复杂先天性心脏病MRI与心血管造影对照分析

笔者对１３例复杂先天性心脏病采用永磁型低磁场机器进行心电门控ＭＲＩ检查并与心血管造影（ＣＡＧ）对照分析。结果８例诊断完全符合，５例有差异。在观察心房内脏位置关系、大血管位置关系方面ＭＲＩ比较准确；在确定心室位置、房室连接及心室大血管连接关系等方面，本组病例提示ＭＲＩ与ＣＡＧ效果相似。但ＭＲＩ存在层厚较厚，定位较难掌握以及难以观察瓣膜结构与功能，易受运动伪影影响等不足。认为低磁场的ＭＲＩ可用于复杂先天性心脏病的检查。     

心脑血管粥样易损斑块的诊断及研究进展

动脉粥样硬化易损斑块是指稳定性差及存在血栓形成倾向的斑块,急性心脑血管缺血事件主要是由易损斑块的破裂和继发血栓形成所致。研究表明,冠状动脉粥样硬化常与头颈动脉粥样硬化密切相关且常同时发生,一些炎症因子在发病早期即可在外周血中被检测到。诊断易损斑块的临床手段有很多,笔者就冠状动脉、头颈部血管粥样易损斑块的影像学诊断及相关血清炎症因子的研究现状与前景进行综述。     

单发右位心的心血管造影与外科术后诊断对比研究

目的比较单发右位心的心血管造影与外科术后诊断,评价心血管造影诊断结果的准确性,探讨最佳的造影方法及投照体位.方法27例先天性单发右位心病例接受外科姑息性或根治手术治疗,回顾性分析其心血管造影资料（常规左、右室造影,其中8例行选择性心房造影,18例加行双斜位）,根据先天性心脏病节段分析法原则,将其与外科术后诊断进行对比研究.结果心血管造影诊断与外科术后诊断结果对比显示22例诊断基本一致,5例不一致,包括1例解剖校正型大动脉错位误诊为功能校正型大动脉错位,1例完全性大动脉错位误诊为功能校正型大动脉错位,1例单心室误诊为右室双出口（合并心房不定位误诊为心房正位）,2例解剖左室双出口误诊为功能校正型大动脉错位.结论单发右位心并复杂的心血管病畸形,因解剖复杂,在常规行双侧心室造影和正侧位造影基础上加行选择心房造影和双斜位造影,有利于达到准确诊断的目的.     

肺动脉异常起源于升主动脉的影像学诊断

目的 探讨肺动脉异常起源于升主动脉的影像学诊断价值。资料与方法 6例肺动脉异常起源于升主动脉，作心血管造影(ACG)及MRI检查。结果 6例中3例为右肺动脉异常起源于升主动脉，均为近端型；3例为左肺动脉异常起源于升主动脉，1例属近端型，2例远端型。结论 肺动脉异常起源于升主动脉为少见的先天性心脏病，心血管造影仍是诊断的主要手段，MRI是非创伤性检查中较为可靠、有潜力的诊断方法。     

婴儿孤立性二尖瓣瓣上狭窄环的影像学诊断（附三例报告）

目的：分析孤立性二尖瓣瓣上狭窄环的影像学特征。材料与方法：３例婴儿二尖瓣瓣上狭窄环病例均进行胸部平片、超声心动图检查，其中２例行心血管造影检查。结果：（１）胸片显示肺静脉高压；（２）胸骨旁及心尖长轴位心动超声图确定左房内异常隔膜形成的回声增强亮带；（３）选择性肺动脉造影或左房造影清楚地证实左房内的隔膜影；（４）４支肺静脉及左心耳均位于左房隔膜上腔内。结论：超声心动图是诊断本病的首选方法，对于复杂的病例应进行心血管造影     

Ruptured sinus of Valsalva aneurysm in children: Report of two cases and literature review

Two children with ruptured sinus of Valsalva aneurysm are described, each with a ventricular septal defect, and in one there was also an associated discrete subvalvular aortic stenosis. The diagnostic appearance of two-dimensional echocardiography and axial angiocardiography are emphasized to allow early diagnosis and surgical repair. A literature review of recent reports in English disclosed that 13 patients under age 20 had been reported to have ruptured sinus of Valsalva aneurysm.     

The measurement of pulmonic valve area by angiocardiographic and hemodynamic methods

The validity of angiocardiographic measurements in assessing the severity of pulmonic valve stenosis was determined. The pulmonic valve orifice area was measured in the lateral projection on cineangio-cardiographic films in 24 patients with valvar pulmonic stenosis. The valve orifice area was also obtained in the same patients by the Gorlin and Bache formulae. The right ventricular output value required for insertion in these formulae was obtained by angiocardiographic right ventricular volume measurement and by the Fick method. The correlation between the directly measured valve orifice area and the area calculated using the Fick principle and the Bache formula was 0.80. The substitution of angiocardiographically measured right ventricular stroke volume for the Fick value gave a correlation of 0.82. The results support validity of employing direct angiocardiographic measurements of pulmonic valve orifice area and angiocardiographic right ventricular volume measurements for quantitative assessment of the severity of pulmonic valve stenosis. The angiocardiographic methods thus represent an alternative to the Fick technique which can be used in conditions where the Fick method cannot be expected to give valid results. This work was supported in part by National Heart and Lung Institute Training Grant in Cardiovascular Radiology HL 05824     

马凡综合征升主动脉病变17例影像分析

本文对17例马凡综合征患者的血管造影、CT 和MR 进行了分析,并对马凡综合征升主动脉瘤同其他原因引起的升主动脉瘤进行了比较,分别测量马凡综合征患者和其他原因引起的升主动脉瘤的窦直径、升中径、弓前径、弓中径、降上径,发现马凡综合征患者的升主动脉瘤最大直径均位于主动脉窦部,窦横径与弓前径的比值均≥1.78;而非马凡综合征患者的这一比值均明显<1.78。本文马凡综合征患者中有82%(14/17)合并主动脉瓣关闭不全。     

Imaging procedures in the detection of cardiac tumors,with emphasis on echocardiography: A review

Although cardiac tumors are relatively rare, their diagnosis is important because successful treatment is usually feasible if the diagnosis is made preoperatively. An analysis of 219 reports of cardiac tumors described in the English literature from 1972 through 1977 demonstrated the predominance of benign tumors, in particular myxoma, which is in agreement with past reviews. The methods of diagnosis employed included plain chest films, echocardiography, cardiac catheterization, angiocardiography, and cardiac scintigraphy. Conventional x-ray examination of the chest was abnormal in 83% of cardiac tumors but non-specific and should lead to further evaluation, first by echocardiography. Echocardiography, the most efficient diagnostic procedure for screening possible cardiac tumors, was abnormal in 94% of the cases. Cardiac catheterization was abnormal in 80% of cardiac tumors while definitive detection was made by angiocardiography in 94% of the cases. Cardiac scintigraphy has had limited use in the diagnosis of cardiac tumors, but has been diagnostic in 100% of the cases in a small series of myxomas.