冠状动脉介入治疗前后缺血性二尖瓣反流的超声定量比较

目的：应用超声技术评价缺血性二尖瓣反流（Ischemic Mitral Regurgitation, IMR）患者冠脉介入治疗术前、术后左室收缩功能及二尖瓣反流容积变化,探索IMR发生机制,预测IMR发展,从而为临床治疗提供帮助。方法：运用超声技术分析41例患者冠脉介入治疗术前及术后左室应变,并评估二尖瓣反流容积。根据二尖瓣反流变化情况将患者分为非恶化组（Ⅰ组）和恶化组（Ⅱ组）。结果：I组：患者术后纵向和径向应变均较术前改善,其中,术后径向应变及左室射血分数与术前相比显著提高（P＜0.05）;Ⅱ组：患者术后左室射血分数较术前提高无统计学意义（P＞0.05）,左室舒张末期内径有增大趋势。结论：超声技术可以较敏感的评价左室心肌功能。冠状动脉介入治疗通过改善左室收缩功能可以减少IMR。     

Echocardiography in evaluation of mitral valve prostheses

Thirty-three patients with mitral valve prostheses were studied with echocardiography in an effort to determine if this technique could be useful in detecting significant abnormalities. Recordings were obtained in the supine position with the transducer directed to record maximum excursion of the prosthesis. Echoes from the struts, poppet and sewing ring were readily recorded. Amplitude of excursion and opening and closing velocities of the poppet were measured. Fifty echocardiographic recordings were obtained from the 33 patients. Of the 33 patients studied, 22 were thought to have “normal” echo tracings while in 11, the tracings were considered “abnormal.” Apparent abnormalities consisted of: 1) abnormal diastolic separation between the poppet and strut, 2) increased echoes near the poppet, strut or sewing ring and 3) a combination of both. There was only one instance of suspected “sticking” of the prosthesis. All patients who had “abnormal” studies except one developed complications associated with their prosthesis (90%) compared to only 36% in patients with “normal” tracings. Five patients in each group died. Autopsy studies are described and correlations with the echocardiographic findings are made. In low profile valves reduction in excursion of the disc may be an indication of malfunction. Echocardiography appears to be of value in the assessment of function of mitral valve prostheses.     

Pulmonary vascular resistance and proper timing of percutaneous balloon mitral valvotomy

It is frequent to see pulmonary hypertension (PH) in patients with mitral stenosis (MS) secondary to increased pulmonary vascular resistance (PVR), data about the effect of PVR on the results of percutaneous balloon mitral valvotomy (PBMV) are insufficient. To detect the role of PVR in predicting residual PH immediately after PBMV. This prospective study comprised 49 consecutive patients with moderate to severe MS who were investigated pre and within 48 h post a successful PBMV for the first time. Echocardiography was used to assess the mitral valve area (MVA), mean transmitral pressure gradient (MPG), mitral valve resistance (MVR), right ventricular systolic pressure (RVSP) and PVR. Patients were classified into two groups according to the pre PVR (≥?1.6 WU as group I and < 1.6 as group II). At baseline compared to group II (32 patients), Group I (17 patients) had higher MPG (13.6?±?5.2 vs. 11.7?±?3.7 mmHg, P?<?0.05), RVSP (45.6 vs. 37.9 mmHg, P?<?0.001) and PVR (2.2?±?0.1 vs. 1.2?±?0.1WU, P?<?0.001) with no significant difference regarding age, gender, MVS, MVA and MVR. Patients of group I had comparatively lower improvement immediate post procedural of RVSP and PVR with no significant difference in immediate post procedural improvement in NYHA classification, MVA, MPG and MVR. Basal PVR?>?1.8WU was proved to be a highly specific (91%), a good predictor (AUC 0.78) of persistent elevation of RVSP?>?50 mmHg post PMV. Pathological rise of PVR that associates MS had provided a strong and an independent predictor of persistent pulmonary hypertension post PBMV and by this aspect it could be used as a valuable tool as MVA and MPG to send patients earlier for PBMV even with less severe MS. PVR?>?1.81 WU could be used as a noninvasive parameter for predicting regression of PH immediately after PBMV.     

Utility of stress Doppler echocardiography in patients undergoing percutaneous mitral balloon valvotomy.

A subset of patients with mitral stenosis have symptoms out of proportion to the resting hemodynamics. Exercise Doppler echocardiography is a useful diagnostic modality to determine which patients are limited by their valve obstruction and would therefore benefit from percutaneous mitral balloon valvotomy. We analyzed 11 patients who showed a peak exercise mean mitral gradient that doubled from baseline or a final gradient of > 15 mm Hg. The mean mitral gradient increased from 7 +/- 2 mm Hg at rest to 19 +/- 6 mm Hg (P < .001) with exercise. All patients reported improvement in symptoms of at least 1 functional class after valvotomy.     

超声心动图诊断双心房占位

目的探讨双心房占位病变的临床表现及超声心动图特征。方法回顾性分析双心房占位患者8例,分析其临床资料及超声心动图表现,并与术后病理相对照。结果双心房占位的8例患者中,双心房血栓5例,肿瘤3例,其中良性1例,恶性2例。6例表现为活动后胸闷憋气,2例为下肢水肿,1例为右胸痛。双心房血栓占位主要表现为基底部较宽,无蒂,较易附着于心房顶部、心房侧壁心耳开口处及心耳内血流缓慢处。良性肿瘤主要为黏液瘤,表现为多发,瘤体松散,活动度大,有较窄的蒂与心房壁或房间隔相连。恶性肿瘤占位主要表现为向心房壁或间隔壁浸润性生长,位置固定,宽基底并伴中-大量心包积液。结论应用超声心动图可探查双心房占位的原发病变,可为临床治疗方案提供依据。     

Echocardiography in the diagnosis of thoracic aortic pathology

Transthoracic two-dimensional and Doppler echocardiography has been well established as a useful technique for evaluating many pathologic processes affecting the thoracic aorta. However, the distance of the aortic arch and descending thoracic aorta from the chest wall and the interposition of highly attenuating lung and highly reflective mediastinal structures between the transducer and the aorta present unavoidable limitations. Transesophageal echocardiography is a relatively new technology that overcomes many of the inherent limitations with transthoracic imaging. Complete echocardiographic evaluation of the entire thoracic aorta can now be achieved in nearly all patients. This article will review the continually expanding role of echocardiography in the evaluation of thoracic aortic pathology, including the dramatic impact of transesophageal imaging on the diagnosis of life-threatening disorders such as aortic dissection.     

超声心动图诊断胎儿心肌病

目的 探讨胎儿超声心动图诊断胎儿心肌病(FCM)及其并发症的价值.方法 对11 360胎胎儿进行超声心动图检查;对其中诊断为胎儿心肌病或可疑心肌原发病变者进行分析,并与大体病理结果及出生后超声心动图表现进行对照分析.结果 11 360胎中检出FCM 19胎,检出率为0.167%(19/11 360).其中扩张型心肌病10胎(累及双心室4胎、右心室4胎、左心室1胎、右心房1胎)、肥厚型心肌病2胎(累及双心室1胎,室间隔1胎)、心内膜弹力纤维增生症4胎(原发型1胎、继发型3胎)、心肌致密化不全3胎(累及双心室2胎、右心室1胎),FCM累及心室中以双心室为著.结论 胎儿超声心动图可对FCM做出诊断及分型,且可评估胎儿心脏功能及血流动力学的变化,并判断FCM的预后.     

原发性心脏肿瘤的彩超检查

目的：探讨彩色多普勒在诊断原发性心脏肿瘤中的价值。方法：对21例病人进行二维彩色多普勒检查,结果：超声诊断原发性心脏肿瘤的灵敏度为100％,漏诊率为0％,原发性心脏良性肿瘤中以粘液瘤最多见,瘤体内均未记录到血流信号,恶性肿瘤以肉瘤多见,易侵及邻近组织及心包,瘤体内均记录到血流信号,结论：彩色多普勒可做为诊断原发性心脏肿瘤的首选,并可鉴别良恶性和判断预后。     

超声心动图诊断甲状腺功能亢进性心脏病

目的 探讨甲状腺功能亢进症(甲亢)的超声心动图表现。方法 回顾分析282例甲亢患者(包括单纯甲亢及甲亢性心脏病患者)的超声心动图资料,与100名正常对照者(对照组)相比较,并做统计学分析。结果 单纯甲亢患者的左心室射血分数(LVEF)高于对照组(P<0.01),二尖瓣、主动脉瓣及肺动脉瓣的前向血流速度高于对照组(P<0.01),左心房、左心室及右心室大小与对照组差异无统计学意义(P>0.05);并发甲亢性心脏病时,LVEF、二尖瓣、主动脉瓣及肺动脉瓣的前向血流速度与对照组比较早期无明显差异,晚期低于对照组,早期A/E值增加(P<0.01),左心房、左心室及右心室腔大小与对照组比较差异有统计学意义(P<0.01)。结论 超声心动图能够及时发现甲亢患者的心内结构及功能改变,可作为指导临床早期诊断和治疗的常规检查手段。     

超声心动图诊断卵圆孔未闭

卵圆孔未闭（PFO）在成人的发生率约20%~25%,其与年轻患者的隐源性卒中、短暂性脑缺血发等多种疾病有关。超声心动图在PFO的诊断、经皮封堵术中监测及术后随访中均有重要价值。本文对PFO的超声心动图诊断做一综述。     

超声心动图诊断手术前后心下型完全性及部分性肺静脉异位引流

目的 利用多普勒超声心动图术前诊断心下型完全性及部分性肺静脉异位引流,判断术后肺动脉压力及是否存在吻合口狭窄。方法 回顾分析25例心下型完全性肺静脉异位引流及30例心下型部分性肺静脉异位引流患儿超声心动图诊断资料。结果 超声心动图对心下型肺静脉异位引流诊断率可达100%。手术后近期未发生吻合口狭窄者,肺动脉压峰值及右心室/左心室舒张末内径比值与术前差异有统计学意义(P＜0.05);发生吻合口狭窄者,肺动脉压峰值及右心室/左心室舒张末内径比值与术前差异无统计学意义。结论 超声心动图可准确诊断心下型肺静脉异位引流,有利于确定手术方案。