右肺动脉异常起源于升主动脉1例

患者女,5个月,因哭闹后全身紫绀5个月入院治疗.查体:神志清晰,两肺部未听及罗音,心率130次/min,律齐,未闻及杂音,P2亢进,未触及震颤.数字式心电分析仪:窦性心动过速,左右心室肥大.胸片:肺充血,肺动脉弓突出,右心室稍增大,左第三弓饱满.MRI扫描,动脉导管未闭,肺动脉端直径8.1mm,肺动脉总干扩张,左肺动脉发育可,起源于肺动脉总干,右肺动脉异常起源于升主动脉瓣窦上方,扩张明显.诊断:右肺动脉异常起源于升主动脉,PDA,左心房,左心室扩大,室间隔缺损不能排除,建议行心血管造影检查.     

Concurrent dissections of ascending aorta and right coronary artery during primary coronary angioplasty

We present a case of dissection in ascending aorta (AA) accompanying dissection of the right coronary artery (RCA) during transfemoral primary coronary angioplasty (PCA) for acute inferior myocardial infarction (MI). To our best knowledge, this is the first case of dissection both in AA and RCA during angioplasty for acute MI. The dissection in RCA was caused by balloon inflation during PCA. Most probably, an angiographically invisible retro-dissection in RCA resulted in the dissection in AA. A computed tomography (CT) confirmed the diagnosis of aortic dissection that was restrained in AA. The patient was treated conservatively. Five days after the event, a control CT demonstrated that the false lumen in AA disappeared and the dissection was healed entirely.     

Angiographic diagnosis of aorto-right atrial fistula from acute dissecting aneurysm of the ascending aorta

An uncommon complication of acute dissecting hematoma of the aorta is rupture into a right heart chamger. We report a case in which the dissecting hematoma ruptured into the right atrium in addition to causing aortic valve incompetence. These features were diagnosed angiographically. Thereafter, successful surgical repair was performed.     

Anomalous origin of the right pulmonary artery from the ascending aorta: Diagnosis by magnetic resonance imaging

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital anomaly. Magnetic resonance imaging (MRI) was performed on three patients with anomalous origin of the right pulmonary artery from the ascending aorta. ECG-gated, Tlweighted, spin-echo MRIs and cine MRIs were obtained. In one patient, postoperative MRI was also obtained. Echocardiography and cardiac catheterization were performed in three patients and angiocardiography was performed in two. MRI clearly showed anomalous origin of the right pulmonary artery from the posterior aspect of the ascending aorta, as well as combined anomalies including patent ductus arteriosus, aortopulmonary window, and interruption of the aortic arch in all three patients. Echocardiography missed this anomaly in all three. We suggest that MRI is an accurate imaging modality in diagnosing anomalous origin of the right pulmonary artery from the ascending aorta, obviating the need to perform angiocardiography     

Estimation of total coronary artery flow using measurements of flow in the ascending aorta

This paper describes a technique for estimation of total (right + left) coronary artery flow using MRI flow measurements in the ascending aorta. The technique is based on the principle that the flow in a vessel branch is equal to the difference of the net flow measured above and below the branch ostia. Aortic net flow is measured at four or more axial oblique slices from below the aortic valve to above the highest location of the coronary vessel ostia in late diastole. A flow model properly interprets the flow measurements in slices that contain the coronary ostia. Results in five normal subjects show that total coronary artery flow can be measured with a standard error of about 90 cc/min, 30% of total coronary artery flow. Potential clinical uses include noninvasive measurement of coronary flow reserve. Pulse sequence improvements are necessary to reduce examination time and improve accuracy and precision.     

Volume visualization of the ascending thoracic aorta using isotropic MDCT data: protocol optimization

OBJECTIVE: The purpose of this article is to review in detail the optimization of data acquisition, reconstruction, and postprocessing for imaging the ascending aorta with 64- and dual-source 128-MDCT. CONCLUSION: Interpretative success necessitates careful adherence to protocols that maximize dataset resolution and relies on routine use of all of the postprocessing tools available to optimally evaluate the ascending aorta, aortic valve, heart, and coronary arteries.     

320排容积CT三种心电扫描模式在胸腹主动脉CTA中的应用

目的探讨320排容积CT胸腹主动脉成像（CT angiography,CTA）在三种心电扫描模式下的图像质量及辐射剂量,为患者提供个性化扫描方案。方法183例疑似主动脉疾病患者随机分为三组。采用前瞻Wide-Volume扫描（A组）;前瞻性心电门控螺旋扫描（B组）;VHP扫描（可变螺距螺旋扫描）（C组）。每组再根据心率分成两个亚组,亚组1心率〉70次／min,亚组2心率〈70次／min。获得的6组图像数据分别进行图像处理,由2名有经验的放射科医师评价图像质量并进行统计学分析。结果183例患者全部获得满意图像质量。三组中,前瞻性心电门控螺旋扫描获图像质量最佳（主动脉评分-x=1．04分;冠状动脉评分-x=1．18分）,辐射剂量最低（-x=13．62mSv）,在低心率组（〈70次／rain）扫描时间最短（-x=14．1s）;前瞻Wide-Volume扫描在高心率组（〉70次／min）扫描时间最短（-x=14．5s）;VHP扫描辐射剂量最高（-x=24．04mSv）。各组间对比剂用量差异无统计学意义（A组-x=78．1ml;B组-x=79．6ml;C组-x=80．2ml,P〉O．05）。结论前瞻性心电门控螺旋扫描适用较低心率患者（心率〈70次／min）,前瞻Wide-Volume扫描适用于较高心率患者（心率〉70次／min）,VHP扫描辐射剂量较高,对比前两种方法无明显优势。     

Compression of the right pulmonary artery by a dissecting aneurysm of the ascending aorta. Value of x-ray computed tomography

Right pulmonary artery compression by a dissecting aortic aneurysm-value of computed tomography. The authors relate a case of dissecting aortic aneurysm occurring as a late complication of aortic valve replacement and causing right pulmonary artery compression. Computed tomography appears to be performing technique for the exploration of this unusual case.     

Traumatic laceration of the ascending aorta: angiographic assessment

Radiographic evaluation of ascending aortic injuries is rare because they are almost always immediately fatal. We report three cases of ascending aortic laceration studied by angiography, with a review of the literature and discussion of mechanisms of injury. The type of deceleration trauma resulting in ascending aortic laceration differs from the usual driver deceleration injury in that no attenuation of force on the victim occurs at the time of impact. Traction-torsion forces on the aorta at points of fixation and increased intraluminal aortic pressure are the likely mechanisms of rupture. Adequate angiographic evaluation of these patients requires visualizing the entire aortic arch from aortic valve to diaphragm.     

Sonographic demonstration of the right ascending lumbar vein

The right ascending lumbar vein has not previously been described in the sonographic literature. This vein is an important part of the abdominal prevertebral anastomotic network and appears sonographically as an anechoic tubular structure lying dorsal and parallel to the inferior vena cava. It was detected in 14 of 20 randomly selected patients who underwent routine abdominal sonography and had a mean diameter of 2.0 mm +/- 0.8 SD. In another six patients with abnormal blood flow in the inferior vena cava, dilated lumbar veins were demonstrated.