DTI评价完全性左束支传导阻滞室患者心室除极顺序

目的 本文探讨多普勒组织成像（ＤＴＩ）技术评价完全性左束支传导阻滞（ＣＬＢＢＢ）患者心室除极的可行性。方法 应用多普勒组织加速度图及脉冲频谱图检测１０例ＣＬＢＢＢ患者心室除极顺序,并与正常组（２５例）进行对照。结果 （１）ＣＬＢＢＢ心这到了早除极部位位于右室前壁心尖段,与正常组迥然不同,;（２）剑下四腔切面显示ＣＬＢＢＢ心 室除极顺序为：右室前壁心尖、室间隔心尖、右室前壁全部、室间隔全部、左室前侧     

多普勒组织成像技术评价束支传导阻滞患者的心室肌除极状态

目的： 拟在探讨ＤＴＩ技术评价束支传导阻滞患者的心室肌电除极状态的准确性。方法： 应用ＤＴＩ技术的速度模式及加速度模式观察３８ 例经体表心电图证实为束支传导阻滞, 其中２０ 例完全性右束支传导阻滞（ＣＲＢＢＢ）、１８例完全性左束支传导阻滞（ＣＬＢＢＢ） 患者的异常心室肌除极起源与顺序,并与２５例心电图完全正常的健康志愿者相对照。结果： ①加速度图上ＣＲＢＢＢ组的心室除极起源与正常组无差异（Ｐ＞ ０．０５）, 均位于室间隔, 并由室间隔向四周扩布激动; 而ＣＬＢＢＢ组的心室最早除极点位于右室前壁心尖, 其产生的除极扩布过程与正常组、ＣＲＢＢＢ组迥异（Ｐ＜ ０．００１）; ②胸骨旁左室长轴切面上Ｍ 型速度图显示ＣＲＢＢＢ组左室除极正常。其室间隔及左室后壁自心电激动开始（心电图Ｑ波起始） 至收缩带出现的时限与正常组无显著差异 （Ｐ＞ ０．０５）; 而ＣＬＢＢＢ组左室除极则明显延缓。左室后壁收缩带推迟出现, 与正常组、ＣＲＢＢＢ组均有显著差异（Ｐ＜ ０．０１）; ③心尖区四腔心、二腔心及左室长轴切面上脉冲频谱型速度图显示ＣＲＢＢＢ组右室前壁基、中部收缩延迟。自心电激动开始（心电图Ｑ波起始） 至右室前壁基部、中部收缩波起始的时间间隔较正常组     

DTI评价完全性左束支传导阻滞患者心室除极顺序

目的本文探讨多普勒组织成像（ＤＴＩ）技术评价完全性左束支传导阻滞（ＣＬＢＢＢ）患者心室除极的可行性。方法应用多普勒组织加速度图及脉冲频谱图检测１０例ＣＬＢＢＢ患者心室除极顺序,并与正常组（２５例）进行对照。结果①ＣＬＢＢＢ心室最早除极部位位于右室前壁心尖段,与正常组迥然不同（Ｐ＜０．０００１）;②剑下四腔切面显示ＣＬＢＢＢ心室除极顺序为：右室前壁心尖、室间隔心尖、右室前壁全部、室间隔全部、左室前侧壁心尖、左室前侧壁全部;正常人心室除极顺序则为：室间隔基中部、室间隔心尖、右室前壁心尖及左室前侧壁心尖、右室前壁全部、左室前侧壁基部。③和正常组比较,ＣＬＢＢＢ患者右室前壁电除极收缩耦联正常（Ｐ＞０．０５）,而各左室壁除极明显延迟（Ｐ＜０．０００５）,前间隔除极方向由心尖指向心底。结论能显示心室肌收缩顺序的ＤＴＩ技术可直观、实时、精确地反映ＣＬＢＢＢ的心室电除极状态。     

曲线M型组织速度图与应变率图评价右心室起搏时心室收缩顺序的对照研究

目的　评价组织多普勒曲线M型 (CMM )技术检测右心起搏时心室肌的收缩起源和顺序的可行性 ,并比较其组织速度图 (TVI)和应变率图 (SRI)两种成像模式的特点。方法　应用CMM的TVI和SRI成像模式 ,结合同步记录的心电图 ,分别在心尖四腔观、左室两腔观以及心尖左室长轴观评价 2 5例安装右心起搏器患者与 2 0例健康成人局部心肌收缩 (或形变率 )的先后次序。结果　①正常心肌的收缩起源位于室间隔中部 ,室间隔中部早于心尖部收缩的显示率为 90 %;而右心起搏心律组则显示室间隔心尖部最先收缩 ,TVI图和SRI图显示室间隔心尖早于中部、基底部心肌收缩的比例为 84%和 92 %;正常心肌和右心起搏心肌间的差异有显著意义 (P <0 .0 0 1)。②右心起搏心肌的心室收缩顺序与正常心肌迥异。右室游离壁心尖部和室间隔心尖最早除极收缩 ,右室游离壁较室间隔中部、基底部心肌收缩早 ;左室的侧壁、前壁和左室后、下壁心肌的收缩明显延迟 (P <0 .0 5～ 0 .0 0 5 ) ,并呈现由心尖至心底方向依次收缩减慢的特点。结论　高帧频的组织多普勒曲线M型的速度和应变率曲线 ,为超声准确客观地评估心肌电活动状态提供了全新的定量工具 ,具有广阔的临床应用前景。     

DTI无创性评估完全性右束支传导阻滞的电除极状态

目的探讨多普勒组织成像技术评价完全性右束支传导阻滞（Ｃｏｍｐｌｅｔｅｒｉｇｈｔｂｕｎｄｌｅｂｒａｎｃｈｂｌｏｃｋ,简称ＣＲＢＢＢ）除极的可靠性及精确性。方法应用ＤＴＩ速度图,加速度图观察２５例ＣＲＢＢＢ患者的心室除极起源及顺序,并与２５例正常者对照。结果①加速度图显示ＣＲＢＢＢ患者的心室除极起源位于室间隔区,与正常者无显著差异（Ｐ＞０．０５）;②胸骨旁左室长轴切面Ｍ型速度图显示ＣＲＢＢＢ患者的左室除极与正常者无显著差异（Ｐ＞０．０５）,室间隔除极较左室后壁明显提早（Ｐ＜０．００５）;③心尖四腔切面脉冲频谱型速度图显示ＣＲＢＢＢ患者的右室前壁基、中部除极较正常者明显延迟（Ｐ＜０．０００５）。结论本研究表明ＤＴＩ显示的ＣＲＢＢＢ心室除极状态与心电生理研究结果相一致。ＤＴＩ可直观实时、准确无创地评估心电活动,是心电生理学研究的重要补充。     

闭合伤致右室壁大面积破裂自然存活1例

患者,男,３４岁。车祸胸外伤２０小时,急诊入院。查体：血压正常,呼吸略促,神清,右胸第４、５肋间区有皮肤擦伤,压痛阳性;心界略大,心率９５次／分,律齐。胸片示：心影增大,右心缘饱满,右胸第４、５肋骨线性骨折。心电图示：窦性心率,电轴右偏,不完全性右束支传导阻滞,急性右室损伤,酷似心肌梗死心电图改变。超声心动图检查,心尖四腔心示：心包完整,回声略强,右室增大,右室壁可见收缩期３．６ｃｍ,舒张期５．０ｃｍ的连续中断。断裂的右室壁前心包呈“憩室”样改变,见一７．８×２．８ｃｍ的局限液暗区,暗区上下端回…     

人工心脏起搏术后囊袋并发症的观察与防护

我们回顾分析了我院 1997年 3月以前 16例永久起搏患者囊袋并发症的常见原因 ,对 1997年 3月至 2 0 0 0年 8月安置的 2 7例永久起搏器患者加强了观察与防护 ,减少了并发症 ,现报告如下。1　临床资料安置永久起搏器 43例中男 30例 ,女 13例 ,19～ 82例 ,1997年 3月前的16例为Ａ组 ,此后 2 7例为Ｂ组 ,两组患者性别、年龄、诊断、心功能均无明显差异。Ａ组安装起搏器类型为ＶＶＩ型 15例 ,ＡＡＩ型 1例 ,Ｂ组安装起搏器类型为ＤＤＤ型 7例 ,ＤＤＤＲ型 6例 ,ＶＶＩＲ型 11例 ,ＶＡＩ型 3例。Ｂ组由于起搏器重量减轻 ,并加强了对囊袋并发症的观…     

维拉帕米对先天性心脏病左室心钠素的影响

在２２例先天性心脏病患者（ＣＨＤ）行右心导管检查中，通过检测应用维拉帕米（ＶＰ）前后的右室血浆心钠素（ＡＮＦ）浓度和血流动力学变化。结果显示：①应用ＶＰ前ＡＮＦ与平均肺动脉压（ｍＰＡＰ）明显正相关；②应用ＶＰ后伴肺动脉高压（ＰＡＨ）的ＣＨＤ患儿ＡＮＦ浓度与ｍＰＡＰ均明显降低；而肺动脉压正常患儿无明显变化。③ＶＰ对平均右房压，平均右室压和平均心率均无影响，本文提示钙拮抗剂－维拉帕米可降低ＣＨＤ伴ＰＡ     

彩色多普勒显像对室间隔缺损合并主动脉瓣脱垂的诊断和鉴别

目的： 分析室间隔缺损 （ＶＳＤ） 合并主动脉瓣脱垂 （ＡＶＰ） 的超声心动图特征和与主动脉窦瘤的鉴别。方法： １８ 例ＶＳＤ 合并ＡＶＰ 患者进行二维超声心动图 （２ＤＥ） 和彩色多普勒血流显像 （ＣＤＦＩ） 检查并被手术证实。结果： 超声检查发现ＡＶＰ 右瓣１３ 例, 无瓣３ 例; 右瓣和无瓣及左瓣各１ 例。１８ 例２０ 个ＶＳＤ, 超声漏诊干下ＶＳＤ１ 个,分型错误 ２ 例。室间隔缺损类型以干下型多见, 其次为膜周型。超声测定ＶＳＤ 大小１０ 例小于手术。当ＡＶＰ 明显时,超声表现为瓣叶延长、变形、移位和主动脉瓣返流。结论： ２ＤＥ 和ＣＤＦＩ可评价主动脉瓣病变程度, 对外科手术修复ＶＳＤ 和ＡＶＰ 提供有价值的信息。     

急性左室心肌梗死合并右室梗死心电图分析

１资料与方法 我院自１９９５－１９９９年收治的急性心肌梗死患者１２０例,男８５例,女３５例,年龄３５－７８岁。其中左室下壁梗死５８例,左室前壁梗死６２例。所有病例入院时除常规作 １２导联心电图外,还作右胸导联（Ｖ３Ｒ－Ｖ８Ｒ）,判定是否合并右室梗死。２结果 右室梗死的心电图诊断标准为,Ｖ４Ｒ加上１个或１个以上其他右胸导联ＳＴ段抬高≥０．１ｍＶ,符合上述诊断标准者共２６例,男２０例,女６例,年龄４２～７８岁。其中左室下壁梗死合并右室梗死１６例,左室前壁合并右室梗死１０例。起病到记录心电图时间最短 ２．…     

Unusual Electrocardiographic Pattern During Transvenous Pacing From the Middle Cardiac Vein

This report documents the unusual occurrence of a left bundle branch block pattern of ventricular depolarization during permanent pacing from the middle cardiac vein. All previous reports of ventricular pacing from the middle cardiac vein have described a right bundle branch block pattern of ventricular activation (dominant R-waves in the right precordial leads), except in one case where both right and left bundle branch block patterns occurred at separate times. A high posterior infarct allowed early activation of the right ventricle from the middle cardiac vein. Undue reliance on the electrocardiogram may detract from the diagnosis of electrode malposition.     

致心律失常性右室发育不良临床观察

致心律失常性右室发育不良（ＡＲＶＤ）临床少见，常表现反复发作室性心动过速（室速）。笔者回顾近６年收治的７例患者认为：对反复发作左束支传导阻滞（ＬＢＢＢ）型室速患者，如未发作时心电图呈不完全性右支传导阻滞，Ｖ＿１～Ｖ＿４导联见Ｅｐ－ｓｉｌｏｎ波，超声心动图等检查发现右心室形态和／或功能异常，在排除其它疾病后应考虑本病。本文４例用药无效，而用射频消融术，疗效显著。     

Reinitiation of ventricular macroreentry within the His-Purkinje system by back-up ventricular pacing - a mechanism of ventricular tachycardia storm

BACKGROUND: We describe immediate reinitiation of macroreentry ventricular tachycardia (VT) involving the His-Purkinje system by ventricular pacing from the electrode of an implantable cardioverter defibrillator (ICD) as a mechanism of VT storm refractory to ICD therapy. METHODS AND RESULTS: Repetitive reinitiation of bundle branch reentry tachycardia (BBRT), interfascicular tachycardia, or both VTs by ventricular pacing was identified in four ICD patients presenting with VT storm or incessant VT. All patients had a pre-existing prolonged HV interval (75 +/- 9 ms) and left bundle branch block (LBBB) or bifascicular block during sinus rhythm. The VTs included BBRT with LBBB in three patients and interfascicular tachycardia with right bundle branch block (RBBB) and left anterior or left posterior fascicular block in two patients. The paced beats from the ICD electrode exhibited a LBBB pattern of depolarization in two patients and a RBBB contour in V1 and V2 with left axis deviation in two patients. The QRS complex during pacing from the ICD electrode closely resembled that of the recurrent VT in all four patients suggesting that the pacing site of the ICD electrode was in proximity to the myocardial exit site of the bundle fascicle used for antegrade conduction during the reinitiated VT. Ventricular pacing from the ICD electrode after termination of the VT apparently encountered the retrograde refractoriness of this bundle fascicle and allowed immediate re-propagation of the wavefront orthodromically along the VT circuit. BBRT was eliminated by ablation of the right bundle branch. Successful ablation of the interfascicular tachycardias was achieved by targeting (1) an abnormal potential of the distal left posterior Purkinje network or (2) a diastolic potential during VT in the midinferior left ventricular (LV) septum. CONCLUSIONS: Repetitive reinitiation of BBRT and interfascicular tachycardia by ventricular pacing from the ICD electrode should be considered as a mechanism of VT storm refractory to ICD therapy in patients with a pre-existing conduction delay within the His-Purkinje system.     

超声组织追踪和应变率显像技术评价冠心病左室收缩功能

目的探讨超声组织追踪成像(TTI)和应变率成像(SRI)评价冠心病患者左室收缩功能的临床价值,比较TTI和SRI两种方法评价左室收缩功能敏感性的差异.方法A组22例健康人群,B组20例左前降支和18例右冠状动脉狭窄的冠心病患者,应用组织速度成像(TVI)技术于心尖四腔切面、心尖两腔切面、心尖左室长轴切面上显示后间隔、下壁、前壁及前间隔的图像,并应用TTI及SRI定量测量并分析左室11个节段收缩期峰值位移值及收缩期最大应变率.结果B组各节段的各项指标较A组明显减低.冠心病组总节段数为208个,TTI、SRI检出异常节段数分别为141、126个,检出比例分别为67.79%、60.58%.结论TTI和SRI技术能准确地定量评价冠心病患者的左室收缩功能,对左室收缩功能评价TTI与SRI结果之间无明显统计学差异.     

肥厚型(左室)心肌病右室舒张功能的临床研究

目的：1．应用无创伤性频谱多普勒技术研究左室非对称性肥厚型心肌病(HCM)患者的右室舒张功能；2．探讨HCM患者右室舒张功能的可靠、准确的各项指标及其临床价值。方法：应用彩色多普勒超声诊断仪结合标I导心电图，对19例HCM患者及13例正常对照组人群的右室舒张功能进行研究。结果：1．HCM患者舒张早期E峰流速、E峰流速积分显著降低，舒张早期E峰减速时间明显延长，E峰减速度显著下降，E／A比值下降(P＜0．001)，舒张晚期A峰流速、A峰流速积分显著性增加（P＜0．01)；2．HCM思者的等容收缩时间(ICT)、等容舒张时间(IRT)均相对延长，右室射血时间(ET)明显缩短(P＜0．001)，二组的C指数之间亦存在显著性差异(P＜0．001)；3．C指数与ET、(IRT十ICT)间有显著性相关关系(r分别为0．81、0．66，P＜0．001)，C指数与IRT、ICT、ICT／ET间无相关关系。结论：1．HCM思考的右室舒张功能明显减退，右室等容舒张时间延长、舒张早期主动松弛和快速充盈速率降低、舒张晚期右房收缩功能增强，在频谱多普勒超声心动图上表现为IRT明显延长，E、ET、DC、E／A和EI／AI明显降低，A、AI和Td显著增高(P＜0．01～＜0．001)；2．HCM思考的右室收缩功能亦受到负面影响，在频谱多普勒超声心动图上表现为ICT显著延长，ET明显缩短(P＜0．001)；3．应用同时反映右室收缩和好张功能的Tei指数(C)的研究结果表明，正常对照组和HCM组间存在显著性差异(P＜0．001)。     

Unusual Features of Right and Left Idiopathic Ventricular Tachycardia Aholished hy Radiofrequency Catheter Ablation

Two unusual cases are presented with idiopathic right and left ventricular tachycardia(IVT) with intriguing clinical and electrophysiological characteristics. The first patient with a sustained IVT of right ventricular outflow tract origin, and an electrophysiological mechanism suggesting reentry, had been resuscitated from cardiac arrest. The second patient had an IVT with a left bundle branch block morphology, which originated from the basal-septal region of the left ventricle(left ventricular outflow tract tachycardia). Both patients were cured with radiofrequency catheter ablation, guided by endocardial activation sequence and pace mapping.     

Monomorphic Right Ventricular Tachycardia in a Patient with Mitral Valve Prolapse

A patient with mitral valve prolapse and symptomatic ventricular ectopy underwent an electrophysiological study during which a sustained monomorphic ventricular tachycardia with a left bundle branch block/right axis deviation morphology was induced. This morphology was replicated by pace mapping at the right ventricular outflow tract. To the best of our knowledge, this finding has not been previously described and suggests that the association between ventricular arrhythmias and mitral valve prolapse may not necessarily be causal.     

Right Ventricular Radiofrequency Ablation of Ventricular Tachycardia After Myocardial Infarction

Radiofrequency transcatheter ablation of ventricular tachycardia in the setting of a prior myocardial infarction is typically performed with application of energy to the left ventricular endocardium. In this article, two cases are described in which successful radiofrequency transcatheter ablation of ventricular tachycardia occurred with energy delivery to the right ventricular septum after failed ablation attempts from the left ventricle. Both patients had tachycardias with a left bundle branch block morphology and markedly presystolic activity recorded from the right ventricular septum. Right ventricular septal activation mapping during ventricular tachycardia should be performed in patients with left bundle branch block tachycardia morphology and coronary artery disease to maximize efficacy of the catheter ablation procedure.     

组织多普勒成像评价左束支传导阻滞时不同步心室活动

目的超声评价左束支传导阻滞(LBBB)患者局部心肌的纵向运动。方法超声测量15例LBBB患者和15例正常人各瓣环，获得纵向上不同时相的峰值速度(VS、VE、VA)、持续时间(IVC、S、IVR、D)、最大时间-速度积分(TVImax)和最大下移距离(Dmax)，以及心电图QRS波起点到S波起点的时间(Q-Sb)、到S波顶点的时间(TTP)、E波的减速时间(Edc)等。结果LBBB患者左室室间隔、下后壁和前壁瓣环VS、VE、TVImax、Dmax明显减低，Q-Sb、TTP明显延长；左室室间隔、下后壁的IVC、IVR延长，D缩短，IVC／S增高。结论LBBB时左室激动顺序异常，引起左室整体和局部舒缩功能异常；左室各壁出现不同程度的收缩延迟，心室内不同步明显；右室收缩延迟不明显，左、右心室间明显不同步。     

Body Surface Laplacian Mapping in Patients with Left or Right Ventricular Bundle Branch Block

Body surface Laplacian maps (BSLMs) have been previously reported to provide enhanced capability in localizing and resolving multiple spatially separate myocardial events. However, only a few studies have been reported on the clinical applications of BSLM. To test the clinical utility of BSLMs, BSLMs and body surface potential maps (BSPMs) during ventricular depolarization for complete right or left ventricular bundle branch block (CRBBB or CLBBB) were studied in ten patients in each group. As a control group, ten healthy subjects were also studied using the same procedure. One hundred and twenty-eight electrodes were placed uniformly over the entire chest and back of the subjects. BSLMs were computed from recorded potentials, using a numerical algorithm. The BSLMs showed multiple and more localized positive and negative activities compared with the BSPMs. In healthy subjects, the BSLMs showed multiple areas of positive activity overlying the RV, LV, and the RV outflow, and negative activity corresponding to RV free-wall breakthrough and LV anterolateral breakthrough sites, whereas the BSPMs could not separate RV and LV activities. In the patients with CRRRR, the BSLMs showed more localized areas of activity corresponding to the LV apex breakthrough and LV lateral breakthrough, and separated LV lateral and posterior activation. In the patients with CLBBB, the BSLMs showed multiple RV activation, and propagating activation of LV from lateral to posterior. The BSLMs appear to provide enhanced capability in detecting multiple ventricular electrical events associated with normal and abnormal conduction and a more detailed activation sequence of both ventricles in healthy subjects and in the patients with CRBBB and CLBBB. BSLM may provide an important alternative to other imaging modalities in localizing cardiac electrical activity noninvasively.