肺动脉闭锁伴室间隔缺损的产前超声诊断价值分析

目的评价超声心动图对肺动脉闭锁伴室间隔缺损(PA/VSD)的产前诊断价值,分析超声心动图误诊的原因,旨在提高超声心动图对PA/VSD的产前检出率。方法回顾性分析48例胎儿经MRI或产后超声诊断为PA/VSD的产前超声诊断资料。结果48例PA/VSD胎儿超声心动图诊断正确40例,占83.3%;产前超声漏误诊8例,占16.7%;其中2例误诊为永存动脉干,2例误诊为法洛四联症,2例误诊为单心房、单心室、肺动脉狭窄,1例误诊为右室双出口,1例漏诊粗大侧枝血管及右冠状动脉右室瘘。PA/VSD最常见的超声征象为肺动脉内径细小(43例)或不能显示(5例)、动脉导管内逆向血流(42例)、主动脉骑跨(22例),最常见的合并畸形有完全性房室间隔缺损17例(35.4%)、单心房14例(29.2%)、右位主动脉弓13例(27.1%)、单心室9例(18.8%)、右室双出口9例(18.8%)、左侧上腔静脉残存8例(16.7%)、双侧右房结构7例(14.6%)等。结论联合应用四腔心切面、心室流出道切面及三血管切面,可较为准确地诊断胎儿PA/VSD,但需要与法洛四联症及永存动脉干等畸形鉴别。     

经胸超声心动图在经心导管封堵小儿室间隔缺损中的应用

目的:探讨经胸超声心动图在经心导管封堵小儿室间隔缺损(VSD)手术中的应用价值.材料和方法:超声心动图在胸骨旁多个切面测量10例VSD的最大直径,确定VSD部位及其周围关系,VSD封堵术中引导封堵器的放置及疗效评价.结果:10例VSD中主动脉瓣下VSD 3例,其中1例合并主动脉窦瘤形成;膜部VSD 5例中3例合并室间隔膜部瘤形成,其中2例为单孔型,1例为筛孔型;肌部VSD 2例.8例采用Amplatzer VSD封堵器、1例较小VSD用Coil弹簧圈封堵成功,另1例VSDФ>1.2cm Amplatzer封堵失败.结论:TTE可确定VSD封堵适应证,术中正确引导封堵器的放置,在小儿VSD经心导管封堵术中具有重要作用.     

先天性双腔右心室的多普勒超声诊断及分析

本文报告14例先天性双腔右心室患者，均经手术证实，其中12例同时合并室间隔缺损（VSD），1例合并肺动脉瓣狭窄（PS），1例合并永存左上腔静脉。14例患者术前常规行多普勒超声心动图检查，其中1例误诊为法鲁氏四联征，2例误诊为单纯性VSD。本文讨论分析了先天性双腔右心室的多普勒超声心动图特征以及误诊原因和鉴别诊断．     

高原性心脏病的彩色多普勒超声心动图诊断的特点和价值探讨

目的:探讨高原性心脏病的彩色多普勒超声心动图诊断的特点和价值。方法:对56例高原性心脏病患者和51例健康人用彩色多普勒超声心动图检查心脏结构及血液动力学变化。结果:56例患者均有右室流出道增宽,右室右房增大、右室前壁及室间隔增厚,主肺动脉及右肺动脉增宽、肺动脉高压、三尖瓣、肺动脉瓣相对性关闭不全等征像。高原性心脏病患者右心输出量增加,射血分数明显低于健康人。结论:彩色多普勒超声心动图是诊断高原性心脏病的首选方法,对诊断高原性心脏病具有重要意义。     

室间隔缺损膜部瘤的造影分型及介入治疗方法学研究

目的　结合介入治疗实践对室间隔缺损 (VSD)伴膜部瘤形成进行造影分型 ,并对不同类型膜部瘤的介入封堵方法进行探讨。方法　 2 0 0 2年 11月至 2 0 0 3年 11月 ,采用新型Amplatzer膜部室间隔缺损封堵器对 32例合并膜部瘤的膜周部VSD行封堵治疗 ,平均年龄 19岁 (3～ 4 8岁 )。封堵术前常规行左室造影 ,在经胸超声心动图 (TTE)及透视监测下通过建立股动静脉轨道、经右心系统释放封堵器 ,并于术后 1、3、6、12个月随访复查胸片、超声心动图、心电图。结果　根据左室造影的不同形态 ,将VSD膜部瘤分为漏斗型、囊袋型、菜花型、弯管型 4种类型。 32例VSD合并膜部瘤患者中 ,30例成功行VSD封堵术 ,技术成功率 94 %。其中 3例采用封堵瘤体法 ,9例采用封堵右室面破口法 ,18例采用封堵左室面破口法。术后即刻发生少量残余分流 4例 ,其中 2例 3个月随访时消失。 1例术后 2周出现完全性左束支传导阻滞 ,但无心肌受损表现 ,余无其他严重并发症发生。左室舒张末径(LVEDD)由术前的 (47 4± 7 1)mm缩小为术后的 (45 1± 7 1)mm ,缩小明显 (t =3 83,P =0 0 0 2 )。结论　应用新型Amplatzer膜部VSD封堵器治疗VSD膜部瘤是安全有效的 ,VSD膜部瘤的介入治疗需要根据膜部瘤的位置、形态、破口大小、数目等情况采用不同的封堵     

顺序节段分析法在先天性右位心合并心内畸形中的诊断价值

目的提高超声心动图对心脏位置异常合并复杂心内畸形的诊断准确率。方法选择近年来在我院经手术或心血管造影证实的先天性右位心合并心内畸形患者42例,对其超声心动图检查结果进行回顾分析。结果手术证实本组先天性右位心分型：镜像右位心13例,右旋心29例;心内畸形：单心室10例,右室双出口8例,法洛四联症6例,完全性大动脉转位5例,矫正性大动脉转位4例,完全性房室间隔缺损4例,永存动脉干3例,肺动脉闭锁2例。超声误诊、漏诊的病例：3例完全性大动脉转位伴巨大室间隔缺损误诊为单心室;2例右室双出口误诊为法洛四联症;1例矫正性大动脉转位误诊为完全性大动脉转位;1例肺动脉闭锁误诊为永存动脉干;1例肺动脉闭锁超声漏诊左肺动脉缺如及多支体肺侧枝。结论超声心动图顺序节段法对绝大多数先天性右位心并心内畸形能作出准确诊断,但对某些极为复杂的病例心导管检查仍是明确诊断和手术条件的重要手段。     

先天性冠状动脉瘘的产前超声心动图诊断

目的 评价胎儿超声心动图对先天性冠状动脉瘘的诊断价值。方法 回顾性分析3例经胎儿MRI或产后超声心动图诊断为冠状动脉瘘的产前超声资料。结果 3例冠状动脉瘘胎儿的产前超声心动图诊断均正确。其中单纯性冠状动脉右室瘘2例,经胎儿MRI证实,超声表现为右心增大、右心室内舒张期异常血流;1例冠状动脉右室瘘,合并复杂先天性心脏病,产前超声表现为右心室内舒张期异常血流,产后由经胸超声心动图证实。结论 产前超声心动图可以比较准确地诊断先天性冠状动脉瘘。     

冠状动脉瘘的产前超声心动图诊断价值

目的探讨产前诊断冠状动脉瘘(coronary artery fistula,CAF)的超声心动图特征及相关合并畸形情况,产前超声检查诊断CAF的价值。方法选取16例经尸体解剖结果及产后超声心动图诊断为CAF的产前超声心动图资料。结果16例胎儿产前彩色多普勒超声均发现心腔内异常血流束,4例出现瘘入心腔增大,10例冠状动脉增宽。产前超声心动图诊断正确13例,占81.3%;漏误诊3例,占18.7%;其中2例漏诊,1例误诊为肌部室间隔缺损。结论产前超声心动图可以通过心腔内异常血流束诊断CAF,需要注意是否存在其他合并心内畸形,对预后进行评估,为出生后诊断及治疗提供帮助。     

超声心动图诊断右室双出口的价值和鉴别诊断

目的探讨二维超声心动图和彩色多普勒血流显像诊断右室双出口的价值。材料和方法超声检查右室双出口45例,男28例,女17例。所有病例均与手术或心血管造影对照。结果45例右室双出口超声心动图诊断符合率95．6％(43／45),2例误诊为法乐氏四联症。超声分型的符合率97．7％(42／43)。合并畸形以肺动脉狭窄最多见,占71．1％(32／45)。室间隔缺损口径平均值(21．8mm)略大于主动脉环部平均内径(2lmm)。结论二维超声和彩色多普勒血流显像相结合的检查方法对右室双出口诊断、分型和合并畸形检出具有重要价值。     

双腔右心室75例临床诊断及分析

回顾性总结75例经临床检查并经手术证实有双腔右心室患者的临床资料,通过临床体征、X线胸片、心电图、超声心动图、右心导管检查和右室造影表现特点,总结诊断和鉴别诊断经验。结果显示,术前诊断有双腔右心室57例（76％）,其中单纯双腔右心室9例,合并其它心内畸形48例（64％）,同手术结果比较,术前有18例（24％）未诊断出双腔右心室,导管尖端进肺动脉记录肺动脉至右室流入道压力曲线和仔细分析右室造影征象是提高术前诊断率的关键。     

双腔右心室的临床及影像学分析

本文报告了经手术证实的双腔右心室２５例。其特征为：１、症状多出现在２岁以后；２、胸部平片示肺血偏少，右室增大；４０％的病例右室流出道有局限性凹陷带；３、右心造影显示右室流出道呈环形狭窄，将右室分成两个腔。多数可显示室间隔缺损；４、超声心动图可探及右室流出道狭窄环及异常肌束和室间隔缺损。     

Pre-operative evaluation with MR in tetralogy of fallot and pulmonary atresia with ventricular septal defect

Purpose: To assess whether MR imaging could replace angiography in pre-operative evaluation of patients with tetralogy of Fallot and pulmonary atresia with ventricular septal defect (VSD), especially since the surgical correction was done earlier than was previously the rule.Material and Methods: Fourteen patients with tetralogy of Fallot (n=10) or pulmonary atresia with VSD (n=4), mean age 7.5±4.4 months, were evaluated with angiocardiography and MR before definitive surgical correction.Results: There was good diagnostic agreement between the two modalities when evaluating right ventricular outflow obstruction; 86% for valvular and 93% for supravalvular stenosis, but the agreement was somewhat lower for the subvalvular obstruction (57%). Surgery findings, however, were in favour of MR in 5 patients concerning the subvalvular right ventricular outflow tract obstruction. MR images identified all stenoses in the right and left pulmonary arteries, but overlooked one stenosis in the main pulmonary artery. MR could evaluate patency in all palliative shunts.Conclusion: Even in this young age group, MR imaging offers a good alternative to angiocardiography for the pre-operative evaluation of the right ventricular outflow tract, the main pulmonary artery and the proximal right and left pulmonary arteries, before definitive surgical correction of tetralogy of Fallot and pulmonary atresia with VSD.     

Assessment of right ventricular afterload in mitral valve diseases with radionuclide angiography

Right ventricular function at rest and during exercise was studied in 33 patients with mitral valve disease by equilibrium gated radionuclide angiography using 99mTc in vivo labeled red blood cells. Radionuclide measurements of right ventricular ejection fraction (RVEF) were correlated with mean pulmonary arterial pressure (mPAP). RVEF decreased significantly with exercise. There was no significant correlation between RVEF at rest and mPAP. However, mPAP showed significant negative correlation with RVEF during exercise and with the changes of RVEF from rest to exercise. It is concluded that RVEF during exercise in mitral valve disease is affected by right ventricular afterload, and the measurements of RVEF at rest and during exercise by equilibrium gated radionuclide angiography is useful to assess right ventricular afterload.     

20例心脏大血管创伤后晚期后遗症的诊断与治疗

目的：报告心脏大血管创伤后晚期后遗症的诊断和治疗。方法：收集我科１９５４年６月～１９９５年４月治疗２０例心脏大血管损伤后遗症，其中穿入性损伤９例，闭合性损伤６例和医源性损伤５例。病变有瓣膜损伤８例，心脏异物５例，假性动脉瘤和动静脉瘘４例，右心室动脉瘤加心室间隔缺损（ＶＳＤ）、晚期心脏压塞和右下肺弹头、术后缩窄性心包炎各１例。施行手术早期取出心脏异物和心包腔引流４例。择期手术１５例，其中施行瓣膜替换术６例，瓣膜成形术２例，假性动脉瘤和动静脉瘘缝补术３例，心室间隔缺损加右心室室壁瘤缝补术、心腔内异物、血心包和缩窄性心包炎各１例。结果：１９例经手术治疗痊愈出院，１例因动脉导管结扎后假性动脉瘤，控制感染时突然瘤体破裂出血死亡。结论：早期诊断、早期或择期手术可取得良好效果。     

小儿双腔右心室的影像检查

目的：探讨X线胸片、超声、心导管、心血管造影对双腔右心室诊断价值。材料与方法：选择13例经手术证实为双胜右心室的病例，并均有X线胸片、超声、心导管及心血管造影资料，对这四种影像检查进行分析对照。结果：X线胸片无特征性改变，超声正确率仍较低，心导管、心血管造影正确率高于超声。结论：双腔右心室术前确诊应选择心导管及心血管造影检查。     

室间隔缺损伴主动脉瓣脱垂超声心动图诊断分析

目的:探讨室间隔缺损伴主动脉瓣脱垂超声心动图表现。方法:12例室间隔缺损伴主动脉瓣脱垂患儿分别用二维和彩色多普勒超声观察室间隔缺损部位、大小和主动脉瓣脱垂情况,分析两者关系。结果:12例室间隔缺损伴主动脉瓣脱垂均为右冠瓣脱垂,干下型室间隔缺损占了5%(9/12),超声诊断准确率92.3%。结论:超声心动图对室间隔缺损伴主动脉瓣脱垂的诊断具有重要价值。     

VSD following blunt cardiac trauma: MRI findings

In this report, we describe the clinical and radiographic findings of ventricular septal defects (VSDs) following blunt cardiac trauma in two patients. VSDs following either penetrating or blunt cardiac trauma are a rare occurrence. The variable presentation and timing of symptom onset along with the common association of other injuries can make the diagnosis of a posttraumatic VSD difficult. Therefore, investigation should be initiated when elements from the history and physical examination (e.g., new onset murmur), laboratory tests (e.g., cardiac enzymes), EKG, and CT or echocardiography warrant it. The first patient was a 19-year-old male who was hemodynamically stable on initial presentation to this trauma center after a motor vehicle collision. A posttraumatic VSD was found by echocardiography on the day of admission and further defined on cardiac MRI (CMRI). The second patient was a 31-year-oid male who presented after a high-speed motorcycle accident and was found to have a VSD 40 days later on CMRI after a fluctuating clinical course and multiple normal echocardiograms. Both patients had good outcomes with subsequent surgical closure.     

Demonstration of doubly committed juxta-arterial ventricular septal defect with aortic valve prolapse by cardiac computed tomography

A 24-year-old man presented to our hospital with symptoms of dyspnea and palpitation for 2 weeks. Cardiac CT showed not only a leaflet coaptation defect in the aortic valve but also a small ventricular septal defect (VSD) immediately beneath the prolapsed right coronary cusp. A shunt flow in the direction of the right ventricular outflow tract though the defect indicated the doubly committed juxta-arterial type of VSD. A doubly committed juxta-arterial VSD of 3 mm was confirmed and repaired via pulmonary arteriotomy.     

左心瓣膜病患者右心室收缩功能参数对三尖瓣成形术的影响

目的应用二维斑点追踪成像测量左心瓣膜病患者右心室纵向应变,探讨右心室纵向应变对左心瓣膜手术同期行三尖瓣成形术的影响。方法病例组选取经心脏外科手术确诊的左心瓣膜病患者80例,根据左心瓣膜手术同期是否行三尖瓣成形术(TVP),分为TVP组和NTVP组;对照组选取性别、年龄相匹配的健康志愿者40例。病例组、对照组均行经胸超声心动图检查,将各项临床指标和超声参数进行比较,分析轻度(或无)肺动脉高压时,可能影响左心瓣膜病患者同期行TVP的相关因素。结果多因素Logistic回归分析结果显示,仅右心室整体纵向应变(RVGLS)(P=0.007,OR=9.490)、右心室游离壁纵向应变(RVFWLS)(P=0.017,OR=0.110)是左心瓣膜手术同期行TVP的相关影响因素。结论左心瓣膜病患者在轻度(或无)肺动脉高压时,RVGLS、RVFWLS可作为同期行三尖瓣成形术的相关影响因素,为手术方案的选择提供新的参考依据。