经胸超声心动图诊断家族遗传性马凡综合征

目的 评价经胸超声心动图在马凡综合征心血管病变诊断中的临床价值.方法 回顾性分析12例马凡综合征患者心血管病变的超声心动图特征,并与CT和MRI检查结果进行对照.结果 12例患者超声表现为升主动脉瘤、主动脉窦瘤;左房受压,左室扩大;二尖瓣脱垂;不同程度的主动脉瓣和(或)二尖瓣反流;可合并主动脉夹层.12例患者的超声检查结果均与CT和MRI检查结果一致,其中2例经专科医院手术及病理检查证实,诊断符合率为100％.结论 超声心动图具有简便无创、重复性好、准确率高等优点,是筛查、诊断及随访马凡综合征心血管病变的首选方法,对指导临床治疗及预后评估具有重要意义.     

二尖瓣脱垂返流的超声心动图量化评价

目的采用超声心动图连续方程法量化评价二尖瓣脱垂所致返流的严重程度。方法二尖瓣脱垂返流患者26例,采用Simpson方程获得左室心功能参数及二尖瓣返流的返流量(RV)和返流分数(RF)。结果连续方程法测得RV为(51.47±17.46)mL,RF为(43.23±9.13)%,ROA为(1.39±0.63)cm2,并获得了心功能量化参数。结论超声心动图连续方程法能精确量化二尖瓣脱垂所致偏心性返流的严重程度。     

二尖瓣脱垂长期随访临床分析

二尖瓣脱垂(MVP)是指二尖瓣叶在收缩中晚期或全收缩期脱垂入左房引起的临床后果,过去对MVP诊断需依靠左室造影或尸解证实,近年利用M和二维超声心动图检查对确诊MVP有很大帮助,现将50例MVP随访的情况作一临床分析: 1 资料与方法 1.1 超声心动图诊断MVP的标准:M型示收缩中期或全收缩期瓣叶关闭线(CD段)呈弓形异常后移,CD段在全收缩期或收缩中晚期向后凹陷,此与CD二点联线间距离大于2mm,二维示瓣叶上拱越过房室环水平。对于症状和体征典型而超声检查未达上述标准     

多普勒彩色超声心电图检测在急性心肌梗死诊断中的应用研究

目的 研究多普勒彩色超声心电图检测在急性心肌梗死(AMI)诊断中的应用。方法 选择2017年3月—2019年3月在本院就诊的疑似为AMI患者92例,所有患者均行多普勒彩色超声心动图、多普勒彩色超声心电图及冠状动脉造影检查。以冠状动脉造影结果为“金标准”,评估多普勒彩色超声心动图及多普勒彩色超声心电图检测的敏感性、特异性、准确率和符合率。结果 92例疑似为AMI患者,经冠状动脉造影检查确诊AMI患者71例,非AMI患者21例;以冠状动脉造影为“金标准”,多普勒彩色超声心动图诊断AMI敏感性为84.51%,特异性为71.43%,准确度为81.52%,ROC曲线下面积(AUC)为0.803;多普勒彩色超声心电图诊断AMI敏感性为95.77%,特异性为85.71%,准确度为93.48%,AUC为0.907。多普勒彩色超声心电图敏感性、准确度、AUC均高于多普勒彩色超声心动图,差异有统计学意义(P<0.05);多普勒彩色超声心电图病灶符合率(92.96%)明显高于多普勒彩色超声心动图(77.46%),差异有统计学意义(χ2=6.762,P=0.009)。结论 多普勒彩色超声心电图检测在AMI诊断中敏感性、准确度和符合率均较高,具有良好的诊断价值。     

无基础心脏病和感染诱因的感染性心内膜炎14例临床特点分析

目的 探讨无基础心脏病和感染诱因的感染性心内膜炎患者的临床特点.方法 回顾性分析14例无基础心脏病和感染诱因的感染性心内膜炎患者的症状、体征、超声心动图检查、细菌培养等临床特点.结果 发热是最常见的症状(占100.0%),其次为寒战、心功能不全和贫血;有心脏杂音者占100.0%,心率＞100次/min者占85.7%;超声心动图发现赘生物13例,赘生物好发部位依次为二尖瓣(9例),主动脉瓣(6例),二尖瓣和主动脉瓣均受累(2例);瓣膜脱垂8例(二尖瓣5例,主动脉瓣3例),脓肿3例,穿孔1例(均发生在二尖瓣前叶),左室内径增大3例,左室射血分数减低4例;细菌培养阳性8例(占57.1%),最常见的仍是草绿色链球菌,共7例(占50.0%),肺炎链球菌1例(占7.1%).结论 感染性心内膜炎可见于无基础心脏病和感染诱因的人群,其临床特点与有基础心脏病和/或有感染诱因者无明显差别.     

肥厚性心肌病42例临床分析

目的观察原发性肥厚性心肌病(HCM)的临床特点。方法对42例肥厚性心肌病的临床特点、心电图、超声心动图进行回顾分析。结果该病的临床表现无特异性,多数伴有临床症状;心电图的改变多种多样,以ST-T改变多见,超声心动图的改变具有诊断价值。42例HCM患者室间隔舒张末期厚度IVSTd为(18.33±3.8)mm,左室后壁舒张末期厚度LVPWTd为(10.77±2.95)mm,IVSTd/LVPWTd比值为1.74±0.5,左心室舒张末期内径LVIDd为(45.06±5.85)mm。梗阻性和非梗阻性HCM两组病人的左室射血分数LVEF%正常,但组间比较无统计学意义(P>0.05)。左室后壁收缩期增厚率(LVPW△T%)均值较室间隔收缩期增厚率(IVS△T%)均值为大,梗阻性IVS△T%较非梗阻性更小(P<0.05),梗阻性组IVSTd、IVSTd/LVPWTd比值、二尖瓣A波峰值与非梗阻性相比更大(P<0.05)。E/A比值在梗阻性肥厚性心肌病<1,而在非梗阻性肥厚性心肌病则>1,但组间无统计学意义(P>0.05)。结论超声心动图能很好地识别HCM室壁异常增厚的特征,并能评价心室的收缩和舒张功能,结合临床、心电图以及超声心动图可以对HCM作出准确诊断。     

感染性心内膜炎26例临床分析

目的提高对感染性心内膜炎的诊治水平。方法回顾性分析26例感染性心内膜炎的临床表现形式与治疗的关系。结果发热为常见及起始症状,主要症状和体征包括贫血、脾大、肝大、心脏杂音改变、周围动脉栓塞、血管意外。血培养阳性率57.6％,经胸超声心动图发现赘生物73.1％。结论（1）心脏结构异常是感染性心内膜炎的主要基础病因;（2）先天性心脏病,室间隔缺损（VSD）合并主动脉瓣关闭不全,风湿性心脏病有二尖瓣脱垂和联合病变者为发生感染性心内膜炎的高危人群;（3）超声心动图对感染性心内膜炎的诊断有重要价值。     

经食管超声心动图在术中评价二尖瓣置换术的应用价值

目的:分析经管道超声心动图在术中评价二尖瓣置换术中的应用价值。方法:选取我院2013年到2015年间收治的行二尖瓣置换手术的患者40例作为研究对象,所有患者均在术中辅以经食管超声心动图监测,观察患者的手术效果以及瓣周反流发生情况,并分别比较经食管超声心动图、经胸超声心动图判断瓣周反流发生的灵敏度、特异性、准确度。结果:40例实施二尖瓣置换术的患者中,38例一次手术成功,4例患者合并瓣周反流,2例程度轻微,2例中重度瓣周反流患者需要给予行瓣周漏修补术,占5.0%,比较经食管超声心动图、经胸超声心动图诊断瓣周反流的灵敏度、特异性以及总的准确度,可见经食管超声心动图所有结果显著高于经胸超声心动图,有统计学差异(P0.05)结论:采用实时经食管超声心动图检查可以对为医生提供病变住置及其周围结构的更加可靠信息,有利于手术的顺利进行和瓣周反流的及时发现,降低二次开胸率,值得临床推广应用。     

基底动脉尖综合征28例临床分析

目的探讨基底动脉尖(TOB)综合征的临床表现、影像学及经颅多普勒超声(TCD)特征。方法对28例TOB综合征患者的临床资料包括首发症状、临床表现、心脏超声、心电图、TCD、影像学资料、治疗预后进行回顾性分析。结果首发症状常为头晕、意识障碍、瞳孔异常及眼球运动异常、偏盲及皮质盲、记忆力障碍,运动障碍为最常见的症状及体征;头颅影像学表现位于幕上(丘脑、颞枕叶)及幕下(小脑、脑干)改变,双侧丘脑“蝶形”梗死灶为特征性改变;早期CT诊断阳性率为21.4%,而MRI为82.1%,MRI对该病的诊断较CT明显敏感;TCD作为筛选手段,诊断阳性率为91.3%(21/23),并发现皆有不同程度的后循环血管流速改变,结合头颅CT、MRI检查有助于TOB综合征早期诊断,对临床有一定指导意义。结论TOB综合征临床表现复杂,早期往往缺乏特异性改变。有特征性影像学改变,预后不佳。早期诊断和治疗,可改善预后。     

“缘对缘”技术基础上的腱索转移法治疗二尖瓣前叶脱垂

目的 介绍一种操作简单、效果可靠的矫治二尖瓣前叶脱垂的手术方法.方法 2004年1月至2010年10月,应用“缘对缘”技术基础上的腱索转移法治疗二尖瓣前叶脱垂病例共18例,先行脱垂部位前叶与相应部位后叶的“缘对缘”缝合,矩形切下缝合处的后叶,连同相应的腱索、乳头肌,转移至前叶.再行后叶成形,完成瓣膜成形手术.所有患者出院前和半年后随访时再次行超声心动图检查.结果 手术无死亡病例,1例因术后第3天出现二尖瓣前叶穿孔再次行二尖瓣置换手术,血红蛋白尿1例,低心排血量综合征1例,给予对症处理,其余15例患者均顺利康复出院.术后远期随访无死亡,心功能全部恢复至Ⅰ级.复查超声心动图二尖瓣瓣口面积2.8～4.8(3.78±0.52) cm2,均无明显反流,反流面积(0.45±0.22) cm,左房径术前(48.26±11.12) mm,术后(37.57±9.56) mm(P＝ 0.028);左室舒张末径术前(61.43±8.24) mm,术后(42.35±10.79) mm(P＝0.008).结论 “缘对缘”技术基础上的腱索转移法治疗二尖瓣前叶脱垂,操作简单,可以取得良好的成形效果.     

Cardiovascular abnormalities in Marfan syndrome]

During the period February to December 1990, 52 adult patients were referred to our clinic for evaluation of the presence of the Marfan syndrome. In 24 out of 52 patients the Marfan syndrome was diagnosed. Cardiac abnormalities were found in all patients: mitral insufficiency because of mitral valve prolapse (83%), aortic dilatation (67%), aortic insufficiency (38%), tricuspid valve insufficiency with or without tricuspid valve prolapse (17%) and atrial septal defect (4%). In 3 patients an aneurysm of the ascending aorta was found. Early recognition of the Marfan syndrome is relevant for prevention of the life threatening complication of aortic dissection. In patients with valve abnormalities endocarditis prophylaxis is advised. A Marfan outpatient clinic offers optimal diagnostic possibilities.     

Noncardiac chest pain in adolescents and children with mitral valve prolapse

Chest pain in adolescents and children is usually not of cardiac origin. Of cardiac conditions commonly linked to chest pain in childhood, mitral valve prolapse (MVP) is the most prevalent, but this association has recently been questioned. In light of recent reports of gastroesophageal sources of chest pain in adults with MVP, we performed a comprehensive gastroesophageal evaluation of 17 preadolescents and adolescents with mitral valve prolapse who had chest pain as their presenting symptom. Evaluation consisted of esophageal manometry, Bernstein test, esophageal pH probe, and/or esophagogastroscopy. Fourteen of the 17 patients had at least one abnormal finding. Five patients had esophagitis, five had gastritis, one had high-amplitude esophageal contractions, one had abnormal esophageal manometry with positive Bernstein test, one had esophageal reflux and positive Bernstein test, and one had abnormal manometry with esophageal reflux. The 13 patients with esophagitis, gastritis, reflux, or positive Bernstein test were treated with antacid, with resolution of chest pain in 12 patients. Two of these patients underwent follow-up endoscopy with documentation of improvement. The patient with high-amplitude esophageal contractions was treated with dicyclomine, which resulted in resolution of chest pain. The observation that the chest pain was not related to mitral valve prolapse is important in clinical practice and raises further questions as to whether mitral valve prolapse causes chest pain.     

Cerebrovascular accidents and anorexia nervosa—A case report

A case of bilateral cerebrovascular accidents in a patient with anorexia nervosa is presented. This is the first such case to be reported in the literature. The neurological complications of anorexia nervosa are reviewed. This case highlights the potential seriousness of mitral valve prolapse in anorexia nervosa.     

Surgery of the mitral valve--in the work of József Kudász

The author described his results of surgical treatment of mitral valve disease. Of 57 patients, the isolated mitral procedure was performed in 72%, and the combined (valve and coronary) in 28% of the cases. In 75% of the patients valve repair, and in 25% valve replacement were performed. There were 2 cases (3.5%) of early mortality after combined surgery where patients had also ischaemic heart disease. All the replaced valve prostheses and 84% of repaired mitral valve had a normal function. The mitral regurgitation was moderate in 14%, of cases and mild in 2% of cases at the follow up, but no reoperation was needed. After the surgery 85% of patients had sinus rhythm, 13% had atrial arrhythmia and in 2% the pacemaker was needed. Attempt of valve repair had to be made in all patients with mitral valve disease which can be performed in almost every case of degenerative valve prolapse and the rupture of chordae tendineae.     

Surgical treatment of chronic mandibular dislocation--report of a case

Chronic dislocation of the temporomandibular jaw (TMJ) can result from lax joint ligaments and parafunctioning joints; it can also be a consequence of a systemic connective tissue disorder. The authors report a case of hypermobile joint syndrome in combination with mitral valve prolapse. The case was managed by osteosynthesis using modified titanium plate.     

Mitral valve prolapse in eating and panic disorder: A pilot study

The prevalence of echocardiographic mitral valve prolapse (MVP) and arrhythmias was studied in controls (n = 23) and patients with panic disorder (n = 14), bulimia nervosa (n = 14), and anorexia nervosa (n = 21). There was approximately twice the rate of MVP in patient groups compared to controls, a statistically insignificant difference. Importantly, the presence of prolapse was not associated with measures of weight or depression but there was a trend for MVP to be associated with anxiety disorder in bulimic patients. There were no significant arrhythmias found. These results raise the possibility that MVP may not be a state weight-related phenomenon as has been proported, but rather a trait phenomenon reflecting comorbidity with anxiety disorder.     

Large ostium secundum atrial septal defect discovered after severe mitral regurgitation. A case report

Mitral regurgitation is associated with ostium secundum atrial septal defect in about 22% of cases. mitral valve prolapse induced by atrial shunt is the main cause of this regurgitation. Ususually, atrial septal defect discovery precedes that of mitral regurgitation. The aim of this paper is to focus on clinical, hemodynamic and evolutive details of atrial septal defect and mitral regurgitation association. We report the case of large atrial septal defect in 37 years old girl referred for hemodynamic investigation of mitral regurgitation. The divergence of clinical data, electrocardiogram and echocardiography findings has led to atrial septal defect discovery. Hemodynamic data showed severe pulmonary arterial hypertension (medium pulmonary arterial pressure: 45 mmhg). Hence, mitral valve substitution by mechanical prosthesis and closure of atrial septal defect have been carried out. Ten hours after surgery, death occurred because of severe pulmonary arterial hypertension and heart failure. CONCLUSION: Association of severe mitral regurgitation and large ostium secundum atrial septal defect is an original anatomo-clinic entity caracterized by mitral valve lesions diversity and severe secondary pulmonary arterial hypertension. Danger of such a hypertension is due to progressive and infra clinical rise of pulmonary resistances and association of increased pulmonary blood flow and capillary pulmonary hypertension.     

Relevant factors in mitral valve reconstructive surgery. Report of 150 cases

150 patients had mitral valve repair for mitral valve incompetence. There were 57 males and 93 females with a mean age of 22 years, 39% were less than 15 years of age. 60% of the patients were in Class II NYHA and 40% in Class III and IV. According to Carpentier's classification, isolated type I was present in 18 patients (12%), type II in 98 patients (64%) and type III in 34 cases (24%). Mitral repair included correction of valve prolapse, valvular enlargement with pericardial patch and annuloplasty with semi-rigid ring in 128 cases and PTFE patch along the posterior leaflet in 12 cases. The perioperative mortality rate was 2.6% (4 patients). All patients had early post-operative echocardiography. According to this, mitral regurgitation was absent or tiny in 135 patients (92%), grade II in 10 cases and grade III in 2 cases. It was moderate or important in twelve patients (8%). In the late post-operative period, three patients were lost to follow-up. All the others patients were reoperated upon for mitral dysfunction in a mean time of 37 months. The reason for reoperation was in the majority of the cases the recurrence of mitral regurgitation related to increase of valvular and sub valvular disease. The late mortality rate is 7% (10 patients). Out of 126 reviewed survivors on the long run, 71 patients (56%) are asymptomatic in class I, 53 patients (42%) in class II and 2 patients in class III NYHA. Mitral valvuloplasty is the preferred procedure in mitral insufficiency surgical management. It is associated to a low early mortality and morbidity rate. Despite the need for reoperation in about 10% of the cases in the long follow-up, mitral repair offers a good quality of life without anticoagulant treatment.