川崎病合并二尖瓣返流的临床特征及与冠脉损害关系的探讨

目的:探讨川崎病(KD)合并二尖瓣返流患儿的临床特征及其与冠状动脉损害的关系。方法:选取我院KD患儿152例,其中初期(病程第0-2周)合并二尖瓣返流,后期(第4-7周)复查消失者为组Ⅰ;初期及后期均合并二尖瓣返流者为组Ⅱ;初期及后期均无二尖瓣返流者为对照组。比较3组患儿的年龄、性别、实验室资料(包括WBC、PLT、CK-MB、ALB、CRP、ESR)、冠状动脉扩张、左室增大、返流程度。结果:KD患儿初期二尖瓣返流的发生率为22.4%(34/152),后期为9.2%(14/152)。1例发生心力衰竭,3例出现一过性心功能不全,均为组Ⅱ中合并中度返流患儿。组Ⅰ、Ⅱ分别与对照组的性别、左室增大、冠状动脉扩张、WBC、CK-MB、ALB、CRP、ESR比较,差异均有统计学意义(P0.05);组Ⅰ与组Ⅱ之间的左室增大、冠状动脉扩张、返流程度、WBC、CK-MB、CRP比较有统计学意义(P0.05)。结论:KD所合并二尖瓣返流多可自行缓解,但返流严重或持续存在者可出现心功能不全或心力衰竭;合并二尖瓣返流者其炎症水平较高,易发生冠状动脉损害。     

彩色多普勒对川崎病冠状动脉病变诊断及治疗评价

目的：探讨彩色多普超声心动图诊断川崎病(Kawasaki disease，KD)冠状动脉病变及早期治疗和预后的评价。方法：彩色多普超声心动图检查73例川崎病患儿，测量冠状动脉直径，观察是否存在冠状动脉瘤、血栓和动脉狭窄，测量房室内径，计算心功能，观察是否有心包积液和瓣膜返流。结果：在受检的73例川崎病患儿中有冠状动脉损害的共27例，其中单纯左冠状动脉主干病变l5例，双支病变2例，5例发生冠状动脉瘤，l例动脉瘤回缩后主干轻度狭窄，2例冠状动脉于发病30天后发生改变，其中l例40天后发生左、右冠状动脉瘤和左冠状动脉主干血栓形成。27例冠状动脉受累者均合并轻度、中度二尖瓣及三尖瓣返流，l3例合并心包积液，2例有一过性的心功能降低。结论：使用高频探头能提高冠状动脉的显示率，特别是实时观察冠状动脉病理改变及动脉瘤形成和它的进展及转归，评价管壁的厚度和是否光滑、有无蛋白样物质沉积、钙化及血栓形成。早期联合使用阿斯匹林与大计量静滴丙种球蛋白，可减少冠状动脉瘤的发生及血栓形成。     

冠状动脉主干直径变化率对内皮功能障碍的预测价值

目的　探讨冠状动脉主干直径变化率 (ΔD)对内皮功能障碍的预测价值。方法　选取 74例有冠状动脉造影结果的患者 ,分为正常组和病变组。经胸M型超声心动图记录 (同步心电图指导 )左、右冠状动脉主干起始段舒张期内径 (Dd)和收缩期内径 (Ds) ,计算直径变化率 [ΔD =(Dd -Ds) /Dd× 1 0 0 % ]。结果　正常组左冠状动脉主干ΔD平均 2 8.76%± 7.92 % ,明显大于病变组 1 5 .0 1 %± 6.96% (P <0 .0 1 ) ;右冠状动脉主干ΔD平均 31 .99%± 6.35 % ,也明显大于病变组 2 0 .2 7%± 1 0 .1 7% (P <0 .0 1 )。左、右冠状动脉主干直径变化率相关性良好 (r =0 .5 995 ,P =0 .0 0 0 0 1 )。以冠状动脉主干ΔD <1 5 %为界 ,冠状动脉造影显示狭窄率 >75 %者 ,左冠状动脉主干ΔD均值 1 4.9% ,右冠状动脉主干ΔD均值 1 8.33% ,均为病变组的低水平。结论　冠状动脉主干ΔD可以预测内皮功能障碍的程度。随着冠状动脉病变累及支数和狭窄程度的增加 ,ΔD减小。     

冠状动脉搭桥术后的ICU监护

冠状动脉搭桥术后的ＩＣＵ监护 ,对于减少术后并发症 ,提高手术成功率有重要意义 ,现将我们的体会报告如下。1　临床资料例 1女 ,6 6岁。发作性心慌 ,上腹部疼痛 1年余 ,劳累或情绪激动后发作 ,伴有左肩部酸痛 ,发作时间约10ｍｉｎ ,早期休息可自行缓解 ,多次诊断为缺血性心脏病 ,长期服药。为进一步确诊 ,于 2 0 0 1年 5月 2 3日收入院 ,2 4日行冠状动脉造影。术中见右冠状动脉弥漫性病变 ,左主干前降支完全闭塞 ,2处狭窄 80 %以上 ,于2 0 0 1年 5月 2 6日转入心外科 ,血压2 7/ 1 3ｋＰａ,心脏多普勒超声心电图示三尖瓣中度返流。于 6月 2…     

二尖瓣狭窄患者的下腔静脉口脉冲多普勒超声心动图观察

目的探讨二尖瓣狭窄（二狭）患者下腔静脉回流入右房状态。方法用彩色多普勒超声心动图对７４例二狭患者及３２例对照者沿胸骨右缘纵切探查下腔静脉口的最大内径及血流速度。结果对照组、二狭并轻度三尖瓣返流者（Ⅰ组）、二狭并中度三尖瓣返流者（Ⅱ组）及二狭并重度三尖瓣返流者（Ⅲ组）四组的下腔静脉口内径有显著差异（分别为２０．１±２．４ｍｍ、１７．０±５．９ｍｍ、１６．１±６．２ｍｍ及２７．８±１０．２ｍｍ）。但四组的下腔静脉口峰值血流速度及平均血流速度无明显的差别。简单线性相关分析发现二狭非重度三尖瓣返流者（Ⅰ组、Ⅱ组）的下腔静脉口内径与其峰值血流速度之间呈明显的负相关关系（ｒ＝－０．６２，Ｐ＜０．０１），且下腔静脉口内径与左房内径亦呈明显负相关关系（ｒ＝－０．７１，Ｐ＜０．０１）。结论二狭患者增大的左房可引起下腔静脉口的静脉回流减少     

多普勒心动图测定慢性风湿性心瓣膜病并三尖瓣返流时的肺动脉压

目的 旨在探讨肺动脉压与三尖瓣返流之间的关系.方法 慢性风湿性心瓣膜病68例(其中男性19例,女性49例),年龄平均36±10.2岁,依是否伴有三尖瓣返流将其分为三尖瓣返流组(n=33)和非三尖瓣返流组(n=35),所有患者均接受M、二维和多普勒超声心动图检查.结果 统计分析表明,三尖瓣返流组的左心房内径、肺主动脉内径和右心室内径等参数均显著大于非三尖瓣返流组,肺动脉压虽略高于后者但差异并不显著.结论 慢性风湿性心瓣膜病患者三尖瓣返流与肺动脉压之间的关系仍有待于进一步研究.     

血尿酸升高与冠状动脉病变关系的研究

目的探讨血尿酸升高是否与冠状动脉病变的发生有关。方法回顾性分析 34 0例选择性冠状动脉造影的病人 ,其中冠状动脉病变组 (冠状动脉主干或分支有狭窄 ) 2 2 6例 ,对照组 (冠状动脉主干和分支均无狭窄 ) 114例 ,分析两组间血尿酸的差异及血尿酸与冠状动脉狭窄程度、狭窄支数的相关性。结果①冠状动脉病变组血尿酸浓度大于对照组血尿酸浓度 (P <0 .0 5 ) ;②冠状动脉狭窄程度≥ 75 %时 ,其血尿酸浓度大于冠状动脉狭窄程度 <5 0 %时的血尿酸浓度 (P <0 .0 5 ) ;冠状动脉 2支以上病变组血尿酸浓度大于单支病变组血尿酸浓度 (P <0 .0 5 )。结论①血尿酸升高可能与冠状动脉病变有关 ;②血尿酸升高可能与冠状动脉狭窄程度、支数有关。     

MSCT冠状动脉成像与冠状动脉造影的对比研究

目的 :研究MSCT在冠状动脉成像中的临床应用价值。方法 :4 0例疑冠状动脉狭窄者行MSCT扫描 ,利用最大密度投影 (MIP)重建 ,2D重建 ,仿真内窥镜技术 ,了解冠状动脉病变情况 ,并与冠状动脉造影对比。结果 :4 0例 16 0支血管经MSCT成像 ,134支 (84 % )可用于影像学评价 ,2 6支 (16 % )不能评价。冠状动脉造影发现狭窄 4 6支 ,其中左前降支 (LAD)病变 18支 ,回旋支 (LCA)病变 12支 ,左主干 (LMA) 3支 ,右冠 (RCA)病变 13支。MSCT发现狭窄 4 1支 ,其中左前降支病变 14支 ,回旋支病变 12支 ,左主干病变 3支 ,右冠病变 12支。敏感性为 82 .6 % (38/ 4 6 ) ,特异性 97.3% (111/ 114 )。结论 :在控制心率的情况下 ,MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。     

彩色多普勒超声诊断巨大右冠状动脉左室漏1例

患者男,16岁.劳累后胸闷、气短6年,加重4个月,发现心脏杂音半月入院.查体:双肺呼吸音清,未闻及干湿性罗音.心音有力,心率76次/min,心律齐,心尖部可闻及舒张期哈气样杂音.周围血管征阳性.腹平软,肝脾肋下未触及,双下肢无水肿.心电图示窦性心律,左室肥大,室内传导阻滞.X-线胸片示双肺纹理清,肺门不大,左心室增大,左心室段延长,心胸比值0.72. 彩色多普勒超声心动图:左房、室腔明显增大,左室内径达74 mm.胸骨旁左室长轴及心底大动脉短轴观均可见右冠状动脉增宽为13 mm,向右沿右室外侧壁迂曲下行至房室沟处进入左室,开口于二尖瓣后叶瓣环处(图1).脉冲多普勒测得漏口处血流为舒张期向上的湍流频谱.最高流速达3.4 m/s.左室心尖长轴观,彩色多普勒显示舒张期可见由二尖瓣后叶瓣环处向左室内延伸的大量五彩血流束(图2).三尖瓣可见中量返流.主动脉瓣可见少量返流. 左冠状动脉宽为3.3 mm.超声诊断:先天性心脏病右冠状动脉左室漏,三尖瓣返流(中量) ,主动脉瓣返流(少量).     

脉冲多普勒组织成像对冠心病患者右室功能的评价

目的应用多普勒组织成像（DTI）技术测量三尖瓣环运动速度，评价冠心病患者的右室功能。方法分别对A组19例单纯右冠状动脉狭窄者、B组30例左冠状动脉狭窄者和C组36例正常对照者应用DTI从心尖四腔切面测定三尖瓣环的右室侧壁和室间隔的收缩期（Sa）、舒张早期（Ea）和舒张晚期（Aa）运动速度峰值，并进行显著性检验。结果A组和B组的Sa和Ea均低于正常组（P〈0．05～0．01），但A组Ea／Aa之比显著低于正常组（P〈0．01），而B组的Ea／Aa之比和两组的Aa与正常组相比无统计学差异（P〉0．05）。证明冠状动脉病变确实影响了右室壁的运动功能。结论DTI技术测定三尖瓣环运动速度可作为评价冠心病右室功能的新方法。     

胎儿超声心动图在评估室间隔完整型肺动脉闭锁中的应用价值

目的探讨胎儿超声心动图在评估室间隔完整型肺动脉闭锁（PA/IVS）中的应用价值。 方法回顾性选取2017年10月至2020年12月在河北生殖妇产医院诊断为PA/IVS的胎儿29例。超声心动图测量右心室与左心室上下径比值（RV/LV）、三尖瓣流入时间与心动周期时间比值（TVID/CCL）、三尖瓣环与二尖瓣环内径比值（TV/MV）、三尖瓣Z值（TV-Z）等参数，观测静脉导管频谱形态、房室瓣反流量、动脉导管内径和血流方向、有无心包积液、有无合并冠状动脉异常及右心室依赖性冠状动脉循环（RVDCC）。依据右心室流入部、小梁部、漏斗部结构是否存在，对29例胎儿进行分型，并分析其超声心动图特征。 结果29例PA/IVS产前超声心动图均可见动脉导管逆向血流供应肺动脉。24例可见三尖瓣大量反流；5例三尖瓣反流不明显或为少-中量反流。18例静脉导管A波缺失或反向，11例静脉导管频谱正常。29例PA/IVS胎儿Ⅰ型12例、Ⅱ型9例、Ⅲ型3例、Ⅳ型5例，不同分型PA/IVS的RV/LV、TVID/CCL、TV/MV、TV-Z等参数存在明显差别。3例合并冠状动脉异常，其中1例右心室心肌内异常血流信号穿行（Ⅳ型），2例合并冠状动脉-右心室交通（Ⅲ型1例，Ⅳ型1例），这3例考虑合并RVDCC。 结论超声心动图对胎儿PA/IVS的产前诊断、分型及预后评估具有重要价值；产前超声心动图多指标联合应用有助于PA/IVS的准确评估，可为产后治疗提供可靠依据。     

室间隔完整的肺动脉闭锁的产前超声诊断

目的探讨室间隔完整的肺动脉闭锁的胎儿期超声诊断声像特征、检测技巧及其鉴别诊断,提高此类畸形的产前检出率。 方法对33200例胎儿均采取胎儿心脏四腔心切面加胎儿头侧偏转法获得四腔心切面及左右心室流出道及主、肺动脉长轴切面快速筛查胎儿心脏畸形,对疑有胎儿心脏畸形者则更行详细的胎儿彩色多普勒超声心脏检查。分析8例产前及产后诊断的室间隔完整的肺动脉闭锁的声像特征和病理特征。 结果产前共诊断室间隔完整的肺动脉闭锁8例,其主要声像特征是8例均有肺动脉内径细小,彩色多普勒于三血管气管平面显示7例动脉导管内血流反向,7例右室右房扩大,6例右室壁厚,7例中重度三尖瓣反流,1例三尖瓣下移畸形,1例三尖瓣狭窄并右室小。 结论肺动脉内径细小、不同程度的右房右室扩大、三尖瓣畸形、右室发育不良、动脉导管内血流反向是肺动脉闭锁的主要声像特征,三血管气管平面是产前超声诊断室间隔完整的肺动脉闭锁的关键切面,需注意与主动脉闭锁、永存动脉干进行鉴别。     

二维及多普勒超声心动图诊断原发性肺动脉高压

应用二维及多普勒超声心动图首诊８例原发性肺动脉高压（ＰＰＨ）患者，并经心导管等检查证实，ＰＰＨ超声表现为右房、右室扩大，右室壁肥厚，肺动脉扩张，室间隔形态异常，心内间隔连续性好，肺动脉血流频谱形态及收缩时间间期变化、肺动脉瓣返流及高速三尖瓣返流等征象。认为室间隔形态异常和通过三尖瓣返流压差法来间接估计肺动脉压是一种简便可行的方法。虽然ＰＰＨ缺乏特异性超声表现，但结合临床分析，超声检查可以提出ＰＰＨ     

Aortic regurgitation reduces the accuracy of exercise echocardiography for diagnosis of coronary artery disease.

The association of aortic regurgitation with left ventricular size, hypertrophy, and abnormal coronary flow may influence the accuracy of stress testing techniques for the diagnosis of coronary disease. We examined the diagnostic accuracy of treadmill exercise echocardiography to predict coronary artery disease in 76 patients with moderate to severe aortic regurgitation. Rest and poststress images were interpreted by 2 experienced observers, and accuracy was defined by comparison with stenoses >/=50% diameter at coronary angiography. Results were compared with accuracy in a control group of previously published studies in patients without valvular heart disease. After 6 patients were excluded because of a submaximal heart rate response (<85% age-predicted maximal heart rate), 70 patients were included in the final analysis. Patients with aortic regurgitation were of comparable age to the control group and exercised to similar workload. In 16 (23%) patients with significant coronary artery disease and significant aortic regurgitation, the sensitivity of exercise echocardiography was 56% compared with 83% in the control group (P =.03). The specificity in 54 patients with aortic regurgitation but no significant coronary artery disease was 67% compared with 83% in the control group (P =.02). Accuracy was 64% in aortic regurgitation compared with 83% in the control group (P =.02). In patients with aortic regurgitation, accuracy in the left anterior descending artery territory (76%) marginally exceeded that in the posterior (right + circumflex coronary artery) circulation (70%). Thus the presence of significant aortic regurgitation affects the regional wall motion of the left ventricle during exercise and adversely affects the accuracy of exercise echocardiography for the diagnosis of coronary artery disease.     

Tricuspid valve insufficiency: what should be done?

Tricuspid regurgitation is relatively common. Due to the progress made in echocardiography, its diagnosis is in general made readily and in reliable fashion. Basically one has to distinguish between functional tricuspid valve regurgitation due to volume and/or pressure overload of the right ventricle with intact valve structures versus tricuspid valve regurgitation due to pathologic valve structures. The clear identification of the regurgitation mechanism is of prime importance for the treatment. Functional tricuspid valve regurgitation can often be improved by medical treatment of heart failure, and eventually a tricuspid valve plasty can solve the problem. However, the presence of pathologic tricuspid valve structures makes in general more specific plastic surgical procedures and even prosthetic valve replacements necessary. A typical example for a structural tricuspid valve regurgitation is the case of a traumatic papillary muscle rupture. Due to the sudden onset, this pathology is not well tolerated and requires in general surgical reinsertion of the papillary muscle. In contrast, tricuspid valve regurgitation resulting from chronic pulmonary embolism with pulmonary artery hypertension, can be improved by pulmonary artery thrombendarteriectomy and even completely cured with an additional tricuspid annuloplasty. However, tricuspid regurgitations due to terminal heart failure are not be addressed with surgery directed to tricuspid valve repair or replacement. Heart transplantation, dynamic cardiomyoplasty or mechanical circulatory support should be evaluated instead.     

Echocardiographic contrast increases the yield for right ventricular pressure measurement by Doppler echocardiography

Doppler ultrasound has become accepted as a measurement of right ventricular systolic pressure in patients who have a quantifiable signal from tricuspid regurgitation. This study evaluated the use of intravenous injection of saline solution for echo contrast to increase the percentage of quantifiable tricuspid regurgitant signals in patients who have any detectable tricuspid regurgitation at baseline. Patients underwent a standard Doppler evaluation, followed by a contrast study with the injection of 4 to 6 ml of agitated saline solution into a brachial vein. Baseline and contrast tricuspid regurgitant signals were assessed for quality, quantifiability, and reproducibility of the derived pressures by three observers on two occasions. The average absolute pairwise deviation among the three observers was low: 1.6 mm Hg (standard deviation, 1.4 mm Hg). The intraobserver mean discrepancy was low: 0.03 mm Hg (standard deviation, 2.33 mm Hg). Patients who did not have tricuspid regurgitation (n = 10) failed to develop such regurgitation during contrast injection. Only eight of 40 patients (20%) who had trace or mild tricuspid regurgitation had quantifiable baseline signals, but 34 patients (85%) had quantifiable signals with contrast injection. All patients who had mild to moderate, moderate, or severe tricuspid regurgitation (n = 10) had quantifiable signals before contrast injection. Of all patients who had any tricuspid regurgitation, 88% had quantifiable signals with contrast injection. Echo contrast was shown to improve the yield of quantifiable signals in patients who had trace and mild tricuspid.     

Comparison of several noninvasive methods for estimation of pulmonary artery pressure

Noninvasive estimation of pulmonary artery pressure is an important component of cardiac ultrasound studies. A number of methods are available for estimation of pulmonary pressure, each with varying degrees of reported accuracy. To assess feasibility and accuracy, noninvasive pulmonary artery pressure estimates were performed in infants and children at the time of catheterization. Patients were examined prospectively until there were 50 patients, in whom each of six methods for estimation of pulmonary pressure had been accomplished. All patients had tricuspid and pulmonary regurgitation of less than severe degree and no structural, flow, or electrocardiographic abnormality known to compromise the six methods. Systolic pressure was estimated by the Burstin method and also from peak tricuspid regurgitation velocity. Mean pressure was estimated by acceleration time divided by ejection time from waveforms obtained from the right ventricular outflow tract and main pulmonary artery. Diastolic pressure was estimated by systolic time intervals and from end-diastolic pulmonary regurgitation velocity. Noninvasive estimates were compared with simultaneous or nearly simultaneous catheterization measurements. For systolic pressure Burstin estimates were accomplished in 89% with high accuracy (r = 0.97). Tricuspid regurgitation velocities were recorded in 82%, also with high accuracy (r = 0.96). Waveforms for mean pressure estimation were recorded in 98% to 100% of patients. Those from the right ventricular outflow tract corresponded well with catheterization pressures (r = 0.94), whereas those recorded from the main pulmonary artery offered poor prediction of pulmonary pressure (r = 0.63). Systolic time interval measurements were accomplished in only 65% and did not correlate highly with catheterization (r = 0.84). Diastolic pressure estimates based on pulmonary regurgitation velocity were recorded in 98% of subjects with high accuracy (r = 0.96). Each method had advantages and disadvantages. The Burstin method was accurate but technically demanding and is reported to be limited by heart rate and significant right-sided regurgitation. Peak tricuspid velocities proved unexpectedly difficult to record in some patients but when successful, provided excellent prediction of pressure. Recording of waveforms for ratios of acceleration time to ejection time proved easy, but accuracy was high only for outflow tract waveforms. Peculiarities of main pulmonary artery flow may have led to poor accuracy for ratios measured from that site. For diastolic pressure estimation, systolic time interval records were the most difficult to obtain and did not provide useful accuracy. In contrast, pulmonary regurgitation velocities were easily obtained and provided high accuracy results. This is a selected pediatric series, evaluating methods in nearly ideal circumstances.(ABSTRACT TRUNCATED AT 400 WORDS)     

肺动脉高压型胎儿房间隔缺损彩超诊断方法的研究

目的：探讨彩色多普勒超声诊断胎儿伴肺动脉高压型间隔缺损的方法。方法：应用彩色多普勒超声观察胎儿各房室腔大小,主、肺动脉起源,三尖瓣返流及三尖瓣返流压差。将产前超声诊断与产后超声检查结果对照。结果：产前诊断伴肺动脉高压型胎儿房间隔缺损12例,产后11例证实原诊断,1例误诊。认为伴肺动脉高压型胎儿房间隔缺损的主要诊断依据为：右房室腔增大,三尖瓣返流且最大返流压差明显增高,二维超声排除房室腔结构异常。结论：彩色多普勒超声观察房室腔大小及三尖瓣返流情况产前诊断伴肺动脉高压型房间隔缺损具有重要价值。     

Tei指数在超声诊断肺源性心脏病中的价值

目的　探讨右室 Tei指数评价慢性阻塞性肺病临床怀疑肺心病患者右室功能的价值。方法　超声观察测量 4 2例患慢性阻塞性肺病临床怀疑肺心病患者及 33例正常人常规超声指标 ,测量并计算右室 Tei指数。超声指标包括右房横径、右室横径、右室前壁厚度、肺动脉主干内径、根据三尖瓣返流和肺动脉瓣返流估测的肺动脉收缩压、舒张压和平均压。结果　 4 2例患者中 14例具有较明确的肺心病超声征象和中度以上肺动脉高压 ,18例无明显二维超声改变但有不同程度肺动脉高压 ,另 10例患者既无肺心病二维超声征象 ,又无三尖瓣或肺动脉瓣返流 ,多普勒超声无法估测肺动脉压力 ,超声诊断为正常超声心动图表现。上述 3类患者右室 Tei指数与对照组相比均有显著性差异。结论　右室 Tei指数是反映右心整体功能的较敏感的指标 ,尤其对于临床怀疑有右心功能损害而常规超声心动图检查未见明确超声征象者 ,Tei指数的测量可为临床提供一定的诊断信息 ,减少漏诊。