彩色超声心动图在风湿性心瓣膜病中的应用

目的 探讨彩色超声诊断仪在风湿性心瓣膜病中的应用。方法 以常规超声心动图测量各房室大小，瓣叶回声及运动情况，瓣口面积，瓣口血流速度，返流面积，间接估测肺动脉压以及有无血栓形成等。结果 所累及瓣膜增厚，回声增强，活动受限，继发房室增大，室壁增厚，肺动脉高压及左房血栓等。最多累及二尖瓣，其次主动脉瓣，很少三尖瓣及肺动脉瓣。结论 随着彩色超声诊断仪的逐渐普及，对风湿性心瓣膜病临床上早诊断，早治疗有较好的指导作用。     

正常入房室瓣环运动频谱分析

目的：测定正常人房室瓣环运动速度并对结果分析、探讨。方法：心尖四腔切面,用DTI测定房室瓣环运动速度。结果：房室瓣环收缩期Sann峰值速度与年龄无相关,房室瓣环舒张早期Eann峰值速度、Eann／Aann与年龄负相关,Aann峰值速度与年龄正相关。三尖瓣环Eann／Aann与三尖瓣口血流E／A中度相关,二尖瓣环Eann／Aann二尖瓣口血流E／A高度相关。房室瓣环收缩期峰值Sann峰值速度游离壁侧大于间隔部,三尖瓣前瓣环Sann峰值速度最高。结论：DTI测定的房室瓣环运动速度有望用于评价心室收缩及舒张功能。     

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。     

心房纤颤与心脏结构及功能改变的相关性研究

目的：观察分析心房纤颤（房颤）患者心脏结构及功能的改变,进一步明确房颤病因及病理机制对心脏功能及血流动力学的影响。方法：应用经胸彩色多普勒超声心动图观察房颤患者143例,非房颤患者（对照组）118例,测定房室腔径、左室射血分数（EF）及血流动力学参数,并重点观察房腔及心耳内是否存在附壁血栓。结果： ①房颤组左房（LA）、右房（RA）、右室（RV）内径较对照组明显扩大（P<0.001）,左室收缩末内径（LV2）较对照组增大（P<0.05）;房颤组EF较对照组明显降低（P<0.01）,二尖瓣返流（MR）、三尖瓣返流（TR）、肺动脉收缩压（PASP）较对照组明显增大（P<0.01）。②143例房颤患者中有38例（26.6%）并发附壁血栓,其中左心房、左心耳内30例,右房腔内8例（双房腔合并肺动脉内3例）。结论：各种不同病因的房颤多伴有房室增大,其中以左房扩大最为明显;房颤患者伴随左心功能减退及血流动力学异常;26.6%的房颤患者并发附壁血栓,其中右心房附壁血栓发生率为5.6%。     

儿童风湿性心脏炎的超声评价

目的：评价超声心动图对风湿性心脏炎的诊断价值。方法：选择连续住院确诊的风湿热患儿77例，根据本次及以前有无心脏炎分为急性风湿热、风湿热伴初发心脏炎和复发心脏炎3组。超声心动图检查了解风湿性心脏炎患儿的瓣膜形态、瓣膜功能、心包积液和心脏大小及心功能改变。结果：Ⅱ组中19例（90％）患儿二尖瓣增厚、85％中－重度返流。4例二尖瓣瓣叶有不同于感染性心内膜炎的小结节。Ⅲ组全部患儿二尖瓣增厚、3例有瓣叶小结节，21例（91％）二尖瓣中－重度返流。Ⅱ组中分别有12例、3例和1例主动脉瓣、三尖瓣和肺动脉瓣增厚。93％患儿心脏扩大，在左房扩大为主。绝大多数患儿左室收缩功能测值正常或偏高。结论：风湿性心脏炎患儿二尖瓣最易受累，表现为瓣叶增厚、回声稍强、瓣膜明显返流，部分患儿二尖瓣有小结节。超声心动图可检出风湿性心脏炎所致的瓣膜增厚、瓣膜返流、心包积液和心脏扩大，具有重要的临床诊断价值。     

超声心动图对甲状腺功能亢进性心脏病的诊断价值

目的探讨超声心动图对甲状腺功能亢进性心脏病的诊断价值。方法对65例临床确诊的甲状腺功能亢进性心脏病患者进行超声心动图检查。结果心脏扩大45例,占69.2%,以左心扩大为主;室间隔及左室壁肥厚8例,占12.3%;左室收缩减低6例,占9.2%。二尖瓣脱垂6例,占9.2%;二尖瓣返流49例,占75.4%;三尖瓣返流52例,占80%;肺动脉高压47例,占72.3%。另有9.2%的患者出现左房自发性显影现象。结论超声心动图检查是诊断甲状腺功能亢进性心脏病的有效方法。     

甲亢性心脏病的超声心动图表现及分析

目的对临床诊断为甲亢性心脏病（甲亢心）患者的超声心动图进行分析，探讨甲亢心结构特征和功能改变。方法观察心脏各房室腔的大小、室壁厚度和运动，测量左室的舒张及收缩功能、二尖瓣有无脱垂、各瓣膜返流情况．肺动脉压力变化,有无心包积液,结果甲亢心患者超声心动图表现为心腔的扩大，心功能改变．瓣膜关闭不全、二尖瓣脱垂、肺动脉压力增高、瓣膜返流。结论甲亢心结构和功能具有特征性变化，超声心动图可作为评价该病的最佳手段。     

超声心动图诊断鲁登巴赫综合征1例

患者女,51岁.主诉劳累后胸闷、气短4年.查体:二尖瓣面容,口唇紫绀,心界扩大,房颤心律,P2亢进,心尖区闻及3-4/6级双期粗糙隆隆样杂音,肺动脉瓣听诊区闻及2/6级收缩期吹风样杂音.胸片示:二尖瓣-普大型心影,伴肺淤血及肺动脉高压征象.超声心动图示(图1):右房、右室扩大,左房增大,肺动脉扩张;房间隔中部连续性中断,缺损口大小36 mm,房水平双向分流;二尖瓣尖增厚,开放受限,瓣口面积1.2 cm2,二尖瓣口射流伴中量反流,三尖瓣大量反流.超声提示:(1)鲁登巴赫综合征(Lutembacher's syndrome) 房间隔缺损(继发孔型),二尖瓣狭窄并关闭不全;(2)肺动脉扩张,肺动脉高压(中度).术中探查见:中央型房缺,二尖瓣环扩大,瓣叶增厚、脱垂,腱索、乳头肌发育不良,大量反流.     

超声诊断三尖瓣旁异常瓣膜组织一例

患者男，34岁，以“右侧胸腔积液性质待查”收入院。入院后超声心动图检查：心脏各房室腔内径、室壁厚度及左心室射血分数均正常，二尖瓣、主动脉瓣和肺动脉瓣瓣叶结构及启闭功能正常，三尖瓣可见轻度反流，三尖瓣前向血流速度正常；在大动脉短轴、心尖四腔心及右心室流人道切面观察三尖瓣前瓣外侧均可见一瓣膜样组织（图1，2），由两组瓣叶构成，随心动周期可见启闭运动，该组瓣膜的启闭时相与三尖瓣的启闭时相相反，当三尖瓣开放时，该组瓣膜关闭，     

应用彩色多普勒对胎儿心脏血流动力学的研究

应用彩色多普勒血流显象(CDFI)检查了170例16～42孕周的正常胎儿,发现:1.除肺动脉血流(49％)以外,CDFI显示二尖瓣、三尖瓣、主动脉和卵圆孔血流均有较高的成功率(分别为90％、92％、90％和85％);2.二尖瓣血流主要来源于卵圆孔的右向左分流,而三尖瓣、主动脉、肺动脉和卵圆孔血流分别来源于腔静脉、左右房室瓣和右心房;3.取决于声束-血流夹角,血流可显示为红色和蓝色,即使在同一探查位置,各瓣膜区血流也常显示为不同的色彩;4.各瓣口血流常显示为单一色彩,若观察到五彩镶嵌血流图象时,高度提示为异常血流;5.房室瓣血流发生于舒张期,由于心率较快,血流图象中舒张中期消     

Heart Valve Involvement in Fabry Cardiomyopathy

Fabry disease is a rare X-linked lysosomal storage disorder leading to an accumulation of glycosphingolipids in all tissues and organs including the heart. Among the pathologies of myocardial involvement, reviews and registry data list affection of heart valves and its hemodynamic significance as predominant alterations during progression of the disease. We thought to approach this uncertainty with a systematic observational study. In a single center study, 111 patients with genetically proven Fabry disease were systematically investigated by echocardiography for abnormalities of the valves in the left (aortic and mitral valve) and right heart (pulmonary and tricuspid valve). In addition, 60 patients were followed by echocardiography for 2.7 ± 1.5 y (range 1 to 6). Both valve stenosis and regurgitation were classified as mild, moderate or severe. Overall, no patient had severe heart valve abnormalities. The most frequent findings were mild aortic (n = 17), mitral (n = 57) and tricuspid (n = 38) valve regurgitation. Only two patients showed mild aortic valve stenosis. Moderate aortic (n = 1), mitral (n = 2) or tricuspid (n = 1) regurgitation were rarely detected. All Fabry patients in advanced stages (n = 9) had only mild mitral regurgitation and one of them had mild aortic and mitral regurgitation, moderate tricuspid regurgitation and mild aortic stenosis. Thirty patients had completely normal valve function. There was no significant change toward hemodynamic relevant heart valve abnormalities during follow-up. Mild left ventricular valve regurgitations are frequent in Fabry disease. However, these valve abnormalities are not the major limitations for the Fabry heart. (E-mail: weidemann_f@medizin.uni-wuerzburg.de)     

经食管探头行心外膜超声在心脏外科手术中的应用研究

目的：探讨经食管心外膜超声心动图在心脏外科术中监测的操作方法,探索其在多种心脏外科手术中的具体应用价值。方法采用GE公司经食管多平面超声探头,体外循环开放并复跳后行经食管心外膜超声心动图对53例心脏手术患者行术中监测,提供瓣膜功能情况、左心室收缩功能、有无残余分流等信息。结果53例患者均在体外循环复跳后行经食管心外膜超声检查获得满意的图像,无感染、出血、严重心律失常等并发症。5例患者发现左心室壁节段性运动异常给予及时处理;1例患者发现换瓣后机械瓣周残余分流再次转机后分流消失;1例患者三尖瓣成形术后仍为中量反流再次成形反流量减少;2例患者发现室间隔修补术后即刻评价术后残余分流再次修补分流消失。1例肥厚型心肌病左心室流出道梗阻患者,即刻评估流出道血流速度超过正常范围（3.2 m/s）,再次转机手术后流速下降为1.4 m/s,压差降低为8 mmHg（1 mmHg=0.133 kPa）。结论经食管心外膜超声心动图具有操作简便、准确的优势,能够即刻评价手术疗效,在心脏外科手术中具有显著发展前景和重要临床应用价值。     

超声心动图观察二尖瓣成形术治疗二尖瓣关闭不全的近期疗效

目的超声心动图结合血流动力学导管监测观察二尖瓣成形术对严重二尖瓣关闭不全的治疗效果及左心功能的影响。方法对30例中一重度二尖瓣关闭不全的患者。于术前及术后早期进行超声心动图检查，成形术前麻醉诱导后及术后12h Swan-Ganz导管监测血流动力学指标。结果术后20例患者经超声心动图检查返流信号完全消失。2例探及中量返流信号；所有患者二尖瓣口开放面积无明显狭窄。左室舒张末期容积、每搏输出量、射血分数及舒张期左房、室间压差降低，E／Em无明显变化；肺循环阻力、肺动脉楔压等降低。结论超声心动图对二尖瓣关闭不全的严重程度的评价及对病因的诊断与外科手术结果吻合，对成形术疗效及手术前后心功能的评判与血流动力学监测基本相符。     

Native mitral valve regurgitation. Proactive management can improve outlook.

Mitral regurgitation is a common valvular abnormality that can result in substantial morbidity. Primary care physicians should maintain a high index of suspicion for this disorder, especially in patients with symptoms of heart failure. The paramount concern is early identification of patients with mitral regurgitation and prompt referral to a cardiologist when symptoms occur or if evidence of ventricular enlargement or reduction in ejection fraction is found. Echocardiography is an invaluable tool in determining the severity of regurgitation, the integrity of the mitral valve apparatus, the extent of left ventricular enlargement, and the ejection fraction. Although no standard medical treatment has been established for mitral regurgitation, use of ACE inhibitors is appropriate. Patients presenting with severe, acute mitral regurgitation from papillary muscle rupture should be evaluated for ischemia and treated expediently. The preferred operative procedure in patients with severe mitral regurgitation and left ventricular dysfunction is mitral valve repair, if possible, or mitral valve replacement with posterior chordal preservation, if feasible.     

超声心动图检测121例二尖瓣位机械瓣替换术后结果分析

目的与方法：用超声心动图对１２１例二尖瓣位行六种人工机械瓣替换术的患者进行较长时间的随访观察,将手术前后左房、左室容积和左室收缩功能对比分析。结果：术后１１０例的左房容积（ＬＡＶ）较术前缩小;９９例左室容积（ＬＶＶ）恢复到正常;大多数患者二尖瓣下舒张期最大血流速度较术前降低,由术前的１５０～２２０ｃｍ／ｓｅｃ下降到１４０～１８０ｃｍ／ｓｅｃ;１０８例左室射血分数较术前改善;术前有５６例二尖瓣关闭不全,术后探测到５例瓣口有正常返流。结论：二尖瓣人工瓣替换术后远期效果良好。超声心动图在评价人工瓣置换术后的心脏形态和功能方面有着较大的价值。     

The value of Doppler echocardiography in the management of patients with valvular heart disease: analysis of one year of clinical practice

Management recommendations based on Doppler echocardiographic examination and cardiac catheterization were compared in a prospective study in 100 consecutive patients who were admitted for evaluation and treatment of suspected valvular heart disease during 1988. Management recommendations were provided independently after both Doppler echocardiography and cardiac catheterization by different and blinded investigators. Criteria for severe (clinically significant) and moderate to mild (insignificant) valvular lesions and management recommendations were agreed on in advance. There was disagreement on the severity of aortic stenosis based on the aortic valve area and maximum instantaneous pressure gradient in 1 of 54 patients, which resulted in differing management recommendations. Mitral stenosis was severe (valve area less than or equal to 1 cm2) at Doppler echocardiography but not at cardiac catheterization in 5 of 14 patients. Because pulmonary artery pressure increase during exercise at cardiac catheterization also suggested severe obstruction, management recommendations were similar. There was a potentially significant disagreement on the severity of aortic regurgitation in 9 of 76 patients and of mitral regurgitation in 14 of 90 patients; however, this did not produce differing management recommendations because with most patients coexistent valvular lesions or an impaired ventricular function mainly determined the ultimate management decision. Although of good quality, Doppler echocardiographic examination was nonconclusive for clinical decision-making in 15% of the study population because of uncertainty about the severity of mitral regurgitation or aortic regurgitation or because of problems in assessing the degree of left ventricular dysfunction in patients with severe regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)     

彩色多普勒超声在老年退行性心脏瓣膜病诊断中的应用价值

目的:探讨彩色多普勒超声在老年退行性心脏瓣膜病诊断中的应用价值。方法:本研究选取2017年11月-2019年11月我院收治的876例心脏病患者,均接受心脏彩色多普勒超声检查,对其临床资料进行回顾性分析。结果:本组876例心脏病患者共检出老年退行性心脏瓣膜病281例,总检出率为32.08%;男性检出率显著高于女性(P<0.05)。80岁以上年龄段疾病检出率最高,显著高于70~79岁及60~69岁人群(P<0.05)。281例患者中单纯主动脉瓣受累占比61.57%,单纯二尖瓣受累占比18.86%,主动脉瓣、二尖瓣同时受累19.57%。主动脉瓣狭窄49例,二尖瓣狭窄7例;瓣膜功能障碍87例,主动脉瓣反流占70.11%,二尖瓣反流18.39%。结论:心脏超声检查在老年退行性心脏瓣膜病诊断中具有重要应用价值,可作为疾病诊断检查的重要手段。     

双心室起搏与右心室起搏对充血性心力衰竭急性心功能的影响

目的最近研究提示心脏再同步治疗有效地改善了慢性心肌病心力衰竭患者心功能。本研究旨在探讨双心室和右心室起搏对心功能的相对影响。方法 15例慢性心力衰竭患者心功能Ⅲ级,左心室射血分数〈35%,QRS〉130ms和二尖瓣反流。安装心房-双心室再同步起搏器。彩色多普勒超声心动图观察心功能变化。结果急性双心室和右心室起搏并未影响左心室内径和短轴缩短率,也不影响左心室射血速度和排血量。左心室压力上升和下降峰速率无明显变化。等容收缩时间缩短（P〈0.05）,但不影响等容舒张时间。增加Z比例（P〈0.05）。缩短二尖瓣反流时间（P〈0.05）,对二尖瓣环和三尖瓣环运动幅度和峰速率无明显影响。双心室和右心室起搏之间无明显差别。结论双心室起搏改善了慢性心肌病心功能。双心室和右心室起搏无明显差别。双心室起搏是一种有前途的心脏再同步治疗方法。     

Value of pulmonary venous flow characteristics in the assessment of severity of native mitral valve regurgitation: an angiographic correlated study.

To evaluate the relation between left ventricular angiography and pulmonary venous flow velocity in native mitral valve regurgitation, 28 patients with sinus rhythm and valvular and/or coronary artery disease underwent transesophageal echocardiography within 24 hours after cardiac catheterization. Group I consisted of 17 patients, seven patients without (grade 0) and 10 patients with angiographically mild to moderate mitral regurgitation (grades 1 and 2). Group II consisted of 11 patients with angiographically severe mitral regurgitation (grades 3 and 4). Mitral regurgitation by transesophageal echocardiography was evaluated by measuring the regurgitant jet sizes and color-guided pulsed Doppler pulmonary venous flow velocities. Multivariate analysis revealed that the most powerful predictor (p less than 0.001) of angiographically severe (grades 3 and 4) mitral regurgitation was reversed systolic flow into the left upper pulmonary vein (sensitivity 82%, specificity 100%, positive predictive value 100%). If this variable was excluded from analysis, jet area and jet length (p less than 0.001) were the next best predictors for angiographically severe mitral regurgitation. Mean values of systolic peak pulmonary venous flow velocities were significantly lower in patients from group II, 13.0 +/- 11.1 cm/s versus 43.4 +/- 20.6 cm/s (group I) with p less than 0.005. This finding was also true for systolic time velocity integral, 1.3 +/- 1.3 cm (group II) versus 7.8 +/- 5.3 cm (group I) with p less than 0.005.(ABSTRACT TRUNCATED AT 250 WORDS)     

Left atrial booster function in valvular heart disease

This study was designed to assess atrial booster pump action in valvular heart disease and to dissect booster pump from reservoir-conduit functions. In five patients with aortic stenosis and six with mitral stenosis, sequential atrioventricular (A-V) pacing was instituted during the course of diagnostic cardiac catheterization. Continuous recording of valvular gradient allowed estimation of flow for each cardiac cycle by transposition of the Gorlin formula. Left ventricular ejection time and left ventricular stroke work in aortic stenosis or left ventricular mean systolic pressure in mitral stenosis were also determined. Control observations were recorded during sequential A-V pacing with well-timed atrial systole. Cardiac cycles were then produced with no atrial contraction but undisturbed atrial reservoir function by intermittently interrupting the atrial pacing stimulus during sequential A-V pacing. This intervention significantly reduced valvular gradient, flow, left ventricular ejection time, and left ventricular mean systolic pressure or stroke work. Cardiac cycles were then produced with atrial booster action eliminated by instituting synchronous A-V pacing. The resultant simultaneous contraction of the atrium and ventricle not only eliminated effective atrial systole but also placed atrial systole during the normal period of atrial reservoir function. This also significantly reduced all the hemodynamic measurements. However, comparison of the magnitude of change from these two different pacing interventions showed no greater impairment of hemodynamic state when both booster pump action and reservoir function were impaired than when booster pump action alone was impaired. The study confirms the potential benefit of well placed atrial booster pump action in valvular heart disease in man.