经胸及经食管超声在正常成年人肺静脉形态及血流动力学方面的对比研究

目的 探讨经胸超声(TTE)和经食管超声(TEE)在正常人肺静脉形态及血流动力学中的应用价值.方法 50例窦性心律患者.均行TTE和TEE检查,利用二维、脉冲多普勒及彩色多普勒观察4条肺静脉的内径及血流频谱.结果 TTE对4条肺静脉的显示率分别为:左上肺静脉90%,右上肺静脉86%,左下肺静脉40%,右下肺静脉2%;TEE为:左、右上肺静脉均为100%,左下肺静脉83%,右下肺静脉85%.TTE和TEE 2种方法在测量肺静脉形态及血流速度方面没有显著差异,但TEE比TTE所检测的频谱质量要好,而且有良好的信噪比.左、右上肺静脉的血流束与声束间的角度小于20°,可测量到较理想的血流频谱.取样容积的深度在一定范围内对收缩期血流速度及频谱质量没有影响,但随着取样容积位置的加深,舒张期血流速度逐渐减低.结论 在肺静脉的研究方面经食管超声比经胸超声能够获得质量更好、更多的血流动力学信息.     

取样容积位置及大小变化对估测肺血流量的影响

为评价取样容积(SV)位置和大小对超声心动图估测肺血流量(Q_P)的影响,在36例先心病患者中,SV取0.22cm、1.79cm,分别置于肺动脉瓣下、瓣口、瓣上记录肺动脉血流频谱,根据频谱外包络线估测Q_p,并与心导管值对比。结果显示:SV为0.22cm、1.79cm时,肺动脉瓣下、瓣口、瓣上估测的Q_p间相差显著(P＜0.01),与心导管实测值显著相关(r=0.30-0.80);不同大小SV多普勒估测Q_p间差异显著(p＜0.05)。结论:应用肺动脉血流速度频谱外包络线,SV取0.22cm,置于肺动脉瓣口可准确地估测Q_p。     

心房颤动射频消融治疗前后肺静脉形态结构CT成像改变的临床研究

目的:利用CT三维成像技术研究心房颤动(房颤)患者行环肺静脉电隔离术(CPVA)前后肺静脉的形态学变化。方法:房颤患者共28例,行CPVA术(6.5±3.9)个月后进行随访,根据术后有无复发分为成功组(22例)和复发组(6例)。应用64排螺旋CT测量CPVA术前、后肺静脉口的径线、截面积、左心房容积,研究射频消融术后肺静脉的形态学特点并与术前做对比分析。结果:成功组术后左心房容积、左上肺静脉口最大径、右上肺静脉口最大径、右上肺静脉口最小径、右下肺静脉口最大径、右下肺静脉口最小径、4个肺静脉口截面积较术前缩小(P<0.05)。复发组术后仅见右下肺静脉口最大径、左下肺静脉口及右下肺静脉口面积较术前减少(P<0.05)。CPVA术后肺静脉的最大径及最小径狭窄率小于50%者分别为61.6%及56.3%;狭窄率50%～70%者分别为3.6%和5.4%。结论:(1)CPVA成功后可逆转房颤患者的肺静脉和左心房重构,而复发组未出现明显逆重构。(2)CPVA术后可引起部分患者无症状性肺静脉狭窄。     

超声心动图诊断部分性肺静脉异位引流的价值

目的探讨超声心动图对部分性肺静脉异位引流(PAPVC)的诊断价值。方法回顾性分析29例PAPVC患者二维超声及彩色多普勒图像表现并与心血管造影、手术结果对比分析,总结其诊断特点,找出漏诊的原因。结果术前确诊25例,漏诊3例,1例提示诊断。右上肺静脉引流入右心房19例;右上肺静脉引流入上腔静脉2例;右上肺静脉及右下肺静脉均引流入右心房2例;右下肺静脉引流入右心房2例;右上肺静脉及右下肺静脉引流入冠状静脉窦1例;左上及左下肺静脉通过垂直静脉引流入左无名静脉3例。合并房间隔缺损(ASD)27例,其中静脉窦型ASD 20例,继发孔ASD 7例,1例房间隔完整,1例合并卵圆孔未闭。25例超声诊断与心血管造影、手术结果符合。结论超声心动图诊断PAPVC具有较高的准确度,但在成人时期容易漏诊。     

肺静脉流速定量诊断肺小动脉嵌顿压:围术期中与右心导管同步性研究

为探索无创性测定肺小动脉嵌顿压（ＰＡＷＰ）的新途径，本文应用经食管脉冲多普勒超声（ＴＥＥ）测定了７６例不同心脏病患者的左上肺静脉（ＬＵＰＶ）血流频谱，应用常规方法将ＴＥＥ探头插入食管，将取样容积置于ＬＵＰＶ内作者单位：２５００１２山东医科大学附属医院...     

增强型血流成像技术在胎儿四条肺静脉的定位研究

目的采用增强型血流成像技术(e-Flow)显示并定位4条肺静脉,为胎儿心脏畸形的诊断和风险评估提供可靠依据。方法选取2010年6～12月在我院行胎儿超声心动图检查的200例胎儿,孕妇孕龄为20～40周,根据成人肺静脉定位方法,应用e-Flow技术对胎儿不同切面的4支肺静脉进行观察。结果 200例胎儿超声心动图显示及定位肺静脉图像满意。左上肺静脉在胸部横切面显示四腔心及降主动脉时,距离降主动脉较远,斜行进入左心房。左下肺静脉在胸部横切面显示四腔心及降主动脉时,紧邻降主动脉,垂直进入左心房;主动脉弓切面,左下肺静脉与降主动脉胸段呈90°角,走行于降主动脉前方,垂直进入左心房。右上肺静脉在胸部横切面显示四腔心时,紧邻右心房顶部走行,在上腔静脉左侧进入左心房。胸部横切面显示四腔心,右下肺静脉较右上肺静脉距离脊柱更近,平行于房间隔水平进入左心房。结论 e-Flow技术可以显示胎儿4条肺静脉,并能对肺静脉进行定位。     

新生儿持续性肺动脉高压合并先天性心脏病1例

患儿,男,28 d,足月儿,生后数小时内即出现发绀、气急等症状,出生后3 d外院超声心动图及MRI检查发现:右房、右室扩大;卵圆孔未闭,右向左分流;左下及右下肺静脉汇入左房,左上及右上肺静脉显示不清.因怀疑部分型肺静脉异位引流而到我院心外科就诊.     

超声心动图评价高血压对肺静脉内径的影响

目的:探讨长期高血压对肺静脉内径有无影响。方法:将64例高血压病人按有无心房纤颤和左心房内径大小分组,使用心脏彩色超声按M型结合切面超声方法来测量高血压患者左心房内径和左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉内径。结果:高血压伴心房纤颤组肺静脉内径比无心房纤颤组肺静脉内径大;左心房内径增大越明显者肺静脉内径也增大;两组肺静脉内径均比健康组肺静脉内径大。结论:高血压能引起肺静脉内径的增大。     

区域血流追踪法在超声诊断胎儿肺静脉异位引流中的应用价值

目的探讨区域血流追踪法在超声诊断胎儿肺静脉异位引流中的价值。 方法回顾性选取2015年1月至2019年12月在河北生殖妇产医院进行胎儿超声心动图检查，诊断为肺静脉异位引流的胎儿41例。超声检查胎儿肺静脉时，应用区域血流追踪法，即将肺组织大致分为4个区域，左侧前上部1/2肺野、左侧后下部1/2肺野、右侧前上部1/2肺野、右侧后下部1/2肺野，应用彩色血流技术对41例肺静脉异位引流胎儿4个区域内肺静脉分支进行追踪并定位，观察其近心端与左心房的关系及最终回流部位。 结果41例肺静脉异位引流胎儿，4个区域内肺静脉远端分支分别引流入左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉。36例完全型肺静脉异位引流胎儿4条肺静脉近心端均未汇入左心房，其中34例呈现左心房后方汇聚征。心上型25例肺静脉最终回流入上腔静脉；心内型7例中6例通过冠状静脉窦回流入右心房，1例直接回流入右心房；心下型2例肺静脉回流入门静脉窦；混合型2例，1例左侧肺静脉汇入上腔静脉，右侧肺静脉汇入下腔静脉，1例左侧肺静脉汇入上腔静脉，右侧肺静脉回流入右心房。5例部分型肺静脉异位引流胎儿，1例右上肺静脉直接回流入右心房，2例右上肺静脉回流入上腔静脉，1例右上、右下肺静脉直接回流入右心房，1例左肺静脉变异为3支，最上支经无名静脉回流入上腔静脉。 结论应用区域血流追踪法可使肺静脉分支检查更全面，定位更加精确，有助于提高胎儿肺静脉异位引流的诊断准确性。     

64层螺旋CT对肺静脉的形态定量分析

目的用64层螺旋CT定量分析肺静脉直径、截面积及形状。方法分析102例病人,除外影响肺静脉疾病者,进行心脏冠状动脉增强螺旋CT扫描。在工作站用肺静脉血管分析软件,测量4条肺静脉主干的直径(平均直径,最大值,最小值)及截面积。比较男女之间肺静脉直径、截面积和圆率的差异性、4条肺静脉圆率的差异性及4条肺静脉年龄分组的差异性。结果4条肺静脉口平均直径变化较大,右上肺静脉口直径为20.3 mm,右下肺静脉口直径为17.0 mm,左上静脉口直径为18.1 mm,左下肺静脉口直径为13.9 mm。右下肺静脉的平均直径和截面积在男女之间有明显统计学差异性(P值分别为0.022和0.017),肺静脉皆不是完全的圆形,右下肺静脉圆度最大,左下肺静脉圆度、直径和截面积最小(P≈0.000<0.05),4条肺静脉皆由细逐渐增粗进入左心房。左侧肺静脉的平均直径和截面积在年龄分层上有统计学差异(P=0.01及0.008)。结论肺静脉的直径、截面积及形状变化较大,在评估肺静脉狭窄时应特别注意。64层螺旋CT可以无创性地评估肺静脉。     

Four-year prospective study of pulmonary venous thrombosis after lung transplantation.

The objective of this study was to prospectively assess pulmonary venous anastomosis by transesophageal echocardiography after lung transplantation. Thrombus formation at the pulmonary venous anastomotic site after lung transplantation may have catastrophic consequences, including allograft failure and stroke. Eighty-seven consecutive adult lung transplant recipients underwent transesophageal echocardiography within 48 hours after surgery. Thrombosis of a pulmonary vein was diagnosed in 13 (15%) of 87 patients in the early postoperative period after lung transplantation. Mean thrombus width was 0.9 +/- 0.4 cm (range, 0.5 to 1.7 cm), with an average peak flow velocity at the site of obstruction of 127 +/- 23 cm/s (range, 90 to 150 cm/s). Five patients with pulmonary vein thrombosis died in the perioperative period, yielding a 90-day mortality rate of 38%. Larger thrombus size and greater acceleration of flow through a narrowed pulmonary vein correlated with poor clinical outcome. During each year of the study, the incidence of pulmonary vein thrombosis declined progressively. Pulmonary vein thrombosis is a potentially ominous complication in the early postoperative period after lung transplantation. Transesophageal echocardiography is a valuable tool for detecting abnormalities of the pulmonary venous anastomosis. Thrombus size and flow velocity at the anastomotic site may guide prognosis and clinical management. Complications of the pulmonary venous anastomosis are in part technical in nature.     

相位对比磁共振成像诊断小儿继发孔型房间隔缺损

目的 探讨相位对比磁共振成像(PC-MRI)在诊断小儿继发孔型房间隔缺损(ASD)中的应用价值. 方法 42例经胸超声心动图证实为继发孔型ASD患儿,年龄9个月～15岁.采用PC-MRI采集通过ASD的左向右分流束的图像,以及缺损边缘与上下腔静脉及二尖瓣、右上肺静脉连线的PC-MRI图像. 结果 42例PC-MRI测量的ASD直径、缺损边缘与上腔静脉、下腔静脉、房室瓣及右上肺静脉间的距离均与经胸超声心动图的结果有很好的相关性(P<0.001).26例PC-MRI测量结果与外科手术结果高度相关(P<0.001),不同流速编码中,流速编码50～70 cm/s时PC-MRI测量到的缺损直径与外科手术结果相对最为一致. 结论 PC-MRI可直观显示房间隔缺损的位置、数目、大小和与周围心内结构的空间关系,同时可进行准确的定量分析, 为心脏解剖畸形诊断提供了一种新的检测方法和思路.     

彩超观察胎儿肺静脉在产前二级筛查中的应用

目的探讨彩超观察胎儿肺静脉在产前二级筛查中的应用价值。方法对113例妊娠20～34周孕妇进行常规胎儿产前彩超筛查,重点观测胎儿肺静脉及其血流参数:S波(心室收缩期峰值流速)、D波(心室舒张期峰值流度)、A波(心房收缩期流速),计算S/D值和PVI值〔峰值血流指数,PVI=(S-A)/D〕。将其中100例正常胎儿列入对照组(A组),对比分析其4条肺静脉血流参数;将13例产前彩超筛查有先天性心脏病(CHD)的胎儿列入实验组(B组),比较两组的右下肺静脉血流参数。结果 A组4条肺静脉的S波、D波、S/D及PVI差异均有统计学意义(P<0.05),多数A波表现为正向波,但差异无统计学意义(P>0.05)。B组与A组S波、D波及S/D无显著差异(P>0.05),B组A波均值反转,与A组比较差异显著(P<0.05),PVI明显高于A组(P<0.05)。结论观测肺静脉A波、PVI可作为CHD产前筛查的一项指标。在测量肺静脉血流参数时应选取某一条固定的肺静脉进行测量。     

Normal pulmonary venous flow characteristics as assessed by transesophageal pulsed Doppler echocardiography.

Twenty-seven subjects without apparent cardiac abnormalities underwent transesophageal echocardiography to evaluate normal Doppler characteristics of pulmonary venous flow. In particular, the effects of normal respiration and straining during the Valsalva maneuver were analyzed. Pulmonary venous flow during systole consisted of one forward flow wave in 15 cases (56%) and of two forward flow waves in 12 cases (44%). In all instances one forward flow wave was seen during early diastole and in 23 subjects (85%) a retrograde wave related to atrial contraction was present. Maximal velocity during systole was 57 +/- 13 cm/sec (mean +/- SD), during early diastole was 58 +/- 19 cm/sec, and during late diastole was 16 +/- 9 cm/sec. Velocity time integral during systole was significantly higher than during early diastole (11.8 +/- 4.9 vs 9.5 +/- 3.9 cm, p < 0.05), while velocity time integral during late diastole was 1.1 +/- 0.7 cm. During normal inspiration both early diastolic velocity and velocity time integral significantly decreased from 59 +/- 15 to 54 +/- 15 cm/sec (p < 0.01) and from 9.5 +/- 3.9 to 8.5 +/- 4.2 cm (p < 0.05), respectively. During normal expiration, systolic and early diastolic velocity time integral significantly increased, from 11.0 +/- 4.1 to 11.8 +/- 4.5 cm (p < 0.001) and from 9.5 +/- 3.9 to 10.1 +/- 4.3 cm (p < 0.05), respectively. Although statistically significant, the differences were small and do not seem of clinical importance. Straining during the Valsalva maneuver, however, obviously decreased pulmonary venous flow velocities. Systolic and early diastolic velocity decreased from 57 +/- 15 to 32 +/- 10 cm/sec and from 59 +/- 18 to 34 +/- 15 cm/sec, respectively, while velocity time integral during systole, early, and late diastole decreased from 12.0 +/- 5.6 to 4.3 +/- 2.6 cm, from 9.9 +/- 4.4 to 5.2 +/- 3.7 cm, and from 1.3 +/- 0.8 to 0.8 +/- 0.7 cm, respectively. In conclusion, pulmonary venous Doppler characteristics can adequately be analyzed with transesophageal echocardiography. Normal respiration only minimally influences pulmonary venous flow velocities in contrast to straining during the Valsalva maneuver; this should be considered when these variables are applied for clinical purposes.     

Pulmonary venous flow velocity: relation to hemodynamics, mitral flow velocity and left atrial volume, and ejection fraction.

Abnormal pulmonary venous flow velocity patterns are present in multiple cardiac disease states, but the determinants of pulmonary venous flow velocity have not been fully elucidated. To determine the relative importance of several proposed factors that could influence pulmonary venous flow, anatomic, hemodynamic, and Doppler mitral and pulmonary venous flow velocity data were compared in 50 consecutive patients undergoing cardiac catheterization for clinical reasons. Pulmonary venous diastolic flow velocity was most strongly related to left ventricular isovolumetric relaxation time (r = -0.59), left ventricular end-diastolic pressure (LVEDP, r = 0.50), left atrial minimum volume (r = 0.50), mitral deceleration time (r = -0.50), and early diastolic mitral flow velocity (r = 0.45). Pulmonary venous systolic flow velocity related best with left atrial minimum volume (r = -0.45) and left atrial ejection fraction (r = 0.44). Pulmonary venous systolic flow velocity integral also showed the strongest relation with left atrial minimum volume (r = -0.48). Relations between pulmonary venous flow velocity and velocity time integrals and other variables were sometimes significantly different, apparently caused in part to differences in heart rate. These results suggest that pulmonary venous diastolic flow velocity is influenced by the same factors that influence early left ventricular diastolic filling; pulmonary venous systolic flow velocity relates best to left atrial volume and atrial ejection fraction and does not relate to left ventricular ejection fraction. Future studies analyzing pulmonary venous flow velocity variables should include data on both peak velocities and velocity time integrals as well as left atrial size and function.     

冠脉循环对左室舒张功能影响的研究

探讨心肌肥厚患者冠脉血流与左室舒张功能障碍各项指标的相关关系。方法采用经胸和经食管超声心动图技术,测量３０例心肌肥厚患者和１０例正常人冠状窦、二尖瓣及肺静脉血流频谱。结果与正常人相比,收肌肥厚患者冠状窦直径、前向血流和净前向血流流速积分明显增加,并且冠状窦前向血流和ＶＴＩｎｅｔ与左室舒张功能障碍的多项指标存在相关关系。     

Transesophageal Doppler echocardiographic assessment of pulmonary venous flow pattern in subjects without cardiovascular disease

This study was designed to assess pulmonary venous flow dynamics using transesophageal Doppler echocardiography. Under general anesthesia, we studied 54 surgical patients with no history or physical evidence of cardiac disorders. In all patients pulmonary venous flow was easily identified by transesophageal color flow mapping. Pulmonary venous flow pattern, which was obtained clearly in 85% (4654) of patients by transesophageal pulsed Doppler echocardiography, was tri- or quadriphasic. The first wave, which was often biphasic in elderly patients, occurred during ventricular systole (S wave). The second wave occurred in diastole during the early ventricular filling phase of mitral flow (D wave). The third wave was reverse flow toward the pulmonary vein during atrial contraction (A wave). The following variables were measured: the peak flow velocities of each wave (PFVs, PFVd, PFVa), and the ratio of PFVs to PFVd (PFV(S/D)). The PFVd correlated with age (r=?0.56, P<0.001), indicating age-related decrease. The PFV(S/D) correlated with age (r=0.61, p<0.001), indicating age-related increase. These results would indicate that the contribution of pulmonary venous flow during diastole to total pulmonary venous flow decreases with age. Our data suggest that age-related diastolic dysfunction of the left ventricle would affect pulmonary venous flow dynamics and that left atrial storage volume during ventricular systole would increase with age.     

经食管超声心动图检测肺移植术中肺血管切面的应用价值

目的 探讨术中经食管超声心动图(TEE)观察肺血管新的解剖切面图及其在肺移植术中的应用价值.方法 因肺部疾病晚期呼吸衰竭行肺移植术患者17例.于肺移植术前麻醉后送入TEE探头,分别于肺移植术中,断肺前后和供肺支气管、肺静脉、肺动脉全部吻合后连续观察,重点观察左、右肺静脉开口和左、右肺动脉分支,测量肺动脉主干及分支内径、血流速度.结果 17例肺移植患者TEE均获左、右肺动脉及肺静脉图像.术前TEE检测肺动脉分支血流速度正常,平均65 cm/s.断肺侧肺动、静脉血流消失.供体肺与受体肺全部气管、肺静脉、肺动脉吻合完毕开放后,TEE依次检测肺静、动脉吻合口,除1例肺静脉吻合口流速增快外,所有肺静脉吻合口流速和肺动脉分支吻合口流速均较移植前轻度增快(肺动脉分支平均160 cm/s,肺静脉平均149 cm/s).结论 TEE在肺移植术前后可监测肺动脉分支和肺静脉血管直径和血流速度,检测右心功能.左、右肺动脉分支和肺静脉分支切面在观察肺移植前后肺血流中有非常关键的作用.     

经食管超声心动图检测肺移植术中肺血管切面的应用价值

目的 探讨术中经食管超声心动图(TEE)观察肺血管新的解剖切面图及其在肺移植术中的应用价值.方法 因肺部疾病晚期呼吸衰竭行肺移植术患者17例.于肺移植术前麻醉后送入TEE探头,分别于肺移植术中,断肺前后和供肺支气管、肺静脉、肺动脉全部吻合后连续观察,重点观察左、右肺静脉开口和左、右肺动脉分支,测量肺动脉主干及分支内径、血流速度.结果 17例肺移植患者TEE均获左、右肺动脉及肺静脉图像.术前TEE检测肺动脉分支血流速度正常,平均65 cm/s.断肺侧肺动、静脉血流消失.供体肺与受体肺全部气管、肺静脉、肺动脉吻合完毕开放后,TEE依次检测肺静、动脉吻合口,除1例肺静脉吻合口流速增快外,所有肺静脉吻合口流速和肺动脉分支吻合口流速均较移植前轻度增快(肺动脉分支平均160 cm/s,肺静脉平均149 cm/s).结论 TEE在肺移植术前后可监测肺动脉分支和肺静脉血管直径和血流速度,检测右心功能.左、右肺动脉分支和肺静脉分支切面在观察肺移植前后肺血流中有非常关键的作用.     

经食管超声心动图检测肺移植术中肺血管切面的应用价值

目的 探讨术中经食管超声心动图(TEE)观察肺血管新的解剖切面图及其在肺移植术中的应用价值.方法 因肺部疾病晚期呼吸衰竭行肺移植术患者17例.于肺移植术前麻醉后送入TEE探头,分别于肺移植术中,断肺前后和供肺支气管、肺静脉、肺动脉全部吻合后连续观察,重点观察左、右肺静脉开口和左、右肺动脉分支,测量肺动脉主干及分支内径、血流速度.结果 17例肺移植患者TEE均获左、右肺动脉及肺静脉图像.术前TEE检测肺动脉分支血流速度正常,平均65 cm/s.断肺侧肺动、静脉血流消失.供体肺与受体肺全部气管、肺静脉、肺动脉吻合完毕开放后,TEE依次检测肺静、动脉吻合口,除1例肺静脉吻合口流速增快外,所有肺静脉吻合口流速和肺动脉分支吻合口流速均较移植前轻度增快(肺动脉分支平均160 cm/s,肺静脉平均149 cm/s).结论 TEE在肺移植术前后可监测肺动脉分支和肺静脉血管直径和血流速度,检测右心功能.左、右肺动脉分支和肺静脉分支切面在观察肺移植前后肺血流中有非常关键的作用.