双腔右心室的超声诊断

目的　总结超声诊断双腔右心室 (DCRV)的经验。方法　回顾分析 2 0例经手术证实为先天性 DCRV的超声特点 ,并与手术结果对照。结果　超声诊断与手术结果相符者 17/2 0例 ,符合率 85 %。 18例合并室间隔缺损 (VSD) ,1例合并右心室流出道狭窄 ,2例合并肺动脉狭窄。超声测得的狭窄程度与手术测量结果无显著差异。结论　超声心动图是目前诊断 DCRV的首选最佳技术     

彩色多普勒超声心动图对右心室双腔心的诊断价值

目的回顾探讨彩色多普勒超声心动图在右心室双腔心中的诊断价值。方法比较右心室双腔心手术患者22例的术前彩色多普勒超声心动图诊断和术后结果。结果超声心动图诊断和术后诊断符合率95%(21/22),其中2例为单纯右心室双腔心,20例右心室双腔心合并室间隔缺损,2例右心室双腔心合并肺动脉瓣狭窄。结论彩色多普勒超声心动图诊断右心室双腔心及其合并症的主要手段,具有安全、准确、直接的优点。     

双腔右心室的诊断和治疗

１９８８年１月至１９９４年３月，手术治疗双腔右心室３３例。其中合并室间隔缺损３１例，室间隔缺损伴肺动脉瓣狭窄及单纯性各１例。均在体外循环下行心内直视手术，效果满意。彩色多普勒超声心动图有助于本病的术前诊断。并从病理解剖学角度对右心室异常肌束进行讨论，提出诊断与手术要点。     

超声心动图诊断右心室黏液瘤1例

正黏液瘤是心脏最常见的良性肿瘤,好发于左心房者诊断较容易,发生于右心室的少见,较难与其他心脏肿瘤鉴别,现将1例右心室黏液瘤的超声学特征报道如下:1病史简介患者,女性,28岁,因"反复心慌1年余"住院。查体:体温36.7℃,心率82次/分,呼吸19次/分,血压111/80mm Hg,锁骨上淋巴结未及肿大,两肺呼吸音清,心律齐,未闻及病理性杂音,未及心包摩擦音,     

超声心动图评价右心室功能的价值

右心室功能是心脏疾病的一项重要指标。临床中,二维超声已经用于右心室功能的评价。一些新的技术包括组织多普勒、应变率成像、实时三维超声和造影剂超声可以进一步加强对右心室功能的评价。     

彩色多普勒血流显像对右心室双腔的诊断

右心室双腔是一种少见的先天性右室漏斗部下方的狭窄,其临床表现与肺动脉瓣狭窄及右室漏斗部狭窄极为近似.以往诊断有赖于心血管右室造影.近年来,彩色多普勒血流显像对右室双腔的诊断具有独到的价值.本院1987～1993年手术的10例右室双腔患者,术前均接受了彩色多普勒血流显像的检查.结合超声心动图与病理解剖特点进行分析,以供参考.一、资料与方法本组10例患者,男4例、女6例.年龄10～24岁.症状与体征:患者均有心悸、气短,其中1例伴紫绀杵状指(趾).听诊.胸骨左缘Ⅱ～Ⅳ肋间可闻Ⅲ～Ⅳ/Ⅵ级收缩期粗糙杂音10例.P_2减低2例.心电图;大致正常1例,右心室肥厚6例,双心室肥厚1例,左心室肥厚2例.X线胸片:不同程度肺充血6例,不同程度肺缺血4例.     

双腔右心室的术前与术中诊断对比分析

对１７ 例双腔右心室（ＤＣＲＶ） 患者于术前行经彩色多普勒血流显像（ＣＤＦＩ） 检查, 诊断为单纯ＤＣＲＶ４ 例, ＤＣＲＶ 合并室间隔缺损 （ＶＳＤ） ８ 例、肺动脉瓣狭窄 （ＰＳ） １ 例、房间隔缺损（ＡＳＤ） １ 例, 单纯ＶＳＤ２例, 法乐氏四联症１ 例。均经手术治疗, 术中确诊为单纯ＤＣＲＶ４ 例, ＤＣＲＶ合并ＶＳＤ１１ 例、ＡＳＤ１例、ＰＳ１ 例。认为ＣＤＦＩ对ＤＣＲＶ的诊断有较高的准确性, 但对不典型ＤＣＲＶ的诊断仍有一定困难。     

双腔右心室的诊断与外科治疗（附12例报告）

双腔右心室的诊断与外科治疗（附１２例报告）北京海军总医院胸心外科（１０００３７）许开清，李辉，姚松朝双腔右心室（ＤＣＲＶ）是一种少见的先天性心脏畸形。我科自１９８３年５月至１９９２年１２月共收治１２例经手术证实的ＤＣＲＶ，现报告如下。临床资料：本组男...     

Accuracy of the Fetal Echocardiogram in Double-outlet Right Ventricle

Objective. Double-outlet right ventricle (DORV) is a complex congenital heart defect with heterogeneous anatomy. Patients require a variety of surgical interventions, and the long-term prognosis is variable. Therefore, accurate prenatal diagnosis is important in providing parents with appropriate counseling. Design. Medical records were reviewed in patients with a diagnosis of DORV who had fetal echocardiography at our institution from 1998 to 2004. Pre- and postnatal diagnoses were compared, anticipated surgical procedure was compared with surgery performed, and neonatal outcome was assessed. Results. The study group consisted of 49 fetal patients with 6 in utero deaths (including 4 terminations), 2 patients lost to follow-up, and 41 live births. Postnatal echocardiograms or autopsy results were available on 42 patients. The overall accuracy of fetal echocardiography in making a correct diagnosis of DORV was 76%. Accurate prenatal prediction of the type of cardiac surgery that would be performed was made in 91% of patients who had surgery. Among live births, survival to hospital discharge was 76%. Survival was 50% in patients with extracardiac or chromosomal anomalies, compared with 92% in infants without additional anomalies. Conclusion. In most cases, careful evaluation by fetal echocardiography can determine essential anatomic details in fetuses with DORV with enough accuracy to allow for accurate counseling regarding the type of surgery needed. Survival is better than previously reported but is poor in patients with extracardiac or chromosomal abnormalities.     

Right Ventricular Doppler Echocardiographic Study of Indeterminate Form of Chagas Disease

Background

Patients with indeterminate form of Chagas disease/cardiac normality (ICD/CN) exhibited normal electrocardiograms and chest X-rays; however, more sophisticated tests detected some degree of morphological and functional changes in the heart.

Objective

To assess the prevalence of systolic and diastolic dysfunction of the right ventricle (RV) in patients with ICD/CN.

Methods

This was a case–control and prevalence study. Using Doppler two-dimensional echocardiography (2D), 92 patients were assessed and divided into two groups: group I (normal, n = 31) and group II (ICD/CN, n = 61).

Results

The prevalence of RV systolic dysfunction in patients in groups I and II was as follows: fractional area change (0.0% versus 0.6%), mobility of the tricuspid annulus (0.0% versus 0.0%), and S-wave tissue Doppler (6.4% versus 26.0%, p = 0.016). The prevalence of global disorders such as the right myocardial performance index using tissue Doppler (16.1% versus 27.8%, p = 0.099) and pulsed Doppler (61.3% versus 68%, p = 0.141) and diastolic disorders such as abnormal relaxation (0.0% versus 6.0%), pseudonormal pattern (0.0% versus 0.0%), and restrictive pattern (0.0% versus 0.0%) was not statistically different between groups.

Conclusion

The prevalence of RV systolic dysfunction was estimated to be 26% (S wave velocity compared with other variables), suggesting incipient changes in RV systolic function in the ICD/CN group.     

Simple Echocardiographic Evaluation of Right Ventricular Size in Children

Objective. The objective of this study was to develop a rapid, semiquantitative two‐dimensional echocardiographic method to evaluate right ventricular size. Background. Abnormal right ventricular size, secondary to right ventricular volume loading conditions, influences clinical recommendations. Because of convoluted right ventricular geometry, measuring right ventricular volume quantitatively requires complex invasive or noninvasive methods. Methods. We defined a normal right ventricular diastolic area index (RVDAI) via two‐dimensional echocardiographic right ventricular diastolic measurements from 100 children (newborn to 18 years, mean = 6.6 years) with innocent murmurs. We measured RVDAs from the apical 4‐chamber (RVDA4c) and the short axis (RVDAsax), and left and right ventricular end‐diastolic, M‐mode dimensions from the long‐axis view (LVEDD; RVEDD). We calculated an RVDAI from the formula: ([{RVDA4c + RVDAsax}/2]/BSA) × (RVEDD/LVEDD)³. We obtained RVDAI values from 19 children with secundum atrial septal defects or pulmonary valve regurgitation. The pulmonary valve regurgitation patients also underwent cardiac magnetic resonance imaging 0–6 weeks from their two‐dimensional echocardiogram. Results. In normal patients, the RVDAI was ≤1.0 for body surface areas >0.5 m². The RVDAIs for body surface areas <0.5 m² increased exponentially with decreasing body surface area. In patients with heart disease, the RVDAI correlated with atrial septal defect's size and right ventricular volume measured by cardiac magnetic resonance imaging. Conclusions. The RVDAI is a rapid, semiquantitative two‐dimensional echocardiographic method for serially evaluating right ventricular size.     

致心律失常性右心室心肌病临床诊断探讨

目的探讨致心律失常性右心室心肌病的临床诊断标准.方法将19例致心律失常性右心室心肌病患者常规行超声心动图、心电图、X线胸片、24小时动态心电图、心房调搏及心内电生理检查.结果本组19例患者均有心悸,晕厥发作,心电图多为右束支传导阻滞(78.95%),频发室性早搏(89.5%),右心室源性短阵室性心动过速(78.95%),超声心动图右心室50.80±9.88?mm,右心房48.00±8.79?mm,均增大,右心功能减退,射血分数0.294±0.0812.结论致心律失常性右心室心肌病,可根据发作性晕厥,右束支传导阻滞,频发室性早搏及左束支传导阻滞型室性心动过速,右心室、右心房增大,右心室功能减退,并排除其他各类心脏和胸肺疾病后确诊.     

Absent Aortic Valve Associated with Double Outlet Right Ventricle and Aortopulmonary Window: Physiologic Implications of a Rare Malformation in both the Fetus and Neonate

Absence of the aortic valve is a rare congenital heart defect that is detectable in the prenatal period. In this condition, functional aortic valve leaflets are absent; in their place are rudimentary, immobile noncoapting plate‐like structures at the level of the annulus resulting in severe aortic regurgitation. We report the fetal diagnosis and subsequent postnatal course of an infant with the novel association of absent aortic valve, double outlet right ventricle, and aortopulmonary window. This unique combination of defects resulted in an unusual pattern of circular shunting that produced evidence of fetal heart failure. Shortly after birth, the abnormal physiology led to compromised systemic perfusion, intestinal perforation and subsequent rapid demise of the patient. Abrupt postnatal deterioration typifies the vast majority of the absent aortic valve cases found in the literature. Our patient is unique in that it is the first female reported with absent aortic valve and the first reported with an aortopulmonary window. This report demonstrates that absent aortic valve is a condition that can be diagnosed prenatally by fetal echocardiogram; the highly abnormal physiology places these patients at risk for fetal heart failure. Given the potential for clinical instability and rapid deterioration after birth, such patients should undergo rapid postnatal assessment and immediate surgical intervention when deemed appropriate.     

双腔右心室的诊治（附14例报告）

报告双腔右心室（ＤＣＲＶ）患者１４例,其就诊年龄为３～４４（平均１９．１±３．４）岁,合并室间隔缺损（ＶＳＤ）９例,继发三尖瓣关闭不全（ＴＩ）６例、心律失常１０例,术前误诊７例。１４例均在中低温体外循环下行一期根治术,１例术后早期死亡,余疗效满意。提示本病易合并ＶＳＤ,术前误诊率较高,一经确诊,应及时行手术切除异常肌束,同时矫正合并畸形及继发病变。