经食管彩色多普勒超声心动图诊断右心房粘液瘤1例

患者，男，21岁。活动后胸闷、气短两年，加重半年入院。查体：体温36.5℃，脉搏82次，血压13／9kPa，呼吸18次，发育正常。心界不大，心率82次，律不齐，偶可闻及过早搏动，心尖部可闻及Ⅱ级收缩期返流样杂音，肺第二音分裂。肝肋下未触及，双下肢无浮肿，无杵状指（趾）。心电图示电轴 78°，右心房肥大，QRS低电压。X线胸片示欢肺血正常，右二弓凸，心胸比值0.55。经胸彩色多普勒超声心动图示房间隔、室间隔回声完整，位于右心房内可见-6．scm×5．scm光团状回声通过一带连于房间隔上部，光团随心动周期于收缩期和舒张期在右心房和右心…     

心肌梗死后室间隔穿孔介入治疗成功一例

急性心肌梗死并发室间隔穿孔占心肌梗死的0 5 %～2 % ,单纯药物治疗死亡率90 % ,手术死亡率2 5 %～5 0 % ,我们用介入治疗方法封堵室间隔穿孔成功一例,现报告如下。患者,女性,74岁。因胸闷、心悸、气短2个月入院。2个月前在外院诊断急性前壁心肌梗死并室间隔穿孔,用药物治疗症     

两腔心及合并畸形的彩色多普勒超声心动图特征研究

Objective To probe into the color Doppler echocardiographic characteristics of bilocular heart (BH) and associated malformations. Methods Twenty patients of BH were examined with color Doppler echocardiography (CDE) and the characteristics were observed. All the CDE results were compared with angiocardiography and 14 were confirmed by operation. Results Nineteen cases were properly diagnosed based on the CDE characteristics,1 case were misdiagnosed as mitral atresia. CDE characteristics of BH were obvious:① Apical four-chamber view of two-dimensional echocardiography (2DE) showed total echo dropout in both the interatrial septum and the interventricular septum and disappearance of the intracardiac "cross". The common atrioventricular valve closed during systole and appeared as figure "8", named 2DE "8" sign. During diastole, the common atrioventricular valve opened to a common ventricle. ② Color Doppler flow imaging (CDFI) showed common intra-atrial flow signal entereda common ventricle through common atrioventricular valve during diastole in all patients and colorful reflux through common atrioventricular valve during systole in 15 cases. ③ Among the 20 eases, 16 of the common atria were situs solitus,4 were situs inversus; 10 of the common ventricles were type A,2 were type B and 8 were type C. According to the spatial relationship of the great arteries,there were 4 type Ⅰ ,7 type Ⅱ and 9 type Ⅲ.There were 18 pulmonary stenosis and 2 pulmonary hypertension. ④ In the presence of pulmonary stenosis, CDFI showed colorful shunt signals through pulmonary artery during systole. Conclusions BH and associated malformations have obvious echocardiographic characteristics. CDE has a specific value in diagnosing BH and associated malformations.     

彩色多普勒超声诊断先天性主动脉瓣下狭窄

主动脉瓣下狭窄是一种罕见的先天性心脏病,发病率约占先心病的0.3％,彩色多普勒血流显象(CDFI)对本病的诊断有独到的优越性。我们自1987年8月～1992年1月应用CDFI诊断此病13例,全部病例均经手术证实,现报告如下。 13例均为住院患者,男6例,女7例,年龄4～18岁(平均10岁)。其中12例做了心导管及心血管造影,有11例在做左心导管及左室造影同时测定左室压力,以及     

老年动脉导管未闭患者彩色多普勒超声心动图特征研究

目的探讨老年动脉导管未闭(PDA)患者彩色多普勒超声心动图(CDE)特征。方法选择老年PDA患者25例,应用彩色多普勒血流显像(CDFI)分流束血流信号估测PDA肺动脉端直径,与心血管造影对比判断其准确性;连续波多普勒测量三尖瓣最大反流速度峰值,与心导管对比判断其准确性。结果 M型超声和二维超声心动图显示左心房(100%)、左心室(88.0%)内径不同程度增大,室间隔与左心室后壁运动幅度增大。所有患者CDFI均显示过动脉导管左向右五彩镶嵌分流束血流信号。PDA肺动脉端直径与心血管造影呈正相关(r=0.71,P<0.01);连续波多普勒估测肺动脉压力与心导管呈正相关(r=0.63,P<0.01)。合并二尖瓣关闭不全占88.0%、主动脉瓣关闭不全占80.0%、三尖瓣关闭不全占60.0%、肺动脉瓣关闭不全占28.0%。老年PDA患者合并肺动脉高压明显增多,占60.0%。女性(96.0%)明显多于男性(4.0%)。结论老年PDA患者的CDE特征明显,有特异性诊断价值。     

先天性心脏病门诊患者的分布特征

目的:调查和描述先天性心脏病（先心病）门诊患者的分布特征。方法: 从2005年1月起,由先心病内科专家门诊负责,对先心病明确诊断的初诊患者连续登记至2011年1月,共11 780例,由26种畸形组成。统计分析26种先天畸形构成比以及其中8种常见畸形（VSD、ASD、PDA、TOF、PS、AVSD、AS、TGA）在婴幼儿、儿童和成年人等阶段比例和单病种先心病中不同年龄段所占比例;4种常见先心病（VSD、ASD、PDA、AS）的3种并发症（肺动脉高压,心房颤动,感染性心内膜炎）呈现特点。结果: ①不同年龄段疾病构成比不同, VSD,TOF和TGA婴幼儿期明显高于成年人,VSD,TOF和TGA在婴幼儿和成人比例分别为53.8%和26.6%,8.6%和2.5%,5.1%和0.2%,而ASD和AS则成年人显著高于婴幼儿期,分别为41.1%和5.7%,6.8%和0.4%;②并发症呈现特点:艾森曼格综合征在VSD、ASD和PDA患者中绝大多数系成人,占97%,存活达50岁以上不足10%;心房颤动在ASD比较常见（2.4%）,其次是PDA（1.1%）,而VSD少见（0.2%）;感染性心内膜炎在AS中较常见,发生率为6.1%,VSD和PDA分别为0.52%和0.55%。 结论: 先心病在各种不同年龄阶段的构成比不同;婴幼儿期或儿童期手术可预防致残或影响生活质量的并发症。     

动脉导管未闭并重度肺动脉高压封堵术后肺动脉压力变化

目的:探讨动脉导管未闭(patent ductus arteriosus,PDA)并发重度肺动脉高压(pulmonary arterial hypertension,PAH)经导管封堵术后肺动脉压力(pulmonary artery pressure,PAP)变化及其与术后PAH的关系。方法:对111例肺动脉平均压(mean pulmonary artery pressure,m PAP)55 mm Hg,肺/体循环血量比值(Qp/Qs)1.5的PDA患者实施封堵术,术中实时监测封堵术前后PAP变化,术后定期随访并行超声心动图检查。结果:所有患者均成功实施封堵术,术后即刻PAP显著降低(P0.05),但m PAP恢复正常仅37例(33.3%),另有轻度、中度和重度PAH患者51(49.5%),14(12.6%)和9例(8.1%)。随访1~8(中位数4)年。术后3个月共24例(21.6%)患者存在PAH,其中9例术后6个月PAP恢复正常,另外15例(13.5%)PAH持续存在。术后PAP最终恢复正常的患者封堵术后即刻m PAP降低(59±10)%,术后存在持续性PAH者仅降低(24±14)%。术后即刻PAP正常和轻度PAH者术后PAP最终均恢复正常,而术后即刻存在重度PAH者随访期间PAH持续存在。结论:在并发重度PAH的PDA患者中,即使Qp/Qs1.5,仍有13.5%的患者存在术后持续性PAH;关闭PDA后导管测量PAP为重度PAH者,术后PAH不可避免;如果术后6个月PAP仍然高于正常,PAH将持续存在。     

读片窗

病例 男,26岁.运动后乏力、气短8年，加重1个月入院。查体：体温36.0℃,脉搏90次/min，血压15.6/10.4kPa。神志清楚，营养尚可，发育正常，口唇色暗，颈静脉无充盈，     

主动脉瓣上狭窄术后不明原因室壁瘤1例

主动脉瓣上狭窄术后不明原因室壁瘤１例沈阳军区总医院（１１００１５）侯传举，邓东安，杨力军，张玉威齐齐哈尔市第一人民医院宁淑范患者，女，３１岁，患先天性主动脉瓣上狭窄１１个月前在我院行根治术，痊愈出院。近日无明显诱因活动后心悸、气短来诊。查体：血压１５...