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     

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。     

成人及儿童心脏憩室临床分析

目的 :探讨成人与儿童心脏憩室的临床特点。方法 :将经心脏造影或手术证实为心脏憩室的 9例患者临床资料进行回顾性分析。结果 :14例成人患者 (成人组 )皆因并发冠心病在冠状动脉及左室造影检查时被偶然发现。 5例儿童患者 (儿童组 )中 4例因并存其他严重先天性心脏畸形而施行外科矫治手术时被确诊 ,另 1例经左室造影证实。2成人组平均憩室瘤体径为 2 0～ 48(36 .3± 11.8) mm,憩室颈径为 10～ 17(14.0± 2 .9) mm;儿童组平均憩室瘤体径 2 5～ 80 (42 .0± 2 2 .0 ) m m,憩室颈径为 4～ 12 (8.6± 3.9) mm。 3成人组均为孤立性左室肌型憩室 ,无与憩室有关的并发症 ,未行手术治疗 ;儿童组中仅 1例为孤立性左室肌型憩室 ,其余 4例均根据其并存的心脏畸形类型分别接受了憩室缝合术和房、室间隔修补术、三尖瓣成形术、二尖瓣置换术或动脉导管结扎术等治疗。结论 :成人与儿童心脏憩室的临床特点有许多不同之处     

孤立性左心室肌致密化不全10例分析

目的　评价超声心动图技术在诊断孤立性左室肌致密化不全中的作用。方法　 10例孤立性左室肌致密化不全患者 ,均为男性 ,年龄 2～ 6 0 (39± 17.7)岁。分别采用美国HP 5 5 0 0及日本Toshiba 140A型二维及多普勒超声心动图仪进行检查 ,探头频率 2 .5 3 .5MHz。部分患者接受超高速CT或磁共振成像检查。结果　 10例患者均有程度不同的左心功能不全、心律失常等临床表现 ,未见栓塞征象。孤立性左室肌致密化不全超声心动图特征如下 :(1)二维超声心动图可见多发性突入心室腔内的肌小梁 ,且呈节段性分布。好发于左室心尖部、前侧壁 ;(2 )多普勒超声心动图显示深陷于肌小梁隐窝间的血流与左室腔交通 ;(3)左心室壁呈非均匀性增厚或变薄。 10例患者均符合上述诊断标准。 2例行超高速CT检查 ,2例行磁共振成像检查 ,4例患者均可见左室心尖部、前侧壁肌小梁粗大 ,左心室腔明显扩大 ;小梁区心室壁明显增厚。 10例患者均因左心功能不全给予常规利尿剂、血管扩张剂及抗凝治疗。结论　孤立性左心室肌致密化不全是一种罕见的先天性心肌病 ,临床上可表现为渐进性左心功能不全、致命性心律失常及栓塞征象。超声心动图是无创诊断孤立性左室肌致密化不全的准确、可靠方法     

成人左室心肌致密化不全的超声诊断分析

目的 探讨超声心动图对成人心肌致密化不全(NVM)的诊断价值,以提高临床及超声医师对该病的认识.方法 回顾性分析7例成人左室心肌致密化不全患者的心脏形态结构的超声心动图特点及血流改变特征.结果 7例患者超声心动图均可见左室腔内不同程度突起的肌小梁,形成网状结构,其间可见深陷的隐窝,病变均累积左室中下段,以心尖部为主,室间隔基底段基本正常,病变处心内膜节段性缺失.5例左房、左室增大,7例均有左室收缩及舒张功能减低.结论 NVM超声心动图具有特征性改变,是目前诊断该病的首选检查方法.     

多普勒超声心动图对左室舒张功能的评价

目的：应用多普勒超声心动图二尖瓣口血流频谱舒张期充盈速度、容积时间指标，评价心脏左室舒张功能。方法：对68例高血压、冠心病住院病例进行多普勒超声心动图二尖瓣口血流频谱检测和分析。结果：46例高血压病例中42例（占91．8％）、冠心病22例中20例（占90．91％）表现为等容舒张期延长，时间大于110ms,E峰降低、A峰增高，E／A比值小于1。结论：二尖瓣口血流频谱E峰与A峰比值能反映左室舒张功能情况。高血压、冠心病人大部分有左室舒张功能障碍。     

纠正慢性右室压力负荷过度可早期改善左室舒张功能

据报道,在慢性右室压力负荷过度的患者,脉冲Doppler超声测得二尖瓣血流频谱异常。一些研究者认为,肺动脉高压患者左室充盈主要在舒张晚期,是室间隔向左偏移或左室肌本身顺应性改变所致。近来对缺血性心脏病的研究发现,左室舒张早期流速异常的部分原因是左室主动舒张异常。左室几何形状的改变、左室各部分心肌的收绵力不一致和左室超负荷均对左室主动舒张有一定影响。慢性栓塞性肺动脉高压在血栓动脉内膜切除术后,肺动脉压明显减低,这为研究右室后负荷降低以后左室舒张功能的改善提供了极好的机会。本研究在肺动脉血栓动脉内膜切除前后,采用 Doppler 超声测量经二尖瓣的血流频谱,采用二维超声心动图测量左     

超声心动图和左室造影测定冠心病病人左室局部收缩功能异常的比较

本文对46例冠心病病人使用超声心动图测定左室室壁收缩期增厚百分比和判断室壁运动分级,并与左室造影结果比较,结果显示左室造影室壁运动异常各分级组中,超声测定的收缩期增厚百分比差别显著(P<0.01),两种方法测定的室壁运动分级也有很好的相关性(P<0.01)。     

前列腺素E1对冠心病患者左室舒张功能的影响

采用脉冲式多普勒超声心动图（PDE）技术,通过测定二尖瓣血流频谱,评价前列腺素E₁（PGE₁）对冠心病（不稳定型心绞痛）左室舒张功能的影响。结果显示PGE₁对冠心病左室舒张功能有良好改善作用,且无明显增加心率。     

超声心动图评价冠心病左室舒张功能的新进展

冠心病时左室舒张功能的减退发生在左室收缩功能减退之前,故左室舒张功能在反映心肌缺血性病变方面显得更具有敏感性.超声心动图可评价冠心病患者早期左室舒张功能的变化.现就超声心动图评价冠心病左室舒张功能的临床价值做一综述.     

Isolated Congenital Muscular Diverticulum of the Left Ventricular Apex Complicated with Mural Thrombosis in an Adult

We present a case of apical isolated congenital left ventricular (LV) diverticulum complicated with mural thrombosis in an adult and elucidate the echocardiographic features for differential diagnosis of LV outpouchings.     

Three-dimensional echocardiographic assessment of left ventricular function in takotsubo cardiomyopathy

We evaluated left ventricular (LV) function by three-dimensional echocardiography (3DE) in a patient with takotsubo cardiomyopathy (TC). An 82-year-old man was admitted to our hospital with a suspicion of acute myocardial infarction but was diagnosed as TC by coronary angiography and left ventriculography (LVG). Three-dimensional echocardiography showed circular asynergy from the midventricle to the apex associated with hyperkinesis of the base and volumetric data very close to those obtained by LVG. Thus, 3DE is a useful tool in evaluating regional wall motion abnormalities and LV volume in patients with TC.     

Congenital left ventricular diverticulum diagnosed by 64-detector CT imaging

A congenital left ventricular (LV) diverticulum or aneurysm is a rare cardiac malformation. It is a developmental anomaly that occurs during embryogenesis. Most congenital LV aneurysms and diverticula are asymptomatic or may cause systemic embolization, heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging or left ventriculography, visualizing the structural changes. We report the case of a 28-year-old male referred for the evaluation of atypical chest pain who was found to have an LV diverticulum affecting the inferoposterior wall of his LV.     

Left ventricular diverticulum and mitral incompetence in asymptomatic children.

Two children with congenital apical left ventricular diverticulum and significant mitral incompetence are reported. The angiographic and anatomic findings of the few previously reported patients with congenital diverticula and aneurysm were analyzed and a new classification differentiating between the two is proposed. The clinical data analyzed in apical diverticula and aneurysm are similar to those patients with anomalous origin of the left coronary artery from the pulmonary artery. Left ventriculography is the best diagnostic tool. The place of surgery in the treatment of the congenital apical diverticula with or without mitral incompetence in asymptomatic children is not clear. Further observations are needed to reveal its natural history.     

Effects of contrast media on left ventricular function. Comparison with iohexol and diatrizoate

To investigate the effects of a low-osmolar nonionic (Iohexol: I) and a high osmolar ionic contrast media (Diatrizoate: D) on left ventricular (LV) function after left ventriculography (LVG), we studied 19 patients with coronary artery disease (I: 9 cases, D: 10 cases) during diagnostic cardiac catheterization. The first LVG was performed by injecting 40 ml of I or D at a rate of 12 ml/sec, measuring simultaneous LV pressure with a catheter tip manometer (Millar instruments). At 4 minutes after the first LVG, we repeated hemodynamic measurements and LVG. Single-plane volumes (RAO 30 degrees) were calculated every 20 msec (50 frame/sec) using the area-length method. LV systolic function was estimated by ejection fraction (EF), ratio of end-systolic pressure to end-systolic volume (ESP/ESV) and maximal (+)dP/dt. LV relaxation was assessed by the time constant (T) of LV pressure decay. LV diastolic compliance was evaluated by the diastolic pressure-volume (PV) relationship. Results. 1. LV end-diastolic pressure and volume were augmented more significantly in D than in I group, probably due to the difference of their osmolarity. 2. EF increased in D group with increase of LV preload after the first LVG, but didn't change in I group. ESP/ESV and maximal(+)dP/dt were not changed after the first LVG in both groups. 3. LV isovolumic relaxation remained unchanged with I and D. 4. LV diastolic PV relation curve shifted upward more in D than I group. We conclude that Iohexol has less influences on LV function than Diatrizoate and may be used in high risk patients.     

Use of Unique Doppler Flow‐Pattern for the Diagnosis of Left Ventricular Diverticulum

Isolated congenital left ventricular diverticulum (LV) is reportedly a rare finding. It is frequently associated with other congenital defects involving heart, pericardium, sternum, diaphragm, and abdominal wall. It is an outpouching from the ventricle and has all three layers of left ventricular free walls. We present the case of a 53‐year‐old woman who was discovered to have an outpouching of the LV apex on a nongated chest CT scan raising possibility of a pseudoaneurysm. A transesophageal echocardiogram (TEE) showed systolic diminution of this outpouching with unique Doppler flow‐patterns suggesting a diagnosis of a muscular type of LV diverticulum instead of a postinfarct LV pseudoaneurysm. The patient was reassured and treated conservatively.     

A case of congenital left ventricular diverticulum with pulmonary stenosis and its scintigraphic characteristics

We encountered a 31-year-old female patient with mild valvular pulmonary stenosis who had no abnormality in the electrocardiogram but pulmonary dilatation in the chest radiograph. Two-dimensional echocardiography and magnetic resonance imaging demonstrated two small protrusions at the interventricular septum indicating diverticula. Large perfusion defects were observed at the anterior wall in the thallium-201 myocardial tomograms. Short axial and vertical long axial images by ECG-gated blood pool tomography revealed an out-pouching best seen during diastole and a good contraction during systole in the corresponding areas. These findings suggested the presence of thin but normal myocardium in the anterior wall, i.e. a muscular type of left ventricular diverticulum. The presence of the muscular type of left ventricular diverticulum at the anterior and septal walls was confirmed by contrast left ventriculography. A congenital diverticulum at the anterior and septal walls with pulmonary stenosis is very rare. Furthermore, its scintigraphic images were quite characteristic and useful for its diagnosis.     

Assessment of global and regional left ventricular function by electrocardiographic gated N-13 ammonia positron emission tomography in patients with coronary artery disease.

BACKGROUND: Electrocardiographic gated 13N-ammonia positron emission tomography (PET) enables simultaneous assessment of myocardial blood flow and left ventricular (LV) function. The aim of this study was to assess the accuracy of gated 13N-ammonia PET for evaluating global and regional LV function in patients with coronary artery disease (CAD) in comparison with conventional left ventriculography (LVG). METHODS AND RESULTS: Fifty-four patients with CAD underwent gated 13N-ammonia PET and LVG. The LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and ejection fraction (LVEF) by gated 13N-ammonia PET were calculated using Cedars-Sinai automated quantitative gated single photon emission computed tomography (QGS) and compared with those obtained by LVG. The regional wall motion (RWM) was visually scored, and compared with that on LVG. There were good correlations between the 2 methods for LVEF, LVEDV and LVESV (R=0.828, R=0.821 and R=0.874 respectively). The RWM assessed by gated 13N-ammonia PET also agreed well with that by LVG (complete agreement was 70.4%, kappa=0.58). CONCLUSIONS: Gated 13N-ammonia PET combined with QGS works reasonably well for the assessment of both global and regional LV function in CAD patients, although additional calibration may be necessary.     

Cardiac imaging in rheumatic diseases

The majority of the imaging techniques in cardiology could be applied in rheumatic diseases (RDs), such as echocardiography, single-photon emission computed tomography (SPECT), radionuclide ventriculography, angiography, cardiovascular MRI and CT. Inflammatory pericardial involvement is the most common cardiac manifestation in various forms of RD. Echocardiography is the gold standard for diagnosis of pericardial abnormalities, demonstrating location and amount of pericardial effusion. Cardiac MRI and CT can be used to assess the features of pericardial effusions and pericardial structures. In patients with valvular heart disease in RD, transoesophageal echocardiography is a superior method and offers reliable information about valve morphology, the severity of the disease and left ventricular (LV) function. In addition, cardiac MRI is a valuable tool for the evaluation of valvular stenosis and regurgitation severity. Myocardial involvement in RD is demonstrated by abnormalities in LV size and function, indicating myocardial inflammation. In these patients Doppler echocardiography and myocardial tissue imaging can provide essential diagnostic information. Both LV angiography and cardiac MRI can provide reliable information on LV size, function and mass. In patients with coronary disease associated with RD, LV ejection fraction and ventricular wall motion can be assessed by echocardiography, radionuclide ventriculography, gated SPECT and MRI. Three-dimensional (3D) echocardiography is considered superior to 2D echocardiographic techniques. Stress echocardiography is the most used method for detection of myocardial ischaemia. The only accurate visualization of the coronary arteries is by selective coronary arteriography, which remains the gold standard. Although new non-invasive techniques have been developed, including CT and MRI angiography, some limitations apply.