缩窄性心包炎二维超声心动图诊断

缩窄性心包炎二维超声心动图诊断孙长福，张玉金，王佩玉，姜乃琴１资料与方法本文选择我院住院病人３２例、均经手术及病理证实为缩窄性心包炎。本组病例，男２３例，女９例，年龄１３岁～５５岁。平均年龄２３岁。病程长短不一，最短为３个月，最长为３０年。术前３２例...     

超声心动图诊断慢性缩窄性心包炎

本文分析了14例慢性缩窄性心包炎的超声心动图象,重点讨论了本症的超声图象特点。 本组14例中男9例,女5例。年龄24～51岁。其中9例有心包积液病史(5例结核性),1例有化脓性心包炎病史,4例无明确病史。临床表现:全部患者均有不同程度呼吸困难及腹部嘭胀。颈静脉怒张6例、胸腔积液3例、肝肿大7例.腹水8例、下肢浮肿4例。 本文14例均有心脏平片检查,8例诊断慢性缩窄性心包炎.其中2例发现钙化。     

二维及多普勒超声心动图诊断缩窄性心包炎

本文介绍用二维及多普勒超声心动图诊断缩窄性心包炎5例,经手术对照证实:二维超声心动图可准确判断心包厚度、钙化、缩窄部位及范围。多普勒超声可显示主、肺动脉瓣口峰值血流速度减慢,提示心室舒张充盈障碍,射血减少。     

缩窄性心包炎28例超声心动图分析

本文回顾经手术及临床确诊的２８例缩窄性心包炎的超声表现。结果４０％～５０％病例Ｍ型超声示前间壁和左室后壁运动异常；二维超声可发现诸多异常征像：心房增大（７０．０％）、心外形变形（４６．０％）、心包增厚（１００％）、心包积液（８２．１％）、下腔静脉增宽且内径不随呼吸改变（１００％）。实时二维室间隔运动呈抖动状和脉冲式多普勒二尖瓣Ｅ峰幅度吸气时降低＞２５％是诊断缩窄性心包炎较好的指标     

二维多普勒超声诊断慢性缩窄性心包炎的价值

本文应用二维多普勒超声心动图观察了慢性缩窄性心包炎３４例声像图特征。结果显示：患者心包不规则增厚，心脏活动受限，左、右心房增大，左心室正常或缩小，下腔静脉和肝静脉扩张。左房与左室后壁夹角为１３２±１０°，ＤＡ一ＤＶ为３１．８０±９．８０ｍｍ，ＤＶ／ＤＡ为０．６８±０．０５，主动脉瓣口血流频谱呈“奇脉”现象。本文认为二维多普勒超声心动图对诊断慢性缩窄性心包炎有重要价值。     

缩窄性心包炎的彩色多普勒超声心动图表现

缩窄性心包炎是少见的心血管疾病,其起病隐匿,早期正确诊断是提高疗效的关健。本文收集本院近10年米,经手术证实的缩窄性心包炎患者9例,分析如下。     

缩窄性心包炎的超声心动图诊断——附15例临床分析

目的：探讨超声心动图对缩窄性心包炎诊断及鉴别诊断的价值。方法：回顾性研究总结我院超声心动图诊断、手术证实、资料完整的缩窄性心包炎１５例，分析其超声心动图特征，并与手术结果对照。结果：缩窄性心包炎的超声心动图特征主要为心包增厚；心脏活动受限；左、右心房增大；左室缩小或正常；ＤＡ－ＤＶ＞２０ｍｍ；下腔静脉增宽且不随呼吸变化；舒张早期心室快速充盈等。结论：超声心动图是无创伤诊断缩窄性心包炎的首选方法     

经胸超声心动图联合CT对缩窄性心包炎的诊断价值

目的:研究分析经胸超声心动图联合CT检查在诊断缩窄性心包炎中的价值.方法:选择在2018年5月—2020年6月,在我院接受救治的经手术病理学检测确诊为缩窄性心包炎的46例患者作为研究对象,所有患者均进行经胸超声心动图和CT检查,通过统计对比检测准确率,分析各个方法的诊断价值.结果:经胸超声心动图联合CT诊断的准确率为9...     

缩窄性心包炎超声心动图漏诊原因分析

<正>缩窄性心包炎是临床上较少见的心血管疾病,其发病率约占心脏疾病的1.6%,大部分由结核、类风湿和非特异性心包炎引起[1]。超声心动图是诊断缩窄性心包炎的可靠手段,但是对于超声表现不典型的缩窄性心包炎,漏诊率很高。文献[2]报道超声心动图诊断缩窄性心包炎的符合率仅51%~73%,漏诊率高达27%~49%。本组对12例超声心动图表现不典型的缩窄性心包炎进行分析,总结其漏诊原因,为今后临床工作中减少漏诊提供     

左心房容积追踪技术评估缩窄性心包炎患者左心房容积和功能变化

目的 观察左心房容积追踪技术（LAVT）评估手术治疗前后缩窄性心包炎（CP）患者左心房容积和功能变化的临床价值。方法 对20例CP患者及20名健康志愿者（对照组），于心包切除术治疗CP术前（术前组）和术后（术后组）采集心尖四腔及两腔动态超声图像，以LAVT技术获得左心房容积参数，包括最大容积（LAV_max）、预收缩容积（LAV_pre）及最小容积（LAV_min），经体表面积校正得到容积指数（LAVI_max、LAVI_pre、LAVI_min）；以LAVT技术获得左心房容积变化速率参数，包括收缩期峰值充盈速率（dv/dtS）、舒张早期峰值排空速率（dv/dtE）及舒张晚期峰值排空速率（dv/dtA）。根据所得参数计算左心房总射血分数（LATEF）、被动射血分数（LAPEF）和主动射血分数（LAAEF），并进行分析。结果 3组LAV_min差异有统计学意义（P<0.05），术前组和术后组LAV_min均大于对照组（P均<0.05），术前组大于术后组（P<0.05）。3组LATEF、LAPEF、LAAEF、dv/dtS、dv/dtE和dv/dtA差异均有统计学意义（P均<0.05），术前组和术后组均小于对照组（P均<0.05），术前组小于术后组（P均<0.05）。结论 利用LAVT可评估心包切除术前后CP患者左心房容积和功能变化。     

Noninvasive imaging techniques of constrictive pericarditis

Constrictive pericarditis (CP) is the result of scarring and loss of elasticity of the pericardial sac, resulting in external impedance of cardiac filling. It can occur after virtually any pericardial disease process. Patients typically present with signs and symptoms of right heart failure and/or low cardiac output. An important pathophysiological hallmark of CP is exaggerated ventricular interdependence and impaired diastolic filling. Echocardiography is the initial imaging modality for diagnosis of CP. Unfortunately, no echocardiographic sign or combination of signs is pathognomonic for CP. CT scan and cardiac MRI are other imaging techniques that can provide incremental diagnostic information. CT scan can easily detect pericardial thickening and calcification, while cardiac MRI provides a comprehensive evaluation of the pericardium, myocardium and cardiac physiology. Occasionally, a multimodality approach needs to be considered for the conclusive diagnosis of CP.     

Protein-losing enteropathy in association with constrictive pericarditis

Although acute pericarditis is a common and usual benign disorder, sometimes evolution to constrictive pericarditis may occur. We present a case of constrictive pericarditis late after coronary bypass grafting, complicated by right sided heart failure. Edema formation was aggravated due to protein-losing enteropathy, resulting in hypoalbuminemia. Imaging of constrictive pericarditis was done by ultrasound as well as simultaneous pressure recording of the right and left ventricle. Imaging of intestinal protein loss was possible using intravenous Technetium-99m-labelled human serum albumin.     

缩窄性心包炎磁共振成像诊断研究

目的 探讨磁共振成像(MRI)诊断缩窄性心包炎的价值。方法 搜集18例经手术证实的缩窄性心包炎病例,总结MRI表现来分析缩窄性心包炎的心包、下腔静脉、左右心房以及左右心室的改变特点,并采集20例正常志愿者作为对照组进行对比研究。结果 18例缩窄性心包炎病例中14例出现室间隔摆动;12例心脏MRI增强检查中3例出现心包延迟强化。缩窄性心包炎组的右室短径小于对照组,长短径之比大于对照组,心包较对照组增厚,下腔静脉较对照组增宽,左房前后径、左房左右径、左房长径、右房左右径、右房长径均较对照组增大,差异均有统计学意义(t分别=5.72、-4.26、-8.26、-9.67、-7.77、-3.41、-2.75、-5.61、-9.40,P均<0.05)。其中7例右室形态严重改变呈管状,与非管状右室组比较,其右室短径更小,长短径之比更大,右室射血分数(RVEF)更小,差异均有统计学意义(t分别=-3.70、3.23、-2.85,P均<0.05)。结论 MRI是诊断缩窄性心包炎有效的检查方法之一。     

Idiopathic calcific constrictive pericarditis causing pulmonary stenosis associated with a ventricular septal defect mimicking tetralogy of Fallot

We describe an unusual case of pulmonary stenosis caused by calcific constrictive pericarditis associated with a congenital ventricular septal defect in a 16-year-old boy who had a 2-week history of progressive dyspnea, cyanosis, fatigue, and bilateral leg edema. Echocardiographic findings led to an initial diagnosis of tetralogy of Fallot; however, findings on chest radiography and CT were suggestive of calcific constrictive pericarditis with pulmonary stenosis, which was then confirmed on cardiac catheterization. Total pericardiectomy and repair of the ventricular septal defect resulted in a satisfactory outcome. Follow-up examinations at 6 and 20 months showed that the patient was asymptomatic and considered to have class I New York Heart Association functional status. To our knowledge, this is the first reported case of calcific constrictive pericarditis with pulmonary stenosis associated with a ventricular septal defect.     

斑点追踪技术评价缩窄性心包炎患者左心房功能

目的 应用斑点追踪技术评价缩窄性心包炎（CP）患者左心房功能。方法 对36例CP患者（CP组）和35名正常人（对照组）进行常规超声心动图检查,应用斑点追踪技术测量左心房整体与房间隔、侧壁纵向应变,包括峰值负向应变、峰值正向应变、总体应变,并进行统计学分析。结果 CP组左心房整体、房间隔、侧壁的总体应变、峰值正向应变、峰值负向应变较正常对照组显著减低（P均<0.001）。CP组侧壁总体应变、峰值正向应变、峰值负向应变显著低于房间隔（P<0.001）。左心房总体应变与左心房总射血分数、左心房膨胀指数均呈正相关（r=0.745、0.741,P均<0.001）;左心房整体峰值负向应变与左心房主动射血分数呈负相关（r=－0.741,P<0.001）。结论 CP患者左心房储备功能、管道功能、收缩功能均受损,以侧壁受累更明显。斑点追踪技术可准确评价CP患者左心房功能变化。     

Multimodality imaging for the diagnosis and treatment of constrictive pericarditis

ABSTRACT

Introduction: Constrictive pericarditis can result in debilitating congestive right heart failure and has been considered an important cause of morbidity and mortality in patients with cardiovascular disease. Multimodality imaging continues to play a fundamental role in the individual approach to diagnosis, management, and prognosis of patients with this clinical syndrome.

Areas covered: This article gives an overview of the clinical spectrum of constrictive pericardial diseases and the role of multimodality imaging in the diagnosis of constrictive pericarditis. There is a focus on the emerging role of cardiac magnetic resonance (CMR) for the diagnosis, management, and prognostication of patients with constrictive pericarditis based on more recent case series, retrospective and prospective studies, which have helped to define the role of CMR.

Expert opinion: Advanced multimodality imaging assists with identification of both overt and subclinical pericardial inflammation. This allows the pericardiologist to recognize patients with potentially reversible disease, trial medical therapy, and thereby avoid mechanical removal of the pericardium. Further, pericardial characterization by CMR has provided novel information about the natural history of these pericardial conditions, which can help tailor therapy and improve prognosis.     

组织应变成像技术对缩窄性心包炎的临床研究

目的探讨缩窄性心包炎患者组织应变成像的特征及其诊断价值。方法对26例缩窄性心包炎患者、30例对照者,在心尖四腔观组织多普勒图上同步定量显示室间隔和左室侧壁的中段应变曲线图,测量收缩期最大应变值。计算室间隔与左室侧壁最大应变量的绝对值及应变比值。结果缩窄性心包炎患者左室侧壁应变明显小于室间隔[(-5.60±3.46)%对(-14.14±4.11)%,P<0.05];应变差绝对值及比值明显高于对照组[差值(16.40±5.05)%对(3.26±1.95)%,比值5.97±5.67对1.12±0.37,P<0.05]。结论缩窄性心包炎患者应变曲线特征明显,直观易辨,有重要的诊断价值。     

Doppler sonographic diagnosis of severe portal vein pulsatility in constrictive pericarditis: Flow normalization after pericardiectomy

This case report describes the noninvasive assessment of hepatic and portal vein hemodynamics in a patient with constrictive pericarditis before and after pericardiectomy. Doppler sonography of the hepatic veins demonstrated a typical W‐shaped pattern with pronounced late diastolic flow reversal that disappeared after surgery. Preoperatively, we observed severe pulsatility of the portal vein with flow reversal in systole; after pericardiectomy, portal venous flow was normal. We concluded that the high right atrial pressure in this patient might have led to increased hepatic venous outflow resistance, with subsequent trans‐sinusoidal shunting between the hepatic artery and portal vein causing severe portal vein pulsatility. After pericardiectomy and a decrease in right atrial pressure, portal vein flow normalized. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:84–88, 1999.     

定量实时三维超声心动图在评价限制型心肌病及缩窄性心包炎中的应用价值

Objective To investigate value of real-time three-dimensional echocardiography timingexcursion parametric index and 17 segment volume curves index in patients with restrictive cardiomyopathy and constrictive pericardits.Methods Seventeen patients with restrictive cardiomyopathy (proven by biopsy) ,six patients with constrictive pericardits (proven by CT or surgical),twenty subjects with normal left ventricular(LV) function were examined by Philips iE33 with X3-1 probe.Results Parameter index of Tmsv 16-SD,Tmsv 12-SD Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD(%) ,Tmsv 12-SD(%),Tmsv 6-SD(%),Tmsv 16-Dif(%),Tmsv 12-Dif(%),Tmsv 6-Dif(%) was significantly higher in patients with restrictive cardiomyopathy than that in subjects with normal LV function(all P ＜0.05).Average and maximum value and minimum of excursion was significantly lower in patients with restrictive cardiomyopathy than that in subjects with normal LV function (all P ＜0.005).Whereas,compare with subjects with normal LV function,the parametric indexes of timing-excursion and 17 segment volume curves were not significantly difference in patients with constrictive pericardits(all P ＞0.05).Conclusions Realtime three-dimensional echocardiography can evaluate and diagnose fastly restrictive cardiomyopathy and constrictive pericardits.