经胸与经食管超声测量心脏瓣环大小的研究

对６６例不同类型的人工心脏瓣膜置换术患者，采用超声检测法，于入院时及术前一周内进行经胸超声心动图（ＴＴＥ）检查，术中进行经食管超声心动图（ＴＥＥ）检查，分别测量瓣环直径与实际置换瓣膜进行比较。结果显示：实际置换瓣膜与入院时ＴＴＥ比较差异有显著性（Ｐ＜０．０５）；与术中ＴＥＥ比较差异无显著性（Ｐ＞０．０５）；与术前一周ＴＴＥ比较差异也无显著性，但Ｘ２值比术中ＴＥＥ大。表明术中ＴＥＥ测量的瓣环大小与置换瓣十分匹配，为减少瓣周漏及术后并发症提供了高度可靠的新技术。在无条件进行ＴＥＥ检查时，也可于术前一周内采用ＴＴＥ测量瓣环大小     

多平面经食管三维超声心动图测量右室游离壁心肌重量的实验研究

为了探索定量评价右室肥厚的新方法，本文利用自行设计的多平面经食管超声心动图三维重建系统，测量了17只实验犬在体心脏右室游离壁心肌重量，并与其解剖学测值进行了对照研究，结果显示，两种方法的测值高度相关（r＝0．95，SEE＝1．29），且均数间无显著性差异，表面多平面经食管三维超声心动图为准确评价右室肥厚提供了新方法。     

经食管超声心动图在围术期成人主动脉-心室通道中的价值

目的 分析和探讨经食管超声心动图(TEE)在围术期成人主动脉-心室通道中的价值。方法 回顾分析11例诊断主动脉-心室通道的超声心动图检查结果及临床特征,其中10例与手术结果对照,3例行病理学检测。结果 10例主动脉-心室通道中,包括ALVT I型2例、II型4例、III型3例,ARVT 1例,1例ALVT II型及2例ALVT III型病理检查显示通道囊袋结构为纤维组织增生伴局灶性黏液变性、坏死,周围组织为广泛玻璃样变伴急性炎性改变;外科矫治包括直接缝合、补片及人工瓣膜置换,3例ALVT因瓣周漏和/或补片处撕脱行二次手术,其中1例(伴感染性心内膜炎)二次术后再次瓣周漏,最终因心衰而死亡,其余预后良好。术前诊断TEE准确性高于TTE及CT,RT-3D可提供更加直观、生动的信息,iSlice在显示病变细节方面效果优于其他成像模式,TEE二维测值与术中测值相关性最好。结论 在成人主动脉-心室通道的术前诊断、术中监测及术后随访方面,TEE较TTE和CT效果更好。     

三尖瓣环部多普勒超声频谱图评估右心室收缩及舒张功能

目的：采用低频多普勒超声对70例右心室功能异常的心脏病患者进行三尖瓣环收缩期和舒张期低频多普勒运动频谱记录,并与40例正常人的低频多普勒运动频谱参数进行了比较。部分病人进行了三尖瓣环运动频谱测值与右心导管压力参数相关性的比较。结果：三尖瓣环运动频谱图参数能够反映不同病理状态下三尖瓣环运动的变化,其运动变化频谱参数收缩期峰值流速（C－V）和流速时间积分（C－VTI）、舒张早期与晚期的流速比值（A－V／E－V）、舒张晚期流速时间积分与舒张期总流速时间积分之比值（A－VTI／VTIt)与右心室的收缩、舒张功能指标显著相关。结论：三尖瓣环运动频谱能够反映右心室收缩与舒张功能的改变。     

Detection of prosthetic mitral valve leak: a comparative study using transesophageal echocardiography, transthoracic echocardiography, and auscultation

Paravalvular leakage is a major complication of prosthetic valve dysfunction. Sixty-one subjects with valvular heart disease who had received prosthetic mitral valve replacement 5 months to 5 years before (43 received a porcine prosthesis and 18 received Bjork-Shiley valve prostheses) were evaluated for this complication. Careful auscultation was performed by two experienced cardiologists followed by transthoracic and transesophageal echocardiography. Physiologic leaks were detected in all Bjork-Shiley valves, but in only 30% of porcine valves using transesophageal echocardiography. These regurgitant jets were flame-like, with mean low velocities of 50 +/- 12.3 cm/sec and 48 +/- 18.2 cm/sec in the two types of valves. Neither transthoracic echocardiography nor auscultation could detect physiological regurgitant jets. Ten cases with paravalvular leak were detected by transesophageal echocardiography and subsequently demonstrated by left ventriculography (7 porcine, 3 Bjork-Shiley valves). Pathologic regurgitant jets were seen as high-velocity, systolic-retrograde turbulent flow across the prosthesis. However, only 6 cases of prosthetic valve dysfunction were detected by transthoracic echocardiography, 4 cases of mild paravalvular leakage went undetected. Thirteen of the 61 subjects had an apical systolic murmur and suspected prosthetic valve leakage; in 10 of the 13 cases the findings corresponded to those obtained by transesophageal echocardiography. In 3 cases of double valve replacement with Bjork-Shiley valves the magnitude of the leakage was overestimated by auscultation.     

多平面经食管三维超声心动图与心室造影测量右室容量和收缩功能的对比研究

目的：探讨多平面经食管三维超声心动图测量右室容量和收缩功能的可靠性。方法：在６１例患者中进行经胸二维和多平面经食管超声心动图检查,分别采用双平面Ｓｉｍｐｓｏｎ法和自制的三维超声心动图软件系统测量右室舒张末期容积（ＥＤＶ）、收缩末期容积（ＥＳＶ）、心搏量（ＳＶ）及射血分数（ＲＶＥＦ）,并与单平面右室造影所测结果对比。结果：经胸二维超声心动图与右室造影所测ＥＤＶ、ＥＳＶ、ＳＶ及ＲＶＥＦ均呈中度相关,ｒ值分别为０．８４、０．８３、０．８４、０．７０,二者间有显著性差异;而多平面经食管三维超声心动图与右室造影测值高度相关,ｒ值分别为０．９３、０．９４、０．９３、０．９３,二者间无显著性差异。结论：多平面经食管三维超声心动图为定量分析右室容量和收缩功能提供了相对无创和高度可靠的新途径。     

实时三维超声心动图对右心室功能及三尖瓣环运动的评价

目的：应用实时三维超声心动图检查分析三尖瓣环运动和右室收缩功能的关系。方法：２７例包括健康志愿者１４例,接受心脏移植术后患者７例,扩张型心肌病３例,冠心病２例,先天性心脏病１例,所有实验对象均接受三维超声检查。将采集的实时三维图像转移至计算机图像分析仪上,从心尖将右心室三维图像沿右室长轴分布９个切面（每个切面间隔２０度）。在舒张末期及收缩人末期分别标定出三尖瓣环三维空间位置。计算机描绘并测量出不同     

经胸及经多平面食管超声诊断先天性主动脉四叶瓣畸形

目的 探讨经胸（TEE）和多平面经食管超声心动图（MTEE）诊断主动脉四叶瓣（QAV）的价值,方法：采用HP 2500、5500型彩色多普勒超声心动图诊断仪,TTE探头频率2.0～4.0MHz;MTEE探头频率5.0～6.2MHz。重点观察主动脉瓣的数目、形态、回声、附着点、关闭线、启闭,冠状动脉起源和血流动力学。结果：TTE确诊QAV5例,MTEE确诊3例,其中3例经手术证实。男4例,女4例,年龄35～55岁,平均41.1岁。在8例QAV中,四个叶大致相等5例（A型）,其余3例四叶大小不对称,一个瓣叶较小,另外三个瓣叶大致相等,呈三大-小型（B型）。多普勒显示A型中4例轻度和1例中度主动脉瓣返流,B型中2例中度和1例重度主动脉瓣返流。结论：经胸和多平面经食管超声诊断先天主动脉四叶瓣畸形,并为内外科选择治疗方案提供重要依据。     

经鼻咽食管超声心动图初步临床应用

目的 初步探讨经鼻咽食管超声心动图临床应用的可行性.方法 利用Phillips iE Elite彩色多普勒超声诊断仪及S8-3t探头,经鼻咽途径插管对12例需进行经食管超声心动图观察的患者进行检查.并与50例常规经口腔食管超声检查患者结果进行对比.结果 12例经鼻咽插管患者中11例插管成功且获得满意图像,其中7例成功施行于房间隔缺损封堵术中监测且持续时间超过30 min.与常规经口腔插管检查相比,经鼻咽插管患者对插管刺激的反应程度、生命体征变化及检查持续时间等均优于对照组.二组所获图像质量相当.结论 经鼻咽途径插管行经食管超声心动图操作方便,安全可靠,为术中、床边操作及常规经口腔插管不耐受者提供了一种新的检查途径,拓展了该技术的临床应用范围.     

经胸及经食管超声心动图在诊断心脏疾病中的价值探讨

目的：比较经胸超声心动图（TTE）与经食管超声心动图（TEE）对心脏疾病中的诊断价值。方法：回顾分析行TEE与TTE对比检查46例心脏病患者的临床资料。结合直视下心脏外科手术、封堵术,比较TEE与TTE心脏超声影像特点,分析两者在诊断心脏疾病中的差异。结果：TEE诊断心脏疾病准确率为100%,TTE的准确率为82.6%。TEE虽然无法替代TTE,但它可以得到许多TTE无法获得的诊断信息。结论：术前开展TEE有助于提高心脏疾病诊断准确性。     

Comparison of transthoracic and transesophageal echocardiography in the diagnosis of intracardiac tumors in adults

To compare transthoracic and transesophageal echocardiography in the diagnosis of intracardiac tumors, 17 patients (8 men and 9 women, aged 19 years to 67 years) whose intracardiac tumors were detected by echocardiography were studied in a 4-year period. Of these, 14 patients underwent cardiac surgery and 13 were proved to have tumors. There were 4 false-positive and 2 false-negative diagnoses by transthoracic echocardiography, but only one false-positive and no false-negative diagnosis by transesophageal echocardiography. The stalk of a myxoma was detected clearly in 5 of 11 patients by transthoracic echocardiography, whereas in 10 of 11 it was detected by transesophageal echocardiography. The detailed morphologic characteristics of the tumor, such as contour of the tumor, and the presence of cysts and calcification in the tumor, were seen more clearly with transesophageal echocardiography than with transthoracic echocardiography. © 1994 John Wiley & Sons, Inc.     

超声心动图对二叶式主动脉瓣畸形的诊断价值

目的 探讨二叶式主动脉瓣的彩超特征和诊断价值。方法 BS－AU4型超声诊断仪。探头频率体表2.0-4.0MHz，对31例患者进行长、短轴观中观察主动脉瓣叶数目、形态、启闭及血流动力学观察。结果 29例手术确诊为二叶式主动脉瓣，误诊2例。结论 超声诊断二叶式主动脉瓣具有其它检查方法不可比拟的优越性。     

计算机辅助体表2—D超声测量右室容积和右室功能

为了进一步检验和推广体表２－Ｄ超声测量右室容积和右室功能的新方法，须实现计算机与超声心动图仪的联机操作。它既可满足与右心有关疾病的深入研究，又可满足广大患者的诊断要求。我们把本方法编成计算机软件，利用计算机辅助测量右室容积和右室功能。提高了计算速度和测量精度。本文首次介绍了有关计算机测量系统的特点和初步应用，进一步显示了这一方法的实用前景     

经食管超声诊断先天性主动脉二叶式瓣的价值

目的： 探讨ＴＥＥ诊断先天性主动脉二叶式瓣（ＤＡＶ） 的价值。方法： 采用ＨＰ２５００超声诊断仪, 经胸超声（ＴＴＥ） 探头频率２．０～３．５ＭＨｚ, ＴＥＥ探头频率５．０ＭＨｚ。对ＴＴＥ拟诊的３３例ＤＡＶ患者ＴＥＥ做进一步复查, 重点观察主动脉长、短轴切面时主动脉瓣叶的数目、布局、形态、回声、启闭及血流动力学特点。结果： ＴＴＥ拟诊的３３例中有２４例被确诊, 并有１１ 例已经手术证实诊断正确。ＴＴＥ拟诊的其余９例中１例为四叶瓣, ８例为三叶瓣, ＴＴＥ误诊率为２７．２８％ 。结论： ＴＥＥ诊断先天性主动脉二叶式瓣的准确性大大高于ＴＴＥ, 为该病明确诊断和内外科选择治疗方案等有重要价值。     

二维及实时三维超声心动图评价右心室容积的准确度研究

目的 (1)评价实时三维超声心动图测量右心室容积的准确度;(2)探讨二维超声心动图测量右心室容积的方法及其准确度.方法 27例健康志愿者,在24 h内进行常规二维超声心动图(2-DE)、实时三维超声心动图(RT-3DE)及心脏核磁共振(cMRI)检查.2-DE计算右室容积采用Simpson法、对切半椭圆体法和双平面面积-长度法(简称双平面法);RT-3DE采用三平面成像法(Tri-plane)及Tom-Tec 4D RV-Function CAP进行容积计算(结果分别记为RT-3DEV1、RT-3DE V2).cMRI图像采用Argus软件计算容积.将2-DE与RT-3DE测量的结果与cMRI结果对比研究.结果 Simpson法、对切半椭圆体法及RT-3DEV1所得结果低估RVEDV及RVESV (P＜0.001),差异有统计学意义;双平面法及RT-3DE V2结果对RVEDV及RVESV有一定的高估或低估(P＞0.05),但差异无统计学意义.相关分析表明,Simpson法及RT-3DEV1测值与cMRI测值相关性较差(RVEDV,r=0.37,0.38; RVESV,r=0.35,0.38).RT-3DE V2、对切半椭圆体法及双平面法测值均与cMRI测值高度相关,(RVEDV,r=0.72,0.73,0.85;RVESV,r=0.60,0.73,0.80).Bland-Alrman分析显示,RT-3DE V2及双平面法与cMRI的右室容积测值的平均差值更小、一致性界限更窄.结论 (1) RT-3DE采用Tom-Tec 4D RV-Function CAP软件进行分析能够较准确的测量右心室容积;(2)二维测量方法中,双平面面积-长度法能够较准确测量右心室容积.     

心肌肥厚对冠脉循环影响的超声研究

目的： 探讨心肌肥厚患者冠脉循环血流动力学变化的特点。方法： 应用多平面经食管超声心动图（ＴＥＥ） 技术探测３０ 例心肌肥厚患者的冠状窦血流动力学改变, 并与１０ 例正常对照进行对比。结果： 所有受检者均可记录到满意的冠状窦血流频谱 （１００％ ）。心肌肥厚组收缩压、左室重量指数 （ＬＶＭ Ｉ）、冠状窦收缩期血流流速积分 （ＶＴＩ－Ｓ）、净前向血流流速积分 （ＶＴＩｎｅｔ） 和前向血流 （ＣＳＦ） 及其直径明显高于正常组 （Ｐ 均＜ ０．０５）, 余各项参数无显著性差异; 与正常组相比, 心肌肥厚患者有症状组收缩压、舒张压、ＬＶＭ Ｉ、ＶＴＩｎｅｔ 及冠状窦直径明显增加 （Ｐ＜ ０．０５～０．００１）; 无症状组ＬＶＭ Ｉ、收缩压、舒张期血流峰值 （Ｄ）、ＶＴＩ－Ｓ、舒张期血流流速积分 （ＶＴＩ－Ｄ）、ＶＴＩｎｅｔ、ＣＳＦ 亦明显增加 （Ｐ＜ ０．０５～０．００１）; 但有症状组Ｄ、ＶＴＩ－Ｄ、ＣＳＦ 低于无症状组 （Ｐ 均＜ ０．０５）。结论： 心肌肥厚患者冠状窦前向血流增加, 但有症状组冠状窦前向血流低于无症状组, ＴＥＥ 探测冠状窦血流以评价心肌肥厚患者冠脉循环的改变具有较高的临床应用价值。     

The role of echocardiography in the early diagnosis of the complications of endovascular repair of blunt aortic injury

Purpose

Endovascular repair of traumatic aortic injury has been associated with severe procedural complications, including endoleaks, coverage of the left subclavian artery, stent collapse, access complications, and questionable durability. Echocardiography has proven to be a valuable tool in the intraoperative detection of these complications. In the current study, we report on the use of echocardiography as an early postoperative diagnostic technique for the evaluation of endovascular stent graft positioning in the intensive care setting.

Methods

From January 2005 to January 2009, 14 patients who underwent endovascular repair of a blunt aortic injury were admitted in our intensive care unit. Transesophageal and/or transthoracic echocardiography were used as first-line diagnostic tools in the assessment of the endovascular graft position.

Results

Twenty-eight percent of patients (4 of 14) developed a pressure gradient between upper and lower limbs (greater than 50 mm Hg), which presented with persistent hypertension, requiring antihypertensive therapy in high doses and difficult weaning. In all 4 patients, stent graft malposition was identified using echocardiography. The diagnosis was verified by computed tomography and aortography.

Conclusion

Noninvasive echocardiographic monitoring proved to be a valuable tool in the early diagnosis of postoperative stent graft malalignment. To our knowledge, this is the first time that echocardiography is described in the relevant literature as an early diagnostic technique in this setting.