心脏三维超声虚拟内窥镜系统导航与介入方法研究

目的通过心脏三维超声虚拟内窥镜系统导航和介入方法研究,旨在探索并建立复杂型先心病虚拟现实环境下观察的规范化"路径"和介入方法。方法采用体绘制技术重建心腔内表面的三维图像,并置感兴趣的心内结构于可视化显示窗中心,键盘操作与人工导航结合使三维重建图像沿着视线方向前进,产生被观察心内结构目标不断靠近观察者和放大的多帧图像。结果系统通过控制鼠标、键盘立体定位,结合VanPraagh"节段分析法"对感兴趣区域观察,使操作者在虚拟心脏内漫游,实现部分心内畸形结构的诊断。对诊断房、室间隔缺损者,应用虚拟介入装置模拟ASD、VSD介入治疗。结论三维超声虚拟内窥镜为先天性心脏病临床诊断、术前模拟介入、手术计划、外科手术导航及计算机辅助医学教学提供了一种新方法。     

超声心动图对先天性右位心的诊断价值

目的　探讨超声心动图对先天性右位心的形态学特征以及合并畸形的诊断价值。方法　用超声心动图按 Van Praagh节段分析法对右位心心脏结构进行观察 ,结合 X-线进行诊断。结果　 93例右位心患者中镜像心 4 3例 ,右旋心 4 2例 ,右房异构 3例 ,左房异构 5例。镜像心大多各节段连接一致 ,心血管畸形中肺血多的主要为房间隔缺损 (ASD)和室间隔缺损 (VSD) ;肺血少的主要为法洛四联症 (TOF)、右室双出口 (DORV) 肺动脉狭窄 (PS)、单心室 (SV) PS。右旋心中大多各节段连接的不一致 ,且多合并肺血减少的复杂畸形 ,主要畸形为 DORV PS、矫正型大动脉转位 (C- TGA) PS、 SV PS、 TOF、肺动脉闭锁 (PAA)、大动脉转位 (TGA) PS。异构右位心大多各节段连接一致 ,大多合并肺血减少的复杂畸形。结论　先天性右位心各节段均可出现异常 ,多合并复杂心血管畸形 ,超声心动图能准确进行解剖学及血流动力学的诊断及评价 ,可作为首选或筛选方法。     

先天性心脏病三维超声虚拟内窥镜可视化研究

目的 研究开发三维心脏超声虚拟内窥镜系统并对先天性心脏病进行可视化研究.方法 正常小儿10例、先天性心脏病患儿22例(房间隔缺损10例,室间隔缺损6例,法洛四联症6例),将计算机虚拟现实技术和科学计算可视化技术结合,使用C++6.0语言编写和可视化工具库(VTK)开发平台对心脏超声数据集进行三维重建,创建虚拟现实环境系统,建立三维超声虚拟心脏,通过心内导航实现虚拟心内漫游.结果 三维心脏超声虚拟内窥镜系统实现了心脏超声数据的心内三维可视化和心内导航.结论 三维心脏超声虚拟内窥镜系统为先天性心脏病的诊断提供了一种新的可视化方法.     

Central role of real-time three-dimensional echocardiography in the assessment of intracardiac thrombi

The current study was designed to evaluate the feasibility and clinical utility of real-time 3-dimensional echocardiography (RT3DE) for detection of intracardiac thrombi with comparison to 2-dimensional echocardiography (2DE). The study included 45 consecutive patients with intracardiac thrombi detected by routine 2DE (mean age 45 ± 8.4 years, 75% males). The relevant features of the thrombus by 2DE and RT3DE (site, shape, and number) were assessed according to a subjective four-point score index for image quality (1 = not visualized, 2 = inadequate, 3 = sufficient and 4 = excellent). Measurements included: maximum diameter and volume. 2DE and RT3DE detected 45 thrombi (34 in the left ventricle, six in the left atrium, four in the left atrial appendage, four in the right atrium, and two in the right ventricle). RT3DE could detect seven additional thrombi in five patients (three in the left atrial appendage and four in the left ventricular apex). Visualization score by 2DE and RT3DE was comparable (Kappa index: 7.2). RT3DE measurements of maximum diameter were well correlated with 2DE (R ² = 0.88, P < 0.01) and showed better interobserver agreement than 2DE (2.88, −1.92 vs. 5.33, −3.87, respectively). RT3DE was superior to 2DE for assessment of thrombus mobility, differentiation between the thrombus and myocardium, and delineation of the changes in thrombi structure, e.g. calcification, degeneration, or lysis. In addition, volume calculation could be obtained by RT3DE only. In conclusion: RT3DE is comparable to 2DE for the assessment of the intracardiac thrombi and provided more detailed information beyond the scope of the established 2DE.     

动态心内三维超声虚拟现实诊断方法研究

目的应用虚拟现实（VR）技术,通过临床初步应用研究,评价小儿先天性心脏病心内三维虚拟现实诊断方法的可行性.方法正常小儿20例、先天性心脏病患儿30例（ASD 10例、VSD 9例、TOF 11例）,分别进行全心三维图像重建,实现动态三维超声虚拟现实显示,对虚拟心内结构进行三维空间定位观察,显示心内结构异常者与心导管术后或手术后诊断或三维超声诊断进行比较,确定该方法的空间定位及空间结构关系判断的准确性.结果动态心内三维超声虚拟显示技术能正确显示正常及先天性心脏病患儿的心内结构,诊断心内结构异常者与心导管术后或手术后诊断或三维超声诊断一致.结论动态心内三维超声虚拟现实技术为小儿先天性心脏病无创性三维超声诊断提供了一种新方法.     

实时三维超声心动图评价间隔缺损大小的初步研究

目的：探讨实时三维超声心动图测量房、室间隔缺损面积的可行性和应用价值。方法：应用实时三维超声诊断仪获取20例先天性房间隔和／或室间隔缺损患者的三维数据库，利用三维数据工作站对缺损面积的大小进行测量分析，部分病例的三维测量值与二维超声测量值及手术结果对照。结果：实时三维成像能以多种视角观察间隔缺损的全貌并可对缺损面积进行三维测量，同二维超声所测直径相比，三维超声测量结果与手术结果具有更好的相关性(r=0．78 vs r=0．91)。结论：实时三维超声可显示房室间隔缺损的整体形态，可对缺损面积进行准确的定量分析，具有重要的临床应用潜力。     

实时三维超声心动图评价房室间隔缺损大小的初步研究

目的 探讨实时三维超声心动图测量房、室间隔缺损面积的可行性和应用价值。方法 应用实时三维超声诊断仪获取20例先天性房间隔和／或室间隔缺损患者的三维数据库，利用三维数据工作站对缺损面积的大小进行测量分析，部分病例的三维测量值与二维超声测量值及手术结果对照。结果 实时三维成像能以多种视角观察间隔缺损的全貌并可对缺损面积进行三维测量，同二维超声所测直径相比，三维超声测量结果与手术结果具有更好的相关性(r=0．78 vs r=0．91)。结论 实时三维超声可显示房室间隔缺损的整体形态，可对缺损面积进行准确的定量分析，具有重要的临床应用潜力。     

320排容积CT心脏成像在小儿法洛四联症中的应用：与超声对比

目的 探讨320排容积CT心脏成像在小儿法洛四联症（TOF）诊断与治疗中的价值。方法 对20例临床拟诊为TOF的患儿行320排VCT检查,并将CT检查结果与同期超声检查结果对照。结果 20例患者中320排VCT确诊16例,US确诊18例;对16例320排VCT及US均诊断为TOF患儿的McGoon指数分别为1.13±0.04和1.01±0.04（t=1.521,P=0.149）;以手术为金标准,320排VCT及US对室间隔缺损检出率分别为80.00%（16/20）和90.00%（18/20,P>0.05）。320排VCT和US测量室间隔缺损最大径分别为（4.98±0.29）mm和（4.96±0.31）mm（t=0.258,P=0.800）,测量的TOF患儿主动脉骑跨率分别为（0.27±0.01）%和（0.28±0.01）%（t=-0.019,P=0.250）。结论 320排VCT可清楚显示患儿TOF各种畸形,可较准确地评估TOF患儿肺动脉发育及大于2 mm的室间隔缺损,对术前治疗计划的制定有重要意义。     

胎儿右室双出口的产前超声诊断分析

目的探讨先天性心脏畸形右室双出口的产前超声声像特征以提高此类畸形的产前检出率。方法分析我院于2000年8月～2006年5月期间33例胎儿右室双出口的超声资料与随访结果,总结胎儿右室双出口声像图特点及如何鉴别诊断。结果产前正确诊断右室双出口32例,1例右室双出口误诊为完全性大动脉转位,所有33例病例均合并室间隔缺损或心内膜垫缺损,尚有23例合并室间隔缺损以外的其它心内畸形,15例合并心外畸形,4例染色体异常。结论胎儿典型右室双出口的主要声像图特征是主、肺动脉起始部平行排列且均发自右心室;右室双出口常合并其他心内及心外畸形,注意对合并畸形的产前超声诊断和评估具有重要临床意义。     

MDCT诊断右心室双出口

目的 探讨MDCT诊断右心室双出口（DORV）的价值。方法 回顾性分析经手术或心血管造影确诊的36例DORV患者的临床及影像资料,将术前MDCT和超声心动图结果与手术结果进行对比。结果 MDCT明确诊断34例,误诊2例,诊断正确率为94.44%（34/36）,超声心动图诊断正确率为75.00%（27/36）,差异有统计学意义（P=0.022）。对判断室间隔缺损（VSD）与大动脉关系及大动脉位置关系,MDCT正确率均为100%（36/36）,超声心动图诊断准确率为80.56%（29/36）,差异有统计学意义（P=0.017）。共合并心内外畸形119处,MDCT与超声心动图对心内畸形检出率差异无统计学意义（P=0.474）;MDCT对心外畸形的检出率[98.72%（77/78）]高于超声心动图[69.23%（54/78）,P<0.001]。结论 MDCT可准确诊断DORV、准确检出合并畸形,对制定外科手术方案具有重要参考价值。     

实时三维超声心动图在先天性心脏病介入封堵治疗中的临床价值

目的评价实时三维超声心动图(RT-3DE)在先天性心脏病介入封堵术前及术后的应用价值。方法RT-3DE检测21例先天性心脏病患者(包括8例房间隔缺损、8例室间隔缺损和5例动脉导管未闭),分析缺损口和未闭导管的空间位置、大小和形态;并于封堵术后RT-3DE评估封堵器的位置及其距主动脉瓣、二尖瓣和三尖瓣等周围组织和血管的距离。结果RT-3DE能实时动态地显示房间隔缺损、室间隔缺损和动脉导管未闭及其封堵器的位置、形态及其与周围组织的关系,其中1例室间隔缺损和2例房间隔缺损因缺损处周边没有足够的边缘组织,改行外科手术。结论RT-3DE在明确先天性心脏病病变的解剖位置,观察封堵器释放后的形态结构,明确残余分流的性质及原因等方面较二维超声心动图具有明显优势。     

Higher pulmonary vein index on computed angiography and optimum surgical resection ensures smooth postoperative recovery in Fallot's tetralogy: Special emphasis on indices of evaluation and Monocusp preparation

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Its surgical correction requires ventricular septal defect (VSD) closure and right ventricular outflow tract obstruction (RVOTO) relief, with transannular patch enlargement (TAPE) of the pulmonary valve. The first successful repair of TOF was reported in 1954 and consisted of closure of the VSD through a large right ventriculotomy, and RVOTO relief with TAPE of the pulmonary valve. To predict the intraoperative requirements and postoperative course of patients with this condition, various evaluation indices are available that can provide a good indication of patient prognosis. We performed this study in a male child (age, 1 year, 9 months; weight 8.5 kgs.) who underwent intracardiac repair for TOF as a primary procedure. We calculated the pulmonary vein index (PVI), McGoon ratio, and Nakata index. The McGoon ratio was 1.97, Nakata index was 539.22 mm²/m², and PVI was 368.12 mm²/m². The child had an uneventful post‐operative course with no symptoms of low cardiac output syndrome. He was ventilated for 122 h. The length of intensive care unit and hospital stays were 11 and 14 days, respectively. The PVI is a novel indicator offering prognostic indications for pediatric cardiac patients who have undergone surgical correction of TOF.     

三维超声仿真心腔内窥镜技术诊断房间隔缺损的实验研究

目的 探讨三维超声虚拟现实技术实现仿真心腔内窥镜观测房间隔缺损（ASD）的可行性。方法建立10个新鲜离体猪心ASD模型，经超声水槽用HP Sonos 5500超声系统采集三维超声图像，用移动立方体算法进行表面重建及可视化，建立心内三维超声仿真心腔内窥镜系统；同时将该系统的ASD面积、最大径和最小径测值与实测值进行比较。结果10例离体心ASD均成功获得虚拟显示。三维超声虚拟现实技术能够模拟心内视角显示缺损的形态、部位及邻近上腔静脉、下腔静脉间的关系，且与实际观察结果一致。测量三维重建并虚拟显示后的ASD面积、最大径和最小径，测得数据与实测值高度相关（r〉0．95，P〈0．01）。结论三维超声仿真心腔内窥镜技术为小儿先天性心脏病三维超声诊断提供了一种新方法。     

二维和多普勒心动图对房间隔缺损及室间隔缺损定性定位诊断的评价

本文经手术证实的房间隔缺损19例和室间隔缺损36例。二维超声对房间隔缺损和室间隔缺损的诊断阳性率分别为84.2％和83.33％。脉冲多普勒对房间隔缺损和室隔缺损的诊断阳性率分别为89.47％和94.44％。脉冲多普勒的诊断率明显高于二维超声。另外我们实践初步体会,通过测量计算各瓣膜口的血流量的差异是诊断单纯性的房间隔缺损与室间隔缺损的辅助方法之一。     

Velocity vector imaging to quantify left atrial function

The aim of our study was to assess the feasibility of a new image analysis, velocity vector imaging (VVI), in the assessment of left atrial volumes (LAV) and left atrial ejection fraction (LAEF). We retrospectively analysed 100 transthoracic echocardiographic findings in 71 men, and 29 women (mean age 57 ± 19.8 years). Two subgroups of patients were defined: (1) with left ventricular (LV) EF > 50%, and (2) LV EF < 50%. For the VVI method of indexed LAV assessment we used the apical four-chamber view. From the displacement of LA endocardial pixels time–volume curves were extracted which provided automatically data regarding indexed maximum LAV (LAVImax), indexed minimum LAV (LAVImin), and LAEF. LAVs and LAEF by 2-dimensional echocardiograhy (2DE) were measured by Simpson’s biplane disc summation method. Comparing LAVImax, LAVImin, and LAEF by VVI versus 2DE in the total study population, we found significant correlations: r = 0.94, P < 0.0001, r = 0.94, P < 0.0001, r = 0.79, P < 0.0001, respectively. In addition, LAVImax ≥ 40 ml/m² was 94% sensitive and 72% specific, LAVImin ≥ 27 ml/m² was 90% sensitive and 86% specific, and LAEF < 30% was 80% sensitive and 96% specific for the detection of LV systolic dysfunction. There were highly significant inverse associations of LAVImax and LAVImin to LVEF. LAEF was also significantly related to LV systolic function. When comparing the time required for VVI and 2DE measurements, VVI led to 62% reduction in the measurement time. In conclusion, VVI is a feasible method for the assessment of LAVs and LAEF. It provides close agreement with that measured by conventional 2DE Simpson’s biplane method with significant time saved.     

Emergent Comorbidity in At Risk Children with and without Autism Spectrum Disorder—A Cross-Sectional Study

Individuals with autism spectrum disorders (ASD) are noted to be at an increased risk for developing comorbid psychiatric conditions. Little is known about the emergence and etiology of comorbid conditions in ASD. We investigated if this pattern of comorbidity can be detected in those with ASD at an early age. Two-hundred and sixty-nine atypically developing toddlers classified as ASD (n = 109) or non-ASD (n = 160) were studied using the Baby and Infant Screen for aUtIsm Traits-Part 2 (BISCUIT-Part 2). Participants were divided into four age groups: 12–18 months, 19–24 months, 25–31 months, and 32–39 months. A factorial MANOVA was used to assess age and diagnostic group differences on BISCUIT-Part 2 domains. A general trend emerged where toddlers with ASD appeared to have more severe symptoms than atypically developing non-ASD toddlers with there being an increasing trend of comorbid behaviors as age increased. Results and implications are discussed.     

经胸多平面探头三维重建及实时全容积三维超声心动图检测房间隔缺损的实验比较研究

目的探讨经胸多平面探头三维重建与实时三维超声心动图技术对房间隔缺损定性、定量的诊断价值.方法分别应用TTO探头及X4探头对15只离体猪心房间隔缺损模型进行采样后三维重建,以L1a、L2a剖视面对房间隔缺损进行观察;两种不同采样方式三维重建测量房间隔缺损长径、短径、面积与解剖实际测量值进行比较;同时比较两种三维技术在采样及重建及定性、定量分析时间过程中所耗时间.结果 TTO-3DE和RT-3DE均可显示缺损的形态、部位及与周边结构的毗邻关系,两种方法的超声测量值与实测值差异无显著性意义(P>0.05),且与实测值均具有良好相关性,TTO-3DE采样时间远远长于RT-3DE,但重建及定性、定量分析所耗时间无显著性差异.结论 TTO-3DE和RT-3DE能准确显示房间隔缺损的解剖结构信息,RT-3DE因其采样迅速、即时成像的特点,在指导外科手术和介入性治疗方面更具有实用意义.     

MRI for detection of anomalous pulmonary venous drainage in patients with sinus venosus atrial septal defects

Purpose of this survey was to estimate the value of MRI for the assessment of the anatomical and functional features of sinus venosus atrial septal defect (SVD). This prospective study included 13 surgically proven cases of SVD out of 81 subjects submitted to MRI due to inconclusive transthoracic echocardiography (TTE) or suspicion of high intracardiac and/or extracardiac shunt volumes based on echocardiographic findings. MRI examination included cine SSFP sequences, contrast-enhanced 3D gradient-echo (GE) sequences for MR angiography (MRA) and phase-contrast flow-measurements. MRI revealed nine patients with a superior and four with an inferior SVD. Anomalous pulmonary venous drainage (APVD) was observed only in subjects with a superior SVD, and it was right-sided in all cases. All MRI and MRA results for the SVD patients were confirmed intraoperatively. The Correlation coefficient between MR flow measurements and cardiac catheterisation was 0.94 (P < 0.0001). According to MRI the rest of the subjects (n = 68) presented a secundum ASD, whereas in 18% an APVD coexisted. The latter MR outcomes concurred with the cardiac catheterisation (n = 56) and operative (n = 12) results. MRI provides a reliable, non-invasive method for evaluation of SVDs, APVDs and shunt quantification.     

先天性心脏病的左室功能变化特征

测定了103名先天性心血管病患者的STI,心内分流和心外分流者不同。动脉导管未闭(PDA)者的STI,其异常程度不象房、室缺(ASD,VSD)大,这可能与分流水平,分流量大小及分流持续时间等造成的病理改变有关。在修补术后,房、室缺患者的PEP/LVET及ICT/LVET比值减小;而动脉导管未闭患者则增加,这反映了PDA的后负荷在术后增大。另外,PEP/LVET和QP/QS呈正相关,心内分流量越大,PEP/LVET比值就越大。根据PEP/LVET比值,可以粗略估计心内分流量的大小。     

二维超声心动图对右室双出口诊断与鉴别诊断的探讨

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