小儿心内膜弹力纤维增生症的超声诊断

本文对32例小儿心内膜弹力纤维增生症容易误诊的原因进行分析,并提出了二维超声心动图在本病的特点,为早期诊断本症提供了重要的客观依据,对其疗效评价,降低死亡率均具有重要的临床意义。     

心内膜电极导管损伤断裂五例分析

我院在１９７４～１９９２年期间共植入永久性心脏起搏器４００例，其中５例发生了心内膜电极导管损伤、断裂。其原因主要是医源性损伤４例和电极老化１例。为了预防，提出训练有素的手术者，选用高质量的起搏系统、避免患肢过强活动是减少心内膜电极导管损伤断裂的主要措施。     

Epidemiology, and diagnostic and surgical trends in atrioventricular septal defect in Malta

Atrioventricular septal defect (AVSD) is a common congenital cardiac malformation, associated with Down's syndrome. AVSD causes heart failure, and if not treated early, irreversible pulmonary hypertension. In Malta, a decline in age at diagnosis and at surgery was present from 1944 to 1994. The birth prevalence was 0.31/1000 live births, within the range obtained from a literature review. Down's syndrome children are now treated as are non-syndromic children.     

心脏起搏电极导线电性能和病理形态学观察及其临床意义

目的通过动物实验观察心脏起搏电极的电性能和病理形态学变化，以供临床应用时参考。方法将一对电极导线植入犬的右室心尖部后，定期测量电极的电参数和心功能，３个月后处死犬，进行形态和光镜病理检查。结果碳电极的起搏阈值和感知等电性能优于Ｅｌｇｉｌｏｙ电极，且其组织反应小；两根电极导线植入后对心功能和三尖瓣关闭无明显影响；电极头与心肌组织间可见包绕性纤维团块，以纤维结缔组织增生和肉芽组织形成为主，伴少许浆细胞、单核细胞和淋巴细胞浸润。部分电极导线与腱索和三尖瓣环形成粘连。结论良好电性能的电极刺激阈值低，感知功能好，局部组织反应轻，有利于保护心功能；由于电极头与心肌间形成纤维包绕团块，故电极如需拔除，需应用专门器械     

超声心动图诊断部分型心内膜垫缺损合并房间隔肿物1例

<正>患者男,60岁,因发作心慌半年余,劳力性气短、胸闷1月余来我院就诊。体格检查:心界稍大,心率70次/min,律齐,P2亢进,胸骨左缘第三四肋间可闻及2～6级收缩期杂音,传导局限。超声心动图检查:于心尖四腔切面见房间隔下部近十字交点连续中断,缺损口大小为1.2 cm,可见自左房向右房血流信号(图1,2)。于房间隔中部卵圆窝处见一大小约1.5 cm×1.1 cm     

Incremental value of three-dimensional and contrast echocardiography in the evaluation of endocardial fibroelastosis and multiple cardiovascular thrombi: A case report

BACKGROUNDEndocardial fibroelastosis (EFE) is a rare heart disease characterized by thickening of the endocardium caused by massive proliferation of collagenous and elastic tissue, usually leading to impaired cardiac function. Multimodality cardiovascular imaging for the evaluation of EFE with thrombi is even rarer.CASE SUMMARYWe report a rare case of EFE associated with multiple cardiovascular thrombi. Three-dimensional (3D) and contrast echocardiography (CE) were used to assess ventricular thrombi. Anticoagulant therapy was administered to eliminate the thrombi. The peripheral contrast-enhanced thrombi with the highest risk were dissolved with anticoagulant therapy at the time of reexamination, which was consistent with the presumption of fresh loose thrombi.CONCLUSIONThis new echocardiography technique has a great advantage in the diagnosis and treatment of EFE. On the basis of conventional echocardiography, 3D echocardiography is used to display the position, shape, and narrow base of the thrombus. CE does not only help to confirm the diagnosis of thrombus, but also determines its risk.     

多普勒超声对心内膜弹力纤维增生症左心室收缩和舒张功能的评价

本研究采用多普勒超声心动图检测技术对35例心内膜弹力纤维增生症患儿的左心室收缩和舒张功能进行了观察，结果显示心内膜弹力纤维增生症可出现心脏收缩和舒张功能的降低，表现为CI、EF、FS、E、E／A、1／3FF、1／2FF指数的降低和IRT、A增加，并且与正常对照组比较，P＜0．05，同时观察到治疗后收缩功能明显改善而舒张功能有所好转但与治疗前无显著性差异，所以我们认为心内膜弹力纤维增生症治疗时要注意收缩与舒张功能同时纠正。     

The feasibility and usefulness of contrast exercise echocardiography for the assessment of left ventricular function in master athletes.

BACKGROUND: The number of competitive master athletes (MA, over 40 years) has been rising. Since the incidence of coronary artery disease (CAD) is increasing in this population, cardiovascular pre-participation screening, including a maximum exercise test, is recommended. In this context the addition of contrast to echo could be useful because wall thickening and motion are better markers of myocardial function when the whole endocardial border (EB) is visible. OBJECTIVE: To evaluate the feasibility and usefulness of rest and exercise contrast echo for the assessment of LV wall motion in competitive master athletes with suboptimal acoustic windows. METHODS: Forty consecutive MA underwent echo and contrast echo both at rest and during exercise. Contrast-enhanced images were achieved at rest and at peak exercise after administration of SonoVue (BR1), using apical 4 and 2-chamber views divided into 6 myocardial segments (MS). The EB resolution for each segment was graded as: 0=not visible, 1=barely visible, 2=well-delineated. RESULTS: In the baseline at-rest echo 17/40 (45%) patients were graded as score 0, 22/40 (55%) were graded as score 1 and only 1 athlete has reached score 2. In at-rest echo contrast 28/40 (70%) athletes have reached score 1 and 12/40 (30%) score 2. Nobody was graded as score 0. At the same time in the baseline peak-exercise echo 12/40 (30%) athletes were graded as score 0, 24/40 (60%) athletes reached score 1 and 4/40 (10%) score 2, while using contrast at peak-exercise echo 28/40 (70%) were grated as score 1 and 12/40 (30%) reached score 2. The differences about the grading of the score between the two groups with and without contrasts, at rest and at peak exercise, are statistically significant (p<0.001). Considering the whole of the MS analyzed in the majority of the athletic population studied, we can see that at-rest echo, 64/480 MS (13.3%) were graded as 0, 156/480 MS (32.5%) as 1 and 260/480 MS (54.2%) were graded 2, while in the peak-exercise 96/480 MS (20%) were graded as 0, 235/480 MS (48.9%) as 1 and 209/480 MS (43.5%) were graded 2. On the other hand, using contrast, in at-rest echo, 480/480 MS (100%) were graded as 2 while in the peak-exercise echo 460/480 MS (95.9%) were graded as 2 and 20/480 MS (4.1%) as 1. The percentage of the MS graded as 2 reach almost the whole number of the analyzed MS with a percentage increment in the at-rest and peak-exercise echo of 85% and 120%, respectively. CONCLUSIONS: Our results show that the use of contrast echo improves the visibility of the EB in a way that the two groups of competitive athletes show at rest and after exercise a significant increment of the score 2 compatible with a better visibility of the EB. These results suggest that contrast echo, both at rest and during exercise, is a better method for EB analysis to understand the behaviour of the wall motion in subjects with suboptimal acoustic windows, and could be suitable for cardiovascular screening in master athletes.