Echocardiographic features in a case of intrapericardial teratoma.

An infant presented with symptoms of congestive heart failure. Ultrasound examination revealed a dense layer of echoes at the root of the aorta, a large anterior pericardial effusion, and coarse fluttering of the right ventricular wall. The clinical diagnosis of intrapericardial teratoma was confirmed by cineangiography and surgical resection. The pathological examination was consistent with benign teratoma. A postoperative ultrasound examination revealed absence of pericardial effusion and tumor echoes. This appears to be the first echocardiographic report of a pericardial tumor in an infant.     

Non-surgical management in hemodynamically unstable blunt traumatic pericardial effusion: A feasible option for treatment

Introduction

Little is known about the outcomes of deliberate non-surgical management for hemodynamically unstable patients with blunt traumatic pericardial effusion. We evaluated the efficacy of management with pericardiocentesis or subxiphoid pericardial window in hemodynamically unstable patients who reach the hospital alive with blunt traumatic pericardial effusion.

New approaches to the management and treatment of malignant pericardial effusion

The purpose of this study was the evaluation of the effectiveness of intrapericardial administration of tetracycline, 5-fluorouracil and cisplatin in patients with recurrent malignant pericardial effusion. In 33 cases with malignant pericardial effusion 46 pericardiocenteses under two-dimensional echo-cardiography were performed. No complications were observed after this procedure. Pericardiocentesis was followed by catheterization of the pericardial space for a mean period of 15 days (range 1–64). In 4 cases bacterial pericarditis was observed during catheterization. The mean volume of the pericardial fluid was 2.4 l (range 0.4–13 l). In cases with bloody pericardial fluid thePO₂,PCO₂ and pH of the fluid were estimated and the results compared with the values for venous blood obtained from the upper limbs. Highly statistically significant differences were documented. Twenty cases of malignant pericardial effusion were treated with direct pericardial administration of cisplatin, 3 with 5-fluorouracil and 2 with tetracycline. Good results (no fluid reaccumulation) were observed only after cisplatin therapy. We conclude that pericardiocentesis performed under two-dimensional echo cardiography, followed by pericardial catheterization and direct pericardial treatment with cisplatin are the methods of choice in cases with malignant pericardial effusion. In cases with bloody pericardial fluidPO₂,PCO₂ and pH analysis can be useful to differentiate the source of the bloody fluid (blood or bloody fluid).     

胸腔镜心包开窗术联合沙培林腔内用药治疗恶性心包积液疗效观察

【目的】探讨胸腔镜心包开窗术联合沙培林腔内用药治疗恶性心包积液的临床疗效。【方法】选择2009年1月至2013年1月本院收治的38例恶性心包积液患者,随机分为两组：对照组采用常规保守治疗,观察组采用胸腔镜心包开窗术治疗,术中心包灌注沙培林。对两组患者的近期疗效、病情进展时间和中位生存时间、手术前后Karnofsky评分进行比较。【结果】观察组的近期治疗有效率（94．7％）高于对照组（55．6％）,差异有统计学意义（P＜0．05）。观察组手术后病情进展时间和中位生存时间长于对照组,差异有统计学意义（P＜0．05）。观察组手术后的Karnofsky评分高于对照组,差异有统计学意义（P ＜0．05）。【结论】胸腔镜心包开窗术联合沙培林腔内用药治疗恶性心包积液疗效好,可明显改善患者的临床症状,延长生存时间,提高生活质量,值得进一步推广应用。     

心包积液的超声显像研究

目的研究超声心动图对心包积液的应用价值。 方法回顾性分析413例心包积液的超声心动图特征，并与X线、心电图及手术结果相对比。 结果心包积液病因依次排列前5位的是恶性肿瘤、心力衰竭、尿毒症、结核、炎症。超声心动图诊断率100％，X线诊断62例，占15％；心电图诊断12例，占3％。21例外科手术治疗。 结论超声心动图是诊断心包积液最简单、最可靠的方法，也是一种介入心包穿刺，术中动态监测，判断预后的方法。     

超声心动图诊断心包积液的价值

目的 探讨超声心动图在心包积液诊断中的价值。方法应用超声心动图对不同病因所致心包积液进行定量检测,并与普通X光的检出率进行比较。结果 创伤性心包炎成为临床最常见的心包积液病因,少中量心包积液占大多数,在此种情况下超声心动图较X线检查更敏感。结论 超声心动图对心包积液的定性诊断有优势,对病因诊断亦有一定帮助。     

31例甲状腺机能减退症超声心动图分析

３１例甲状腺机能减退症（甲减）患者的超声心动图与正常人对比研究。甲减患者心率减慢心动周期延长，各时相中以射血前期（ＰＥＰ）延长为主，射血前期时间／射血时间（ＰＥＰ／ＥＴ）比值明显增加；舒张期等容舒张期时间也延长。甲减性心肌病Ｍ型超声心动图上室壁增厚率（ΔＴ％）、左室短轴缩短率（ΔＤ％）和射血分数（ＥＦ）降低，多普勒超声心动图上主动脉瓣和二尖瓣血流加速度、减速度和峰值速度降低，提示收缩和主动松弛功能不良。甲减５２％合并心包积液     

介入性超声下引导心包穿刺置管治疗心包积液的临床探讨

目的探讨超声引导下经皮心包穿刺置管持续引流心包积液的临床应用。方法在100例心包积液患者心尖部或心前区置入中心静脉导管引流。结果 100例心包积液病人全部安全有效置管成功,得到有效救治,25例心脏压塞患者引流后症状迅速缓解。置管可长期保留（5~16 d）,操作并发症少。结论超声引导下经皮心包积液置管法简单、安全、有效,便于临床应用。     

心包囊肿的外科治疗：附11例报告

心包囊肿是一种少见疾病。本文报告了我科自1963年到1990年,经手术治疗的11例心包囊肿。11例中,10例术前诊断和疑为心包囊肿,1例误诊为其他疾病。本组病人无手术死亡,术后恢复良好,随访中无复发。本文还对心包囊肿的诊断,鉴别诊断和治疗作了简要讨论     

心包积液的病因及误诊分析

目的分析心包积液患者的病因及误诊原因。方法收集2007～2011年收治的65例心包积液患者的临床资料并进行回顾性分析。结果本组资料心包积液常见病因依次为肿瘤性(33.85%)、结核性(23.08%)、心力衰竭性(10.77%)、非特异性(7.69%)和结缔组织疾病(6.15%),其他各种原因引起者占18.48%。误诊4例。结论肿瘤是心包积液的首要病因。误诊的主要原因是将其他性质的心包积液误诊为肿瘤性心包积液。     

超声监测经皮心包内多部位活检,引流和灌洗治疗

本文介绍应用介入性超声技术在原因不明的心包积液诊断和治疗取得显著效果。３７例患者经心包多部位活检明确病因诊断章取义务兵例，病理论断率８６．３％，比以往常规心包穿刺术诊断率提高了６０％以上；２１例急慢性心包填塞的患者经过导管引流得到完全缓解；根据病因在超声控制引流完全后给予心包腔内灌洗治疗，使数月、数年不能治愈的心包积液变为３－－１０天完成治疗，全部病例复查随访三个月无一例复发。本文详细描述了操作方     

心包囊肿的超声诊断价值

目的探讨心包囊肿的超声诊断价值。方法对2013-2018年7例心包囊肿患者的超声特征及其相关资料分析并随访。结果超声心动图显示心包囊肿大多(5/7)位于心脏右缘膈水平,呈均质类圆形囊性回声,未探及血流信号。3例有症状。6例行手术切除,术后无复发;1例保守处理,复查囊肿较前相仿。结论超声心动图可以检出心包囊肿,具有重要诊断价值;提高对其的认识有助于临床的诊治和预后。     

高位心包上隐窝CT表现与意义

目的熟悉高位心包上隐窝的CT表现及其对诊断与鉴别诊断的意义。方法前瞻性对连续800例进行胸部螺旋CT检查的患者的CT图像进行观察,对明确或怀疑有高位心包上隐窝者进行1.25mm薄层重建和多平面重建,经2名有经验的医师最后确认,统计高位心包上隐窝的出现率,描述其表现并测量其大小。结果①19例最后被确认为高位心包上隐窝,占2.4%。在横轴位上表现为右侧气管旁区圆形、卵圆形、半月形、三角形或铸型灌注状水样密度结构,冠、矢状位呈长条带状,上部盲端呈囊袋状,往下紧贴无名动脉和升主动脉且与常见部位心包上隐窝相连。②大小:横轴位,平均长径和短径分别为19mm和14mm;矢状位或冠状位最长径平均56mm。结论CT薄层和多平面重建可更好地观察高位心包上隐窝,从而更有把握地与纵隔病变相鉴别。     

脾切除术加贲门周围血管离断术治疗门静脉高压症的疗效分析

目的探讨脾切除加贲门周围血管离断术治疗门静脉高压症的疗效。方法回顾68例采用脾切除加贲门周围血管离断术治疗门静脉高压症的临床资料,对手术前后肝功能、再出血率、并发症发生率等进行分析。结果无手术死亡术后半个月肝功能好转58例,无变化10例。术后随访6个月~4年,再出血率9%,全组病人脾亢症状消失。结论脾切除加贲门周围血管离断术治疗门静脉高压症疗效确切,操作简便,止血可靠,再出血率低,有良好的临床实用价值。     

Quantification of Left Ventricular Twisting Mechanics by Velocity Vector Imaging in an Animal Model of Pericardial Adhesions

Diagnosis of constrictive pericarditis remains clinically challenging. Untwisting of the left ventricle (LV) is essential for normal LV diastolic function. Echocardiography is able to measure LV twisting mechanics. We designed an animal model of constrictive pericarditis to determine how pericardial-epicardial adhesions impair LV twisting mechanics. In eight open-chest pigs, the heart was exposed while preserving the pericardium. We simulated early constrictive pericarditis by pericardial constriction and patchy adhesions induced with instant glue and pericardial-epicardial stitches. Using Velocity Vector Imaging™ (VVI), LV magnitudes of twisting and untwisting were measured along with hemodynamic data at baseline and after the experimental intervention. Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. Magnitude of LV untwisting rate decreased from –80 ± 23°/s to –26 ± 10 °/s (p = 0.0009). LV twisting rate dropped from 78 ± 20°/s to 40 ± 8°/s (p = 0.0039) and LV twist magnitude decreased from 9 ± 2° to 5 ± 2 ° (p = 0.0081). Patchy pericardial adhesions are associated with reductions in LV untwisting rate and twisting magnitude, consistent with a negative impact of constrictive pericarditis on systolic and diastolic function. Impairments in LV twisting mechanics may have a diagnostic role in the detection of early stages of constrictive pericarditis. (E-mail: belohlavek.marek@mayo.edu)     

心包囊肿的影像学特征

心包囊肿多位于右侧心膈角区,圆形或椭圆形,内回声均匀,常有传导性搏动,多数患者无症状。绝大多数心包囊肿具有典型的影像学特征,超声心动图和胸部CT是常用的影像学诊断手段。本文通过复习关于心包囊肿的文献报道,总结其影像学特征及相关表现,提高影像学认识。     

心内直视手术延迟性心包压塞的护理

目的 :总结心内直视术后延迟性心包压塞的护理经验。方法 :密切观察 10例心内直视手术后 ,患者的心率、血压、中心静脉压的变化 ,保持心包引流管通畅。结果 :患者经床边心包引流或手术心包开窗引流后痊愈出院。结论 :心脏直视术后要密切观察心率、血压、中心静脉压的变化 ,保持引流通畅。加强营养 ,注意抗凝 ,定期复查 ,可预防延迟性心包压塞的发生     

Swinging heart syndrome with predominant anterior pericardial effusion

A 16 year old male with carcinoma of the anterior mediastinum developed pericardial tamponade. An echocardiogram demonstrated a large pericardial effusion with the swinging heart syndrome. The unexpected finding was the predominant anterior location of the effusion.