保留二尖瓣装置的二尖瓣替换术

1998年至今，我们观察了保留二尖瓣装置的二尖瓣替换术17例，术后5天、1个月超声心动图结果表明，左心室功能恢复较好，射血分数、短轴缩短率明显优于同期行常规切除瓣膜及瓣下结构的二尖瓣替换术。术中对该手术的适应证、方法及注意事项做了阐述。     

平衡法核素心室显像对原发性高血压病的心功能评价

平衡法核素心室显像对原发性高血压病的心功能评价川玲，石湘芸，朱家瑞，贺声，田慧生，赵文锐本研究分析了４４例原发性高血压病（ＥＨ）患者核素平衡法心室里像（ＥＲＮＡ）的变化．并与多普勒彩色超声心动图（ＵＣＧ）以及心机械图（ＭＣＧ）的检测结果进行了对比，着...     

核素心室显像对心动过速患者射频消融或手术前后的心室功能观察

为了评价射频消融（ＲＦＡ）对心室功能的影响，应用核素心室显像（ＲＮＶ）测定了３８例，３例为全并室性心动过速（ＶＴ）患者ＲＦＡ前后以及２０例正常对照者的心室功能，半自动计算左心室射血分数（ＬＶＥＦ）、右心室射心分数（ＲＶＥＦ）、１／３ＬＶＥＦ、左室高峰充盈率（ＬＶ－ＰＦＲ）、右室高峰充盈率（ＲＶ－ＰＦＲ）。结果提示：窦性心律时，对照组与病人组ＲＦＡ前、后心功能差异无显著性，而１０例Ｗ－Ｐ－Ｗ患者经食     

核素心室显像对尿毒症患者左心室功能的评价

为评价晚期尿毒症患者左心室功能，用平衡法门电路心室显像测定３０例正常人和３７例尿毒症患者左室收缩与舒张功能。结果表明，尿毒症患者，即使没有心功能不全的征象，其收缩功能及舒张功能也明显氏于正常组（Ｐ〈０．０１）；尿毒症合并高血压中尉如伴有相角程延长，则提示病情危重，预后不良。因此，核素心室显像可以客观评价尿毒症患者左心室功能，有利于治疗及判断预后。     

核素心室显像对X综合征患者左心室功能的评价

放射性核素心肌断层显像诊断Ｘ综合征的价值已为临床所肯定〔１３〕,而核素心室显像评价Ｘ综合征患者左室功能,特别是在运动负荷状态下左室功能的报道不多。笔者就１２例Ｘ综合征患者核素心室显像结果,与２２例正常对照者和２２例冠心病心绞痛患者进行了比较,现报道...     

核素心室显像评价局部心肌病灶心功能

９ｍＴｃＭＩＢＩ心肌灌注显像对于心肌病变，尤其是冠心病（ＣＨＤ）诊断价值肯定，在心室功能测定方面，核医学检查仍占重要地位，如核素心室显像、门电路心肌平面显像傅立叶分析及左室腔与心肌放射性计数比值测定等〔１、２〕。本研究对照分析了２８例健康人及５６例...     

肺动态显像对瓣膜性心脏病合并肺动脉高压的临床价值

目的 探讨核素肺动态显像对瓣膜性心脏病(简称瓣膜病)合并肺动脉高压(PH)的临床价值。方法 瓣膜病患者140例手术前均行右心导管、肺动态显像、超声心动图检查。按平均肺动脉压力(MPAP)水平分为4组,MPAP<20 mm Hg(1 mm Hg=0.133 kPa)为正常组,20 mm Hg0.05),瓣膜病各组间及对照组与MPAP轻度升高组、中度升高组、重度升高组间差异有显著性(P均<0.001)。②肺动态显像测定的LET与右心导管所测MPAP相关系数r为0.88,超声心动图估测的肺动脉压力与肺动脉收缩压r为0.64。③瓣膜病各组LET与MPAP的符合率分别为71％、78％、81％、100％。④以MPAP≥20mm Hg为标准LET测定肺动脉压力的灵敏度为85％,特异性79％,准确性83％。结论 肺动态显像是一种有效估测瓣膜病合并PH     

二尖瓣脱垂的CT表现

目的了解二尖瓣脱垂的CT表现并探讨CT诊断二尖瓣脱垂的可行性。方法对25例经手术或心脏超声证实的二尖瓣脱垂患者的64层CT心脏图像进行分析。结果所有25例患者均可见收缩期二尖瓣叶突人左心房,并超过瓣环平面2mm。其他CT表现包括瓣叶增厚超过2mm（14例）和腱索断裂（3例）。结论二尖瓣脱垂具有特殊的CT表现,CT能够可靠地诊断二尖瓣脱垂。     

超声心动图在二尖瓣置换术后远期心功能不全病因诊断中的应用

 目的探索超声心动图在二尖瓣置换(MVR)术后远期心功能不全病因诊断中的作用。方法超声随访44例MVR患者术后3个月～13.5a,并根据手术的远期效果,分为心功能不全组(A组)和康复组(B组)。除注意人工瓣和自然瓣的病变外,还分析了这2组手术前后左房、左室内径及左室射血分数(EF)的差异。结果超声显示A组二尖瓣位单组或伴主动脉瓣位双组人工瓣异常5例,其它自然瓣明显病变11例。术后A组的左室内径明显大于B组(P＜0.05),EF值明显小于B组(P＜0.01)。超声心动图提供的信息为36.4％心功能不全代偿期和66.7％失代偿期患者诊断出了导致心功能障碍的主要原因。结论MVR手术前后超声检查对术后远期心功能不全的诊断具有实用价值。     

Fourier phase analysis of SPECT equilibrium radionuclide angiography in symptomatic patients with mitral valve prolapse without significant mitral regurgitation: Assessment of biventricular functional abnormalities suggesting a cardiomyopathy

BACKGROUND: Ventricular premature beats are common in patients with mitral valve prolapse (MVP). The purpose of this study was to determine whether symptomatic patients with MVP had certain functional characteristics and if ventricular arrhythmia (VA) could be explained by functional extravalvular abnormalities. Single photon emission computed tomography equilibrium radionuclide angiography with Fourier phase analysis was preferred to the planar radionuclide method. Only patients without significant mitral regurgitation were studied. METHODS AND RESULTS: A total of 23 symptomatic patients with MVP (13 men, 10 women, mean age, 47+/-14 years) without mitral regurgitation underwent single photon emission computed tomography equilibrium radionuclide angiography. Symptoms were present in 20 patients, and VA was present in 14 patients. Ejection fraction, regional wall motion, and Fourier phase analysis were examined in both ventricles and compared with results for normal subjects. Ventricular abnormalities were observed in 20 (87%) patients: decreased left ventricular and right ventricular ejection fractions, increased standard deviations of the mean phase and focal wall motion, and/or delayed phase abnormalities. Abnormalities were less frequent but more marked in the right ventricular free wall, the infundibulum, or the septum compared with left ventricular delayed abnormalities, which were more frequent but limited. In 12 of 14 patients with VA, phase-delayed areas were observed in the ventricle where the origin of ventricular premature beats was suspected on the basis of their electrocardiographic morphologic features. A relation was found between late potentials and delayed-phase areas (right ventricle or septum) and left bundle branch block morphologic features of VA. CONCLUSIONS: Symptomatic patients with MVP frequently have ventricular dysfunction in 1 or both ventricles, sometimes limited but more marked in the presence of severe VA even without significant mitral regurgitation, suggesting structural modification. The use of a sensitive, accurate, and 3-dimensional method such as single photon emission computed tomography equilibrium radionuclide angiography may be of interest for a noninvasive investigation, especially in young symptomatic patients with MVP and VA.     

ECG-gated multi-detector row CT for assessment of mitral valve disease: initial experience

Our objective was to evaluate applicability and image quality of contrast-enhanced, retrospectively ECG-gated multi-detector row CT (MDCT) for visualization of anatomical details of the mitral valve and its apparatus, and to determine the value of MDCT for diagnosing abnormal findings of the mitral valve. Twenty consecutive patients with mitral valve disease underwent MDCT preoperatively. Two readers assessed visibility of the mitral valve annulus, mitral valve leaflets, tendinous cords, and papillary muscles by using a four-point Likert grading scale. Abnormal mitral valve findings [thickening of the mitral valve leaflets, presence of mitral annulus calcification (MAC), and calcification of the valvular leaflets] were compared with preoperative echocardiography and intraoperative findings. Visibility of the mitral valve annulus and mitral valve leaflets was good or excellent in 15 patients (75%) and in 19 patients (95%) for papillary muscles. The MDCT yielded a 95–100% agreement compared with echocardiography and surgery with regard to the assessment of mitral valve leaflet thickening and the presence of calcifications of the mitral valve annulus or mitral valve leaflets. Intermodality agreement between MDCT and echocardiography was excellent with regard to classification of mitral valve leaflet thickness (κ=1.00) and good regarding classification of MAC thickness (κ=0.73). Contrast-enhanced, retrospectively ECG-gated MDCT allows good to excellent visualization of anatomical details of the mitral valve and its apparatus, and demonstrates good agreement with echocardiography and surgery in diagnosing mitral valve abnormalities. Electronic Publication     

放射性核素心脏显像对SLE患者的临床应用

目的评价系统性红斑狼疮（ＳＬＥ）患者左心室功能。方法用平衡法门电路心室显像及心肌显像测定２０例正常人和３０例ＳＬＥ患者左室收缩和舒张功能。结果ＳＬＥ患者左室射血分数、相角程、高峰射血率、高峰充盈率分别为０５２±０１１、６０８９±１２１２°、３０８±０４８ＥＤＶ／ｓ和２８８±０４７ＥＤＶ／ｓ；正常对照组分别为０６８±００２、５３２５±５２６°、３６６±０５１ＥＤＶ／ｓ和３３４±０８８ＥＤＶ／ｓ。两组比较，ｔ值分别为４５０、３１１、５８０和４６０，Ｐ均＜００１。阳性率为４８６％，心肌显像阳性率为６４％；放射性核素心脏显像检测ＳＬＥ心肌损害的灵敏度为６３％，特异性为８５％。结论放射性核素心脏显像可以客观评价ＳＬＥ患者左心室功能，对发现ＳＬＥ心肌损害及指导治疗有一定意义。     

Dynamic computed tomographic assessment of the mitral annulus in patients with and without mitral prolapse

ObjectivesTo obtain 3D CT measurements of mitral annulus throughout cardiac cycle using prototype mitral modeling software, assess interobserver agreement, and compare among patients with mitral prolapse (MP) and control group.BackgroundPre-procedural imaging is critical for planning of transcatheter mitral valve (MV) replacement. However, there is limited data regarding reliable CT-based measurements to accurately characterize the dynamic geometry of the mitral annulus in patients with MV disease.MethodsPatients with MP and control subjects without any MV disease who underwent ECG-gated cardiac CT were retrospectively identified. Multiphasic CT data was loaded into a prototype mitral modeling software. Multiple anatomical parameters in 3D space were recorded throughout the cardiac cycle (0–95%): annular circumference, planar-surface-area (PSA), anterior-posterior (A-P) distance, and anterolateral-posteromedial (AL-PM) distance. Comparisons were made among the two groups, with p < 0.05 considered statistically significant. Interobserver agreement was assessed on ten patients using intraclass correlation coefficient (ICC) among 4 experienced readers.ResultsA total of 100 subjects were included: 50 with MP and 50 control. Annular dimensions were significantly higher in the MP group than control group, with circumference (144 ± 11 vs. 117±8 mm), PSA (1533 ± 247 vs. 1005 ± 142 mm²), A-P distance (38 ± 4 vs. 32±2 mm), and AL-PM distance (47 ± 4 vs. 39±3 mm) (all p < 0.001). Substantial size changes were observed throughout the cardiac cycle, but with maximal and minimal sizes at different cardiac phases for the two groups. The interobserver agreement was excellent (ICC≥0.75) for annular circumference, PSA, A-P- and AL-PM distance.ConclusionA significant variation in the mitral annular measures between different cardiac phases and two groups was observed with excellent interobserver agreement.     

Abnormal septal motion after aortic valve replacement for chronic aortic regurgitation: no evidence for myocardial ischaemia by exercise radionuclide angiography

To evaluate interventricular septal motion and left ventricular function after aortic valve replacement for chronic aortic regurgitation, we studied 12 patients at rest and during exercise by radionuclide angiography after a mean of 19 (range 12–36) months after operation (group I). Twenty patients with chronic aortic regurgitation without aortic valve replacement served as controls (group II). None of the patients had coronary artery disease as documented by arteriography. Abnormal interventricular septal motion at rest was seen in 11 patients of group I, of whom 8 showed hypokinesis and 3 akinesis. During exercise, the interventricular septal wall motion improved in 4 patients, worsened in 3 patients and did not change in 5 patients. All patients of group II had normal interventricular septal motion at rest. During exercise, 5 patients showed septal wall hypokinesia together with apical and posterolateral wall motion abnormalities. The left ventricular ejection fraction at rest was 62% ± 20% in group I and 66% ± 8% in group II (not significant). During exercise, the left ventricular ejection fraction was 59% ± 24% in group I and 68% ±13% in group II (not significant). We conclude that abnormal interventricular septal motion at rest is commonly found in patients with aortic valve replacement for chronic aortic regurgitation. During exercise, septal wall motion in the patients with aortic valve replacement shows a variable response from complete normalization to akinesia. These findings are mostly associated with a normal global left ventricular function both at rest and during exercise, which precludes myocardial ischaemia as a primary cause for abnormal septal wall motion after aortic valve replacement.     

Heart rate variability in soccer players with mitral valve prolapse or benign arrhythmia

Abstract Numerous studies have reported increased cardiac vagal activity in well endurance-trained athletes. However, no clear data exist regarding the cardiac autonomic activity in athletes with common cardiovascular findings, such as mild mitral valve prolapse (MVP) and transient benign arrhythmias. Therefore, the purpose of this study was to investigate and compare the cardiac autonomic outflow by heart rate variability (HRV) analysis between soccer players with mild MVP and rhythm disorders and other athletes with transient benign arrhythmias but without any structural cardiac disease. Twenty Greek male soccer players with mild MVP (group A, aged 20.2±4.5 years), 20 players with benign cardiac rhythm and conduction disorders without structural cardiac disease (group B, aged 21.0±3.6 years) and 20 healthy age-matched sedentary men (group C) were examined. All subjects underwent clinical evaluation, resting electrocardiogram for QTc calculation, echocardiography and 24-h ambulatory Holter recordings for HRV analysis. The mean 24-h heart rate, the HRV index and the mean 24-h R-R interval were significantly increased in all athletes compared to controls (p<0.05). Moreover, group A presented significantly decreased HRV index compared to group B by 18.2% (p<0.05). Resting QTc was prolonged only in group B compared to groups A and C by 9.5% and 11.2%, respectively (p<0.05), whereas no significant difference was found between groups A and C. It is concluded that athletes with MVP present limited exercise-induced cardiac vagal predominance compared to those with benign arrhythmias and without any structural cardiac disease.     

Left ventricular dimensions during isometric exercise in aortic valve incompetence assessed by M-mode echocardiography and gated equilibrium radionuclide angiography

We compared M-mode echocardiographic and gated equilibrium radionuclide angiography assessement of the left ventricular (LV) dimensions at rest and during isometric exercise in 18 patients with chronic aortic valve incompetence. The two methods showed a satisfactory correlation when comparing LV size at rest and during exercise (LV end-diastolic dimension in echocardiography vs LV end-diastolic volume in radionuclide angiography, r=0.80, P0.01 at rest and r=0.81, P0.01 during exercise; LV end-systolic dimension in echocardiography vs LV end-systolic volume in radionuclide angiography, r=0.81, P0.01 at rest and r=0.75; P0.01 during exercise), but fractional shortening in echocardiography and ejection fraction in radionuclide angiography did not correlate (r=0.27, not significant (NS) at rest and r=0.34, NS during exercise). Thus echocardiography and radionuclide angiography describe LV dimensions at rest and during handgrip exercise in a similar fashion, documenting the concordance of these noninvasive methods to describe LV size in aortic incompetence at rest and during exercise.