例中,腔静脉窦型房缺 14例,二孔型房缺9例,无顶冠状静脉窦型房缺1例;肺静脉异位引流中完全性肺静脉异位引流4例,其中心上型3例,心脏型1例,部分性肺静脉异位引流20例,其中心上型8例,心脏型12例。CT的诊断准确性为100%,TTE的诊断准确性为75%（18/24） 。结论：CT在ASD合并APVC的诊断中具有很高的价值,对临床诊断和手术方案的制订起到重要作用。     

彩色多普勒血流显像对成人亚临床型房间隔缺损的诊断价值

目的　评价彩色多普勒血流显像对成人亚临床型房间隔缺损的诊断价值。方法　对 12 2例经彩色多普勒血流显像检查首先诊断的成人亚临床型房间隔缺损进行回顾分析。结果　此组病例年龄较大 ,女性居多 ,无特异性的症状和体征 ,经彩色多普勒血流显像检查均显示不同程度房水平左向右分流。结论　彩色多普勒血流显像是诊断亚临床型房间隔缺损的非侵入性首选技术     

房间隔缺损修补失误的预防及处理

本院自1988年1月至1992年12月间发生房间隔缺损修补失误4例,占同期直视房缺修补例数的3.4％,现报告该组病例处理体会。 1 临床资料 1.1 例1,男性,19岁。诊断:完全肺静脉异位引流。术中探查见其房间隔几乎缺如,术时因补片修剪偏小,缝至缺损外下缘时有张力,勉强缝合。术后仍存心脏杂音,B超检查提示残余分流,病人反复出现心衰。23个月后再次手术,见邻近下腔静脉开口处补片撕脱,面积约3cm×2cm。仍以补片修复该缺损,三尖瓣成形,术后全愈出院。     

二维超声心动图诊断先天性心脏病房间隔、室间隔缺损的价值

先天性心脏病(下简称先心病)为临床较常见的心脏疾患。二维超声心动图结合声学造影和多普勒频谱检查对各种先心病的检查诊断有着重要价值。本文总结我院1986年8月～1987年2月对30例房间隔缺损、空间隔缺损(下简称房缺、室缺)术前超声心动图显象结果与手术所见进行了对比观察,现报道如下: 资料 本组30例中男11例,女19例,年龄51/2～30岁。儿童组(4～15岁)20例,成年组(16～31)岁)10例,室缺17例,房缺8例,房缺室缺共存5     

多普勒超声心动图诊断部分性肺静脉异位引流

目的:评价多普勒超声心动图诊断部分性肺静脉异位引流(PAPVC)的价值。方法:回顾分析132例经心外科手术确诊为PAPVC患者的超声心动图诊断情况。结果:根据Brody分型,132例患者中A型14例,超声诊断11例,诊断正确率78.6%;B型103例,超声诊断57例,正确率55.3%;C型4例,超声诊断3例,诊断正确率75%;D型3例,混合型8例,术前超声均未能做出正确诊断。132例患者中右侧肺静脉异位引流90.1%;左侧肺静脉异位引流7.4%,双侧占2.5%。合并房间隔缺损(ASD)121例(91.7%),其中静脉窦型ASD 40例(33.1%),功能性单心房(大型ASD)或单心房18例(14.9%),继发孔型ASD 63例(52%);9例房间隔完整(6.8%),2例冠状静脉窦隔缺损(1.5%)。结论:彩色多普勒超声心动图可以清晰显示肺静脉的回流情况,准确诊断PAPVC。     

Atrial septal defect in older adults: atypical radiographic appearances

Atrial septal defect (ASD) is the most common congenital cardiac anomaly manifested in adulthood. Clinical and radiographic features are well defined in patients less than 30 years of age. In older patients, however, the clinical symptoms are often atypical, and the auscultatory findings may be misleading. The radiographic manifestations in older patients have not been well described. In the current study, of 70 patients over the age of 50 years with proved ASD, 21 (30%) had atypical radiographic features, including apparently normal vascularity, left atrial enlargement, pulmonary venous hypertension, and pulmonary edema. In a control group of 70 younger patients with ASD, only 5.7% had atypical findings. The development of pulmonary venous hypertension and pulmonary edema in older patients was associated with smaller defects and a higher prevalence of mitral valve disease, left ventricular dysfunction, and pulmonary arterial hypertension than seen in older patients with typical radiographic findings.     

MR phase-shift velocity mapping of mitral and pulmonary venous flow

Mitral and pulmonary venous flows are important indexes in the evaluation of left ventricular diastolic function and in the assessment of mitral valve disease. We used MR phase-shift velocity mapping to measure mitral and pulmonary venous flow velocity in 10 healthy volunteers and mitral flow velocity in 5 patients with mitral valve stenosis. Normal mitral flow shows two positive peaks: one during early ventricular diastole and the other during atrial contraction. Peak mitral flow velocity (mean +/- SD) in early diastole was 68 +/- 12 cm/s and during atrial contraction 39 +/- 10 cm/s. The ratio of peak mitral flow velocity in early diastole to that during atrial contraction was 1.9 +/- 0.6. In patients with mitral valve stenosis, the initial high flow velocity persisted through diastole. Peak mitral flow velocity of patients with mitral valve stenosis correlated well with values obtained from Doppler echocardiography. Pulmonary venous flow showed two positive peaks: one during ventricular systole and the other in ventricular diastole. A small backflow during atrial contraction was noticed. Peak systolic velocity in the right lower pulmonary vein was 47 +/- 11 cm/s, peak diastolic velocity was 40 +/- 9 cm/s, and peak backflow velocity was 14 +/- 3 cm/s. Magnetic resonance velocity mapping is a noninvasive technique for the evaluation of time-related flow velocity patterns and for quantitative measurement of mitral and pulmonary venous blood flow velocity.     

房间隔缺损是否合并肺动脉瓣狭窄的超声心动图诊断

探讨先天性心脏病Ⅱ孔房间隔缺损 (ASD)患者是否合并肺动瓣狭窄 (PS)的过肺动脉瓣最大血流速度 (Vpvmax)界限。超声心动图 (TTE)诊断单纯性Ⅱ孔ASD 98例 ,ASD合并PS 2 7例 ,均行心外科手术治疗 ,比较TTE诊断与外科手术结果。结果显示 ,98例单纯性Ⅱ孔ASD手术证实正确 ;TTE诊断Ⅱ孔ASD合并PS 2 7例中 1 9例正确 ,另外 8例患者为单纯性ASD。研究表明 ,TTE诊断ASD患者是否合并PS时 ,应结合二维超声和Vpvmax综合判断 ,以提高诊断的准确性 ,当Vpvmax增高达 2 6 5～ 3 2 5m/s时 ,应考虑合并有肺动脉瓣狭窄     

双源CT对先天性心脏病肺静脉异常连接的诊断价值

目的：探讨双源CT（DSCT）在先天性心脏病肺静脉异常连接（APVC）中的诊断价值。方法：35例患者中男25例,女12例。22例经手术证实,对DSCT诊断APVC类型进行分析。结果：双源CT诊断APVC的符合率为100%（22/22）,对伴发畸形的诊断符合率为90.9%（20/22）。DSCT诊断完全型APVC 20例57.1%（20/35）,最常见异常连接血管为上腔静脉48.9%（23/47）、垂直静脉42.6%（20/47）,多数存在伴发畸形95%（19/20）,房间隔缺损最常见52.6%（10/19）。DSCT诊断部分型APVC 42.9%（15/35）,最常见异常连接为右肺静脉连接至右心房占51.6%（16/31）,多数存在伴发畸形86.7%（13/15）,房间隔缺损最常见46.2%（6/13）。结论：DSCT可以满足APVC的诊断。     

Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation

PURPOSE: To evaluate and classify the various drainage patterns of the pulmonary veins as depicted with thin-section chest computed tomography (CT). MATERIALS AND METHODS: Thin-section (2.5-mm collimation) contrast material-enhanced CT scans of 201 consecutive patients obtained over a 3-month period for diagnosis of pulmonary embolism (n = 197), pulmonary vein stenosis (n = 2), or aortic injury (n = 2) were routinely reviewed in transverse and (if necessary) coronal and coronal-oblique imaging planes. A classification was formulated based on both the number of venous ostia on each side and the drainage patterns of pulmonary veins. The frequency of each pattern was determined, and association with atrial arrhythmia was assessed with the chi(2) and Fisher exact tests. RESULTS: Most patients (n = 142, 71%) had two ostia on the right side for upper and lower lobe veins. Fifty-six patients (28%) had three to five ostia on the right side, which were due to one or two separate middle lobe vein ostia in 52 (26%) patients. Three patients (2%) had a single venous ostium on the right side. Most patients (n = 173, 86%) had two ostia on the left side for upper and lower lobe veins. The remainder (n = 28, 14%) had a single ostium. There was no significant association between any particular venous drainage pattern and atrial arrhythmia; however, patients with a separate ostia for the right middle lobe pulmonary vein(s) tended to have a higher frequency of atrial arrhythmia than those with other patterns (P =.053). CONCLUSION: A classification system to succinctly describe pulmonary venous drainage patterns was developed. Right-sided venous drainage was more variable than left-sided venous drainage. One-quarter of patients had more than two venous ostia on the right side.     

Assessment of normal and abnormal erectile function: color Doppler flow sonography versus conventional techniques

The penile arteries were studied with color Doppler flow sonography in 10 subjects with normal and 39 patients with abnormal erectile function. The relationships of systolic and diastolic velocities to spectral waveform changes in the penile arteries in response to tumescence were studied before and after intracorporal injection of vasoactive medications that induce erection. In normal subjects, a characteristic spectral waveform pattern corresponded to increasing intracorporal pressure. Patients with abnormal arterial inflow and/or abnormal venous sinusoidal leakage demonstrated deviation from the patterns noted in normal subjects. Patients with abnormal arterial inflow had lower mean peak systolic velocities than normal subjects. Patients with severe venous sinusoidal incompetence had an arrest of waveform progression with evolution to but not beyond phases 1 or 2 (diastolic flow remained positive). Patients with abnormal arterial inflow and abnormal venous sinusoidal outflow had waveform changes that reflected both processes. Systolic/diastolic velocity and waveform relationships can be used to define the integrity of both the cavernosal artery inflow and venous sinusoidal outflow occlusion mechanisms.     

Partial anomalous pulmonary venous return in Turner syndrome

PurposeThe aim of this study is to describe the prevalence, anatomy, associations and clinical impact of partial anomalous pulmonary venous return in patients with Turner syndrome.Methods and resultsAll Turner patients who presented at our Turner clinic, between January 2007 and October 2015 were included in this study and underwent ECG, echocardiography and advanced imaging such as cardiac magnetic resonance or computed tomography as part of their regular clinical workup. All imaging was re-evaluated and detailed anatomy was described. Partial anomalous pulmonary venous return was diagnosed in 24 (25%) out of 96 Turner patients included and 14 (58%) of these 24 partial anomalous pulmonary venous return had not been reported previously. Right atrial or ventricular dilatation was present in 11 (46%) of 24 partial anomalous pulmonary venous return patients.ConclusionWhen studied with advanced imaging modalities and looked for with specific attention, PAPVR is found in 1 out of 4 Turner patients. Half of these patients had right atrial and/or ventricular dilatation. Evaluation of pulmonary venous return should be included in the standard protocol in all Turner patients.     

Congenital complete heart block. Radiographic findings in 13 patients without associated defects.

The radiographic findings in 13 patients with congenital complete heart block without associated anomalies are presented to illustrate characteristic features. Findings related to the increased stroke volume in these patients include: (a) simulated shunt vasculature; (b) pulmonary venous pypertension with redistribution of blood flow to the upper lungs, and, in one patient, peribronchial edema; (c) cardiomegaly with right ventricular, pulmonary artery, left atrial, left ventricular, and aortic enlargement; and (d) variation in cardiac size on serial examinations. Less commonly seen were findings related to atrioventricular dissociation with transitory marked pulmonary venous hypertension present in one patient when left atrial contraction occurred during ventricular systole when the mitral valve was closed.