M-mode and cross-sectional echocardiographic diagnosis of right ventricular cavity masses

Two patients with metastatic carcinoma (one cervical and one testicular) in whom echocardiography was instrumental in diagnosing a right ventricular cavity mass are presented. In the first case the M-mode echocardiogram revealed dense echoes in the right ventricle and right ventricular outflow tract during systole and diastole. Surgical confirmation of the mass lesion was obtained. The second case also revealed abnormal echoes in the right ventricle and right ventricular outflow tract, but they were less dense and distinct. Two-dimensional echocardiography clearly delineated a highly mobile mass of tissue in the right ventricle which corresponded to the necropsy findings.     

Obstruction of right ventricular outflow tract by extended cardiac metastasis from esophageal cancer

We report a patient in whom there was right ventricular outflow tract obstruction by extended metastasis from esophageal cancer. A 65-year-old man was admitted to the hospital for evaluation of recent onset of weight loss and heart murmur. Esophagogram and endoscopy showed a 10-cm, ulcerative, infiltrative esophageal cancer. This esophageal cancer was histologically proven to be a squamous cell carcinoma. To assess the cardiac metastasis, echocardiography, magnetic resonance imaging, coronary angiography, and endomyocardial biopsy were performed. The magnetic resonance imaging, echocardiography, and right ventriculography revealed a 7-cm lobulated mass extending to the right ventricular outflow tract, right ventricle, septum, and anterior wall of the left ventricle. Interestingly, the feeding vessels of the tumor were identified by echocardiography and coronary angiography. Histologically, the cardiac tumor was proven to be have the same pathologic findings as esophageal cancer, compatible with carcinomatous metastasis.     

Effects of exerimental right ventricular hypertrophy on myocardial blood flow in conscious dogs.

The effects of right ventricular hypertrophy on the overall and regional distribution of myocardial blood flow in the absence of an elevated coronary arterial driving pressure were evaluated in 18 concscious dogs subjected to a chronic pressure overload of the right ventricle induced by pulmonary artery constriction. The sustained pressure overload for duration of 4--6 wk or 4--5 mo resulted in significant increases in right ventricular mass (45 and 110%, respectively) and right ventricular fiber diameter (22 and 60%, respectively). Moreover, the presence of moderate and severe hypertrophy was associated with marked increases in transmural blood flow per gram to the right ventricle proportional to the observed increases in mass, i.e., of 36 and 109%, respectively, from a normal value of 0.67 +/- 0.04 ml/min per g, whereas left ventricular blood flow remained unaltered from a normal value of 1.00 +/- 0.06 ml/min per g. Despite the large increase in blood flow per gram to moderately and severely hypertrophied right ventricle, no significant changes in the ratio of capillary:muscle fiber number were observe. These data suggest that the development of right ventricular hypertroph is characterized by a sustained compensatory response of the coronary circulation to the augmented work load and mass, and that is not associated with a proliferative response of the vasculature supplying the enlarged ventricle.     

Modulation of right and left ventricular wall thicknesses in experimental hypertension

Enalapril maleate and hydrochlorothiazide were administered over an 8-week period to groups of Dahl salt-sensitive and Dahl salt-resistant rats receiving either a high (8%) or low (0.4%) salt diet. Regional differences of interventricular septal thickness, left ventricular free wall thickness, right ventricular free wall thickness, right ventricular weight/body weight ratio, left ventricular weight/body ratio, and heart weights were determined. For salt-sensitive rats of both diet groups, lowering of blood pressure induced by either drug was associated with a reduction in cardiac weight which was localized to the left ventricle. For salt-resistant rats, irrespective of diet, the associated reduction of cardiac mass induced by enalapril maleate was largely confined to the right ventricle. Regional changes in tissue thickness were, however, not always associated with corresponding changes in tissue mass or blood pressure. These regional modulations appeared to be quite dependent on salt intake and the nature of the antihypertensive drug, for a given animal type, suggesting that pressure afterload is not the only factor in the pathogenesis of left and right ventricular hypertrophy. The responses of the right ventricle were not necessarily the same as those of the left ventricle to identical dietary and drug regimens. In all animal groups, ventricular mass and tissue thickness did not always change in the same sense, suggesting that alterations in the nature and packaging of the cellular constituents may be induced by the combined actions of the dietary salt and antihypertensive medications.     

The role of 1.5T cardiac MRI in the diagnosis,prognosis and management of pulmonary arterial hypertension

Cardiovascular magnetic imaging is a noninvasive, three dimensional tomographic technique that allows for a detailed morphology of the cardiac chambers, the accurate quantification of right ventricle volumes, myocardial mass, and transvalvular flow. It can also determine whether right ventricular diastolic function is impaired through pulmonary hypertension. The aim of this article is to review the main kinetic, morphological and functional changes of the right ventricle that can occur in patients affected by pulmonary arterial hypertension (PAH) and to assess how the MRI findings can influence the prognosis, and guide the decision-making strategy. In those cases in which MRI shows a significant cardiac diastolic dysfunction, the prognosis is predictive of pharmacological treatment failure, and mortality. This leaves double lung-heart transplantation as the only therapeutic option. The coexistence of PAH and left ventricle impairment causes worse right ventricle function, leads to a poor prognosis, and may change the therapeutic strategies (for example, PAH associated with left ventricle dysfunction may require a double lung-heart transplant).     

Review of Movahed’s sign (D shaped left ventricle seen on gated SPECT) suggestive of right ventricular overload

Recently, D shaped ventricle seen on gated SPECT imaging (Movahed’s sign) has shown to correlate with right ventricular overload similar to the D shape ventricle seen on echocardiography. Right ventricle (RV) imaging during gated SPECT studies is challenging because of the low tracer uptake due to relatively smaller right ventricular myocardial mass and lower coronary flow to the RV. Increased mass or workload causes higher tracer uptake in the RV wall secondary to increase in RV wall thickness and higher coronary flow. Furthermore, increased RV volume or pressure load can cause displacement of the septum towards the left ventricle causing septal flattening and a D shaped configuration of the left ventricular septum. This is an important finding that should be a part of nuclear gated SPECT interpretation.     

彩色多普勒超声对原发性肝癌伴下腔静脉和右心房转移的诊断价值

目的探讨原发性肝癌伴下腔静脉及右心房转移的超声特征、发生机制及病理过程，为临床提供诊断和治疗依据。方法应用彩色多普勒超声(CDFI)及DSA等对11例原发性肝癌伴下腔静脉及右心房转移患者进行检查。结果11例原发性肝癌伴下腔静脉及右心房转移患者超声均可见肝原发病灶伴肝静脉癌栓阻塞，下腔静脉腔内见中等回声团块，其远端扩张，生理性搏动消失。心脏超声见右心房内大小不等呈椭圆形或不规则的稍高回声团块，其中9例位于右房后壁、2例位于右房侧壁，CDFI见红色血流环绕肿块从三尖瓣流人右室，同时肿块内显示较丰富的动脉血流信号。DsA造影提示癌栓由肝动脉供血。结论超声能显示肝内肿瘤、静脉内癌栓和右心房转移灶的声像图特点以及血流动力学的改变，对后续的检查、手术、介入治疗等追踪观察具有重大的价值。     

Acute cor pulmonale secondary to metastatic tumor to the heart: A case report and literature review

Metastatic tumors to the heart are becoming more common due to improved survival afforded by advanced treatment of malignancies. Their presence should be sought in a cancer patient who develops new primary cardiac symptoms. We present a case of a 50-year-old woman who succumbed to acute cor pulmonale secondary to metastatic laryngeal carcinoma to the right ventricle with subsequent tumor emboli to the pulmonary vasculature.     

Confirmation of a retrosternal mass by echocardiogram

Case report of a 14 year old girl with Hodgkin's disease whose echocardiographic findings showed an anterior mediastinal mass between the right ventricle and the chest wall. The echocardiogram permitted an accurate measurement of the AP diameter of the mass. This technique, in conjunction with chest x ray, provides a means of determining changes in overall mass size as an indication of response to therapy.     

Transesophageal echocardiographic evaluation of right atrial mass lesions

Transesophageal echocardiography with color flow Doppler studies was performed on 10 consecutive patients who had right atrial masses identified by transthoracic echocardiography. In one patient with right atrial myxoma, transesophageal study identified the tumor by its attachment to the atrial septum and ruled out the transthoracic finding of possible additional tumor mass in the right ventricle. In two instances the mass in the atria were deemed to be thrombi because of lack of attachment to the atrial septum, atrial fibrillation, and enlarged right atrial chambers. In all patients, the thrombi appeared larger by transesophageal study and was associated in one instance with atrial septal defect. The atrial septal defect was not identified by the transthoracic study and probably accounted for stroke of the patient through paradoxical emboli. In six patients, because of superior quality images rendered by transesophageal imaging, the right atrial mass lesions were deemed to be anatomic variants, which included prominent eustachian valves, remnants of Chiari network, and thickened atrial septum. We concluded that transesophageal echocardiography is superior to transthoracic imaging in elucidating the cause and significance of right atrial mass lesions and that it helps in guiding appropriate therapy.     

孤立性右心室发育不全彩色多普勒超声心动图诊断

应用彩色多普勒超声心动图（ＣＤＥ）检查５例孤立性右心室发育不全（ＩＲＶＨ），均经手术证实，结果５例ＣＤＥ均正确诊断。本病ＣＤＥ表现是二维超声心动图（２ＤＥ）显示右心室内径明显变小，左心室内径不同程度增大。彩色多普勒（ＣＤ）显示右心室内血流信号明显减少。作者认为ＣＤＥ对本病有特异性诊断价值，诊断关键是２ＤＥ显示右心室内径明显变小。     

心血管MR组织追踪技术定量评估肥厚型心肌病右心室心肌应变

目的 探讨心脏MR组织追踪（CMR-TT）技术评价肥厚型心肌病（HCM）右心室功能的可行性及右心室应变与左心室应变的相关性。方法 对32例HCM患者（HCM组）及32名健康志愿者（对照组）行CMR电影序列扫描,测量心功能及左、右心室应变参数。结果 HCM组左心室质量较对照组明显增高（t=11.26,P<0.001）,其余左心功能参数（左心室射血分数、舒张末期容积、收缩末期容积）2组间差异均无统计学意义（P均>0.05）。与对照组比较,HCM组左心室、右心室整体圆周应变（GCS）、整体径向应变（GRS）和整体纵向应变（GLS）均明显减低（P均<0.05）;除左、右心室基底部径向应变外,HCM组各节段局部应变较对照组减低（P均<0.05）。HCM组右心室GRS与左心室GRS呈正相关（r=0.375,P=0.034）,与左心室GLS呈负相关（r=-0.466,P=0.007）;右心室GCS与左心室GCS、GLS均呈正相关（r=0.531、0.462,P=0.002、0.008）。结论 右心室节段应变、整体应变能敏感地反映HCM右心室心肌收缩功能;HCM患者在左心室射血分数减低前左、右心室心肌收缩功能已存在受损;HCM右心室与左心室心肌收缩功能受损存在一定相关性。     

Tumor extending through inferior vena cava into the right atrium. A late recurrence of renal cell carcinoma

Renal cell carcinoma is a tumor with a distinct feature; it can invade through renal vein to the inferior vena cava (IVC) and growths intravascularly extending sometimes into the right cardiac chambers. Previous reports of renal cancer with extension to the right atrium at the time of diagnosis have been published. We present the case of a patient with a right atrial mass arising from the IVC found by echocardiography, which was subsequently proved to be a recurrence of renal cell carcinoma 5 years after radical nephrectomy.     

Multicentric cardiac myxoma treated with extended surgery

We present the case of a 37-year-old male patient with a multicentric myxoma admitted to hospital with dyspnoea, syncope and chest pain. Physical examination revealed a grade 3/6 systolic murmur at the left lower sternal border and diffuse bilateral lung rales. Transthoracic echocardiography and thoraco-abdominal computed tomography revealed a right atrial mass and a right ventricular mass obstructing the outflow tract. The patient underwent urgent surgical treatment. At operation, a solitary right atrial myxoma and a right ventricular myxoma originating from the tricuspid valve and attached to the free wall of the right ventricle were seen. The tumours were successfully excised and the tricuspid valve was replaced with a No. 33 Omnicarbon metallic valve. The right ventricular free wall was repaired with a glutaraldehyde-treated pericardial patch. Histopathological examination of the tumours confirmed the diagnosis of myxoma. Post-operative recovery was uneventful and there was no recurrence after 1 year's follow-up.     

PDE 研究高血压病左室肥厚各型对右心功能的影响

目的 应用脉冲多普勒超声心动图（ＰＤＥ）对高血压病肥厚各型对右心功能的影响及其临床意义。方法 将１２５例早期原发性高血压病分成４组：无肥厚组３０例,室间隔肥厚组３０例,向心型肥厚组３１例,扩张型肥厚组３４例和正常对照组３０例。对各组间右心功能的差异性进行研究。结果 高血压病早期期可出现右心功能受累。左室肥厚加重右心功能的损害,室间隔肥厚型右心功能受损最重。结论 此项研究为高血压病人右心功能评价及肥     

组织多普勒右室Tei指数评价肺动脉高压患者右心室功能

目的 运用组织多普勒成像技术(tissue Doppler imaging,TDI)测算肺动脉高压患者右心室Tei指数,探讨其在评价不同程度肺动脉高压患者右室功能的临床应用价值以及获取右室Tei指数的合理观测点.方法 入选研究对象为正常对照组和肺动脉高压组,并依肺动脉压力升高的程度将肺动脉高压组分为轻、中、重度3个亚组.组织多普勒分别在心尖四腔切面三尖瓣前瓣附着处、隔瓣附着处及胸骨旁右心两腔切面后瓣附着处记录三尖瓣环运动频谱并测算右室Tei指数.结果 (1)肺动脉高压患者右室Tei指数较正常对照组增高(P<0.05);(2)三尖瓣前瓣附着处取样点所测右室Tei指数在轻、中、重度肺动脉高压组间均有明显差异,且Tei指数与肺动脉压力呈正相关(r=0.75,P<0.05);(3)隔瓣及后瓣附着处取样点所测Tei指数轻、中度组间无显著性差异,重度组较轻、中度组增高(P<0.05).结论 肺动脉高压患者右心室Tei指数升高,提示右心室整体功能降低,且与肺动脉收缩压呈正相关.TDI测量右室Tei指数可较准确反映右室整体功能,为临床评估肺动脉高压患者右心功能提供了一种无创的、新的检测方法.心尖四腔切面右室侧壁三尖瓣前叶瓣环处测定右室Tei指数是较为理想的测定点.     

急性右室心肌梗塞的二维超声心动图特征

目的：研究右心室梗塞（ＲＶＩ）的二维超声心动图特征;方法：１０例于发病第一周或第二周的急性右室梗塞患者应用二维超声心动图检查,结果：７例右室下后壁节段异常;４例右室游离壁无运动;３例室间隔运动异常,其中１例矛盾运动,２例运动增强,４例右室扩大,４例右房扩大;同时伴有左室壁节段运动异常。结论：右室梗塞多与左室梗塞并存,在右室壁节段运动异常存在的同时,并有左室壁节段运动异常。     

Surgical management of pulmonary atresia, and critical pulmonary stenosis with intact ventricular septum

Our experience with the surgical management of hypoplastic right ventricle with intact ventricular septum has included 20 patients with pulmonary atresia and 3 patients with critical pulmonary stenosis. Group 1 consisted of 7 infants who were treated by transarterial pulmonary valvotomy. Four of them were lost shortly after surgery. Group 2 included 11 neonates and one infant who were treated by systemic-pulmonary shunt with 2 operative death. Group 3 included 4 infants who underwent primary prosthetic enlargement of the right ventricular outflow tract. Two of the 4 were lost in the early postoperative period. Eight of 13 patients in groups 1 and 2 who survived the initial palliative procedures underwent additional operations to enlarge the right ventricular outflow tract, and 5 patients survived. However, adequate right ventricular and tricuspid valve growth was obtained in only patients in whom the prosthetic enlargement of the right ventricle was performed in early infancy. These findings strongly suggest the necessity to decompress the right ventricle completely, as early as possible. In conclusion, 1) transarterial pulmonary valvotomy seldom provided satisfactory decompression of the right ventricle, and operative risk was high. 2) systemic-pulmonary shunt to re-establish pulmonary blood flow improved neonatal survival, although this procedure may not provide a satisfactory long term palliation. 3) primary or secondary operative enlargement of the right ventricle in early infancy provided decompression of the right ventricle and accelerated substantial right ventricular growth. For patients without an infundibulum or for those in whom attempts to induce tricuspid valve growth had failed, a Fontan type procedure seemed to be the procedure of choice.     

急性肺血栓栓塞症患者右室长轴应变及应变率变化的初步研究

目的：观察急性肺血栓栓塞症（APTE）患者右室压力负荷增加后右室长轴应变、应变率变化特点,并寻找可能判断右心功能不全的有效参数。方法：采集21例APTE患者及30例健康自愿者心尖四腔切面的二维图像,在组织速度显像（TV I）模式下应用应变、应变率成像技术测量右室游离壁及室间隔的基底段、中间段、心尖段心内膜下心肌收缩期峰值应变、应变率,进行分析研究。结果：APTE患者肺动脉压中度增高后,右室游离壁及室间隔基底段、中间段收缩期应变和应变率代偿性增强,左室收缩功能变化不大,而舒张功能轻度减低;APTE患者肺动脉压重度增高后,右室各节段收缩期应变和应变率较对照组均明显减小,以右室游离壁中间段变化最为明显,同时左室、右室收缩功能均减低。以右室游离壁中间段作为代表节段,以收缩期应变小于-15%,应变率小于-1.2s^- 1作为APTE时右心功能可能失代偿的参考指标。结论：应变、应变率技术是评价急性肺血栓栓塞症患者右室收缩功能变化的一种敏感、有效的方法。     

甲状腺功能亢进性心脏病左心结构与功能临床研究

目的探讨甲状腺功能亢进（甲亢）性心脏病（HHD）病人左心功能与结构的改变和早期诊断。方法应用彩色多普勒超声显像仪检测31例单纯甲亢和65例HHD病人左、右心室舒张末期内径（LV、RV）,舒张末期左心室后壁及室间隔的厚度（IVS、LVPW）,收缩末期左、右心房横径（LA、RA）;测量左心室舒张早期（E峰）及舒张晚期（A峰）二尖瓣最大血流速度,左心室射血分数（EF）。计算左心室质量（LVM）、左心室质量指数（LVMI）及舒张早晚期的最大血流速度比值（E/A）,并与30例正常对照组比较。结果HHD病人早期LVMI明显高于对照组和单纯甲亢组,二尖瓣血流频谱E/A比值明显低于对照组和单纯甲亢组（F=5.47、20.32,q=4.93～5.10,P〈0.01）,而早期EF与对照组比较差异无显著性（P〉0.05）。HHD病人早期左心房、左心室大于单纯甲亢组和对照组,右心房、右心室无明显的变化,晚期右心房、右心室大于HHD早期和单纯甲亢病人。HHD晚期EF低于对照组,差异有显著性（F=5.03,q=4.87,P〈0.01）,单纯甲亢病人EF高于对照组,差异有显著性（q=5.02,P〈0.01）。结论甲亢病人左心室收缩功能增强。HHD病人早期出现左心舒张功能不全,收缩功能正常,晚期出现收缩功能不全。HHD病人先左心扩大,晚期全心扩大。LVMI结合E/A可早期诊断HHD。