肺动脉闭锁的超声诊断与心导管检查及手术结果对比分析

198 5～ 1998年本院共收治肺动脉闭锁患者 37例。室间隔完整型 1例、室间隔缺损型 36例。应用超声心动图可观察肺动脉、分叉总汇、左右肺动脉的发育及其瓣叶的形态、结构、右室腔的大小、三尖瓣的形态、活动及漏斗部与肺动脉是否连续。二维结合多普勒可明确诊断。超声观察肺动脉干的发育好坏以及右室腔的发育是否完备可为外科选择手术适应症提供有利的依据。198 5～ 1998年本院共收治肺动脉闭锁患者 37例。室间隔完整型 1例、室间隔缺损型 36例。应用超声心动图可观察肺动脉、分叉总汇、左右肺动脉的发育及其瓣叶的形态、结构、右室腔的大小、三尖瓣的形态、活动及漏斗部与肺动脉是否连续。二维结合多普勒可明确诊断。超声观察肺动脉干的发育好坏以及右室腔的发育是否完备可为外科选择手术适应症提供有利的依据。     

经胸超声心动图对肺动脉吊带患者诊断的临床价值

目的：探讨经胸超声心动图对于肺动脉吊带的诊断、鉴别及指导治疗的临床价值。方法：对2007年1月至2023年6月间,我院儿童心脏中心收治并经手术证实的28例肺动脉吊带患者的超声心动图及临床资料进行回顾性分析。总结超声诊断特点及鉴别诊断,分析误诊、漏诊原因。结果：28例患者均行外科根治术,26例手术所见与超声心动图诊断结果完全相符,无1例漏诊合并畸形,仅2例患者超声提示左肺动脉内径轻度狭窄但术中探查左肺动脉内径尚正常。85%患者合并永存左上腔静脉、室间隔缺损、房间隔缺损等心内畸形。超声诊断要点为肺动脉分叉消失,主肺动脉直接延续为右肺动脉,于右肺动脉发出异常起源的左肺动脉。结论：超声心动图可早期无创准确诊断肺动脉吊带及心内合并畸形,并为进一步外科手术治疗与预后提供可靠依据,具有重要临床价值。     

325例动脉干下型室间隔缺损超声诊断评价

目的　了解超声心动图对动脉干下型室间隔缺损的诊断价值。方法　总结经手术证实的干下室间隔缺损 3 2 5例 ,观察各年龄组合并肺动脉高压和主动脉瓣病变 ,室间隔缺损大小与肺动脉高压、主动脉瓣病变的关系。结果　 1.经胸超声心动图检出该型室间隔缺损 2 94例 ,符合率 90 .5 %。2 .随着年龄增长 ,合并肺动脉高压的机率减少 ,程度减轻。3 .随着年龄增长 ,合并主动脉瓣病变明显增加。 4.随着干下室间隔缺损增大 ,发生肺动脉高压的机率、严重程度及合并主动脉瓣病变显著增加。 5 .中、小室间隔缺损 (<2 0 mm)合并主动脉瓣病变发生率有随缺损增大而增加的趋势 ,但≥ 2 0 mm的大室间隔缺损合并主动脉瓣病变发生率反而下降。结论　该型室间隔缺损一经诊断应根据病情早期手术。对先天性心脏病动脉干下型室间隔缺损的诊断超声心动图是准确性很高的检查方法 ,但应注意主动脉瓣病变所造成的误差     

超声心动图在胎儿心脏畸形诊断中的应用

对800例孕妇行胎儿超声心动图检查,采用二维、彩色及频谱多普勒观察胎儿心脏解剖结构及血流状况。共检出胎儿心脏畸形11例（三尖瓣闭锁3例、三尖瓣下移畸形2例、完全型心内膜垫缺损2例、单纯肌部室间隔缺损2例、右心室双出口合并肺动脉狭窄1例、单心室合并大动脉右转位1例）。认为超声心动图能较准确的诊断胎儿心脏畸形。     

常用超声介导房间隔缺损封堵方法的优缺点比较

房间隔缺损是一种常见的先天性心脏病,经皮房间隔缺损封堵术是全世界首选的微创外科修补治疗方法.超声介导是经皮房间隔缺损封堵术中最重要的技术环节.目前,经食道超声心动图是最常用的超声介导方法,另外,经胸超声心动图以及心腔内超声也在运用.现试从经胸超声心动图、经食道超声心动图及心腔内超声的影像学特点、检查安全性,及并发症、检查费用等方面对上述三种方法进行比较.     

室间隔完整型肺动脉闭锁的彩色多普勒超声诊断

目的 探讨室间隔完整型肺动脉闭锁（PAIVS）的超声影像特点.方法 回顾分析7例PAIVS的超声心动图表现,并与外科手术结果进行比较.结果 PAIVS的超声心动图特征明显：（1）二维超声心动图胸骨旁左心室长轴切面显示室间隔回声完整.（2）心尖四腔切面显示2个心房正位,室间隔回声完整.（3）胸骨旁大动脉短轴切面显示2条大动脉位置关系正常,肺动脉瓣无开放运动,肺动脉瓣无血流信号通过.手术证实7例PAIVS中肺血由未闭的动脉导管供应者6例;主肺动脉及分支发育不良,仅有体肺动脉侧支供应肺血者1例.心房水平右向左分流者7例：其中5例为卵圆孔未闭,2例为房间隔缺损.合并畸形包括三尖瓣闭锁,三尖瓣发育不良伴狭窄、房间隔膨凸瘤等.结论 PAIVS患儿肺血来源多样化,肺动脉发育程度不一,超声心动图特征明显,对PAIVS有特异性诊断价值.     

杂交手术在先天性心脏病中的临床应用

目的:探讨杂交手术(hybrid procedure)治疗先天性心脏病的临床经验.方法:在经食管超声心动图辅助下,采用杂交手术治疗动脉导管未闭(PDA)7例,继发孔型房间隔缺损(ASD)45例,室间隔缺损(VSD)72例,Ⅰ型肺动脉闭锁2例,完全性大动脉转位合并VSD 1例.结果:127例中120例成功实施杂交手术,65例采用对称性封堵器,55例采用偏心性封堵器;7例中转常规体外循环手术.所有患者术后5~7 d出院.随访3~24(10.2±1.9)个月,术后恢复顺利,所有患者心功能Ⅰ级,无主动脉瓣关闭不全,无左、右室流出道狭窄,无心律失常及封堵装置移位.结论:食管超声心动图辅助下利用杂交手术治疗先天性心脏病创伤小、疗效可靠、手术风险降低.     

食道超声在室间隔缺损修补术中的应用体会

【】 目的：探讨经食道超声心动图在室间隔缺损修补术中的应用价值与经验。方法：2012年3月至2013年9月,我院在先天性心脏病矫治术中,共有259例应用食道超声心动图(房室间隔缺损6例,法洛四联症33例,右心室双出口3例,大动脉转位5例,肺动脉闭锁9例,主动脉弓中断1例),记录术后残余分流发生率、残余分流的位置、大小、分流速度。结果：１、在整个研究过程中,术中食道超声发现14例残余分流,术后复查新发现残余分流1例,共15例。2、术中使用食道超声后,术后1周残余分流发生率为1.56%,术后3月残余分流发生率0.79%。结论：１、术中使用食道超声能够明显减少术后残余分流发生率。2术中食道超声发现的残余分流在直径≤2 mm,并且左向右分流流速在3m/s以下的,不需要二次手术。     

经胸实时三维超声心动图对房室间隔缺损的诊断价值

目的探讨经胸实时三维超声心动图对房室间隔缺损的诊断价值。方法回顾性分析2009年6月至2011年11月间首次二维超声心动图检查诊断为房室间隔缺损的81例患者,再做经胸实时三维超声心动图补充检查。81例房室间隔缺损均经手术证实。结果经胸实时三维超声心动图较二维超声心动图能提供更丰富的病变信息。结论经胸实时三维超声心动图能对房室间隔缺损诊断作更好的补充,对房室间隔缺损的术前评估及术后随访有重要的临床意义。     

经导管封堵室间隔缺损术后传导阻滞的临床分析

本研究对6 0例室间隔缺损封堵术后并发传导阻滞的病例进行分析,报告如下:1.资料与方法:6 0例经介入封堵术治疗的室间隔缺损患者,4例术后72h内发生了不同类型的传导阻滞,术前资料如表1所示。手术方法:按常规方法建立股动-静脉导丝轨道,从静脉侧沿导丝递送输送器入左心室内,沿传送鞘送入Ampatzer封堵器。表1　4例患者术前心电图、超声心动图资料病例心电图　超声心动图1正常室间隔上部回声中断2 .5mm ,位于主动脉短轴11点2正常室间隔上部12mm×11mm假性瘤,其上回声中断3mm ,位于主动脉短轴10点3不完全性右束支传导阻滞室间隔上部膨胀瘤,其上…     

Pulmonary atresia and suprasternal echocardiography

A 54-year-old housewife with pulmonary atresia and ventricular septal defect developed increasing cyanosis, dyspnea, weakness, and myocardial ischemia. Initial cardiac catheterizations with angiography, including subtraction techniques, did not definitely indicate main pulmonary artery or right or left pulmonary arteries that would make her amenable to currently available surgical correction. Single-crystal suprasternal notch echocardiography indicated the presence of a small but definite right pulmonary artery. She subsequently underwent first-stage surgical correction after angiography and selective catheterization of aortopulmonary shunt vessels, which also revealed the presence of small proximal pulmonary arteries.     

Transarterial pulmonary venous wedge arteriography in pulmonary atresia,ventricular septal defect,and intact atrial septum

Transarterial pulmonary venous wedge arteriography was performed in four cases of pulmonary atresia (PA), ventricular septal defect (VSD), and intact atrial septum. In two cases, only the left pulmonary artery was visualized by selective injection to the patent ductus arteriosus (PDA) or Blalock-Taussig anastomosis (B-T shunt), and the right pulmonary artery was opacified by transarterial retrograde pulmonary arteriography. In two other cases, with nonfunctioning B-T shunt, the pulmonary artery was not opacified by either aortography nor by injection into the B-T shunt. Transarterial pulmonary vein wedge arteriography visualized a confluent pulmonary artery. Transarterial pulmonary vein wedge arteriography was a useful and safe procedure for opacifying the pulmonary artery that could not be visualized antegradely in VSD, PA, and intact atrial septum.     

Coronary‐pulmonary arterial fistula in a neonate with pulmonary atresia—ventricular septal defect and single coronary artery

In cases of pulmonary atresia with ventricular septal defect (PA‐VSD), coronary‐pulmonary arterial fistula (CPAF) as the main source of pulmonary blood supply is extremely rare. These fistulae may arise from the left coronary artery, right coronary artery, or a single coronary artery. Fistulae from a single coronary artery are unusual. We are reporting a case of PA‐VSD with single coronary artery and CPAF as the main source of pulmonary supply in addition to two major aortopulmonary collateral arteries (MAPCAS). Successful surgical correction with VSD closure and right ventricle (RV) to the pulmonary artery (PA) conduit was made.     

Use of small stents for rehabilitation of hypoplastic pulmonary arteries in pulmonary atresia with ventricular septal defect.

Branch pulmonary artery stenosis frequently occurs in pulmonary atresia with ventricular septal defect (PA/VSD). Balloon dilation alone is often unsuccessful in patients with severely hypoplastic pulmonary arteries with residual stenoses after surgical repair. In an attempt to promote distal pulmonary artery growth, 17 stents were placed in 12 severely stenotic pulmonary artery lesions in 10 patients with PA/VSD. All had prior surgery, including pulmonary artery repair, right ventricle to pulmonary artery homograft, and, in 6 of 10, closure of VSD. Median age at stent placement was 16.8 months (range, 13.2-56). Stents were placed using 3.0, 3.5, or 4.0 mm balloons in all but one lesion, in which a 7 mm balloon was used. Following stent placement, there was an increase in the lesion diameter from 1.5 to 3.4 mm (P < 0.05) and an increase in flow to the affected lung from 27% to 34% (P < 0.05). Repeat catheterization 2 to 6 months after stenting in six patients revealed complete occlusion in two of eight lesions. In the other six vessels, there was an increase in distal vessel diameter from 2.96 to 3.94 mm (P < 0.05) even though four had severe restenosis requiring restenting. Two patients underwent surgical pulmonary artery reconstruction and stent removal because of adequate distal vessel growth. Stenting of hypoplastic pulmonary arteries in PA/VSD results in immediate improvement in vessel size and blood flow. Stent restenosis is common although distal vessel growth can be achieved. Stenting of these lesions should be reserved only for those patients unresponsive to other interventions.     

Evaluation of ventricular septal defect repair using intraoperative transesophageal echocardiography: frequency and significance of residual defects in infants and children

Intraoperative transesophageal echocardiography (IOTEE) is commonly used to assess for residual defect and the need to return to bypass after repair of ventricular septal defect (VSD). The frequency and significance of residual septal defects as noted on IOTEE has not been well defined. We evaluated the frequency of residual VSD via IOTEE and the relationship between size of a residual VSD and rate of reoperation. In addition, we looked at the relationship between the presence of a residual VSD via IOTEE and the presence of residual VSD at follow-up transthoracic echocardiography (TTE). Residual VSD was measured via the largest width of the Doppler color jet diameter originating at the left ventricular septal surface. Of the 294 patients evaluated with IOTEE after VSD repair, one-third had a residual defect by IOTEE Doppler color flow mapping. Two-thirds of these defects closed spontaneously on TTE by the time of hospital discharge. There was no difference in frequency of residual VSD between simple (VSD closure alone, n = 90) and complex (VSD with associated lesions, n = 204) repair. Return to bypass with immediate reoperation was undertaken in nine patients, all of whom had significant shunt via oximetry (Qp/Qs > 1.5:1.0). All had residual VSD color jet diameters > 3 mm. Seven patients had residual color jet equal to 3 mm; however, hemodynamic studies did not reveal a significant shunt and none of these had reoperation. Seven patients with no VSD or < 3 mm residual VSD via had late reoperation to close residual VSD at 4 days to 5 months after initial operation. These were due to patch dehiscence or development of an "intramural" VSD in patients with conotruncal anomaly. A residual defect on IOTEE color Doppler measuring > or = 4 mm predicts the need for immediate reoperation, while a 3 mm defect may be significant and requires additional intraoperative hemodynamic evaluation. The majority of small defects noted on IOTEE are not present at discharge TTE. Patients with conotruncal defect repair should be followed closely for development of late significant "intramural" defects.     

超声心动图在嵴内型室间隔缺损封堵中的作用

目的:研究超声心动图在嵴内型室间隔缺损（VSD）封堵中的作用,并与X线左室造影结果比较。方法:入选病例包括嵴内型VSD患者13例。二维超声心动图及彩色多普勒血流图于胸骨旁左室长轴、大血管短轴及心尖五腔观测量缺损大小及其距主动脉右冠瓣、肺动脉瓣及三尖瓣的距离;术中行X线左室造影观测缺损口大小、距主动脉右冠瓣距离。封堵器释放后测量其腰部的直径。结果:二维超声心动图与彩色多普勒血流图除2例部分切面难以判断缺损口大小外,其余病例均显示缺损口大小及距各瓣的距离,大部分病例超声术前测量的缺损口大小与释放后封堵器的腰径相似。X线左室造影5例因造影角度不佳无法显示分流口大小,仅显示右室内存在分流;显示分流口的病例中部分明显小于释放后封堵器腰径。本组病例中1例封堵后出现少量主动脉瓣返流,1例术后出现封堵器移位,并出现残余分流。结论:超声心动图对嵴内型VSD封堵的术前选择优于X线左室造影。适合于嵴内型VSD封堵的患者缺损口不宜大于8mm,并无主动脉瓣脱垂。如缺损口过大可能出现术后主动脉瓣返流或封堵器移位。     

Stenting of stenosed aortopulmonary collaterals and shunts for palliation of pulmonary atresia/ventricular septal defect.

Patients with unrepaired pulmonary artery atresia and ventricular septal defect (PA/VSD) depend on aortoplumonary collaterals and surgically created shunts for pulmonary blood flow. These vessels frequently develop stenoses with time, leading to hypoperfusion of lung segments and systemic hypoxemia. The purpose of this article is to describe catheter palliation of hypoxemic patients with PA/VSD who were not candidates for surgical repair. We present our experience with stent implantation for stenosis of aortopulmonary collaterals and shunts in these patients. Three patients with hypoplastic pulmonary arteries underwent stent placement in aortopulmonary collateral arteries (APCAs) or their shunts. Technical aspects of the interventional catheterization procedure are discussed in detail. Case 1 underwent placement of five stents in collateral vessels and one stent in the Blalock-Taussig shunt (BT) with dramatic increase in vessel size and improvement in saturations from 70% to 89%. Case 2 underwent placement of two overlapping stents in a collateral vessel with an increase in diameter of the collateral vessel from 2.3 to 6 mm and an improvement in saturation from 68% to 88%. Case 3 underwent placement of three overlapping stents in a BT shunt with an increase in diameter of the shunt from 2.2 to 6.6 mm and an improvement in saturation from 71% to 89%. All three patients had excellent clinical improvement and stable saturation at follow-up. Stent placement for maintaining patency of APCAs and aortopulmonary shunts is feasible and safe.     

Perimembranous Ventricular Septal Defect and Gerbode Defect

A 27‐year‐old male presented with a known history of congenital ventricular septal defect (VSD). A Gerbode‐type defect was discovered intraoperatively that was originally misinterpreted as pulmonary hypertension. The case report will review the Gerbode defect and the transesophageal echocardiography findings. It is important, in patients with history of perimembranous VSD, to consider Gerbode‐type defect when the tricuspid regurgitation jet velocity is high (Echocardiography 2010;27:215‐217)     

Pulmonary atresia and suprasternal echocardiography.

A 54-year-old housewife with pulmonary atresia and ventricular septal defect developed increasing cyanosis, dyspnea, weakness, and myocardial ischemia. Initial cardiac catheterizations with angiography, including subtraction techniques, did not definitely indicate main pulmonary artery or right or left pulmonary arteries that would make her amenable to currently available surgical correction. Single-crystal suprasternal notch echocardiography indicated the presence of a small but definite right pulmonary artery. She subsequently underwent first-stage surgical correction after angiography and selective catheterization of aortopulmonary shunt vessels, which also revealed the presence of small proximal pulmonary arteries.