Left ventricular function following withdrawal of chronic metoprolol treatment in patients with ischaemic heart disease. A double blind study

The effect on left ventricular function of a gradual withdrawalof chronic metoprolol treatment in postinfarction patients wasstudied. All patients were in a randomized double-blind post-infarctionstudy with metoprolol (M 100–200 mg daily; N=14) or placebo(P; N =18). After three years treatment the study medicationwas gradually withdrawn during one week. M-mode echocardiography,guided by concomitant cross-sectional recordings, were performedbefore, one and 12 weeks after the withdrawal. Treatment (i.e.M or P) had to be reinstituted in eight patients (5 M; 3P) becauseof the development of disabling symptoms during the follow-up.Heart rate was lower in patients treated with M (57±4)than with P (69±10) (p<0.01). One week after withdrawalof M, heart rate had increased to 77± 13(p<0.001),while patients on P showed no significant change. In order tominimize the influence of heart rate on the evaluation of timeintervals in the cardiac cycle, heart rate dependent correctionfactors were used. One week after M withdrawal there was a prolongationof the pre-ejection period (PEP) from 120±15 ms to 133±16ms (p< 0.01), mainly due to a prolongation of the intervalfor early isovolumetric contraction (Q Mc) from 87±10ms to 101±11 ms (N=11; p0.001). Simultaneously, valuesfor isovolumetric relaxation increased from 228±28msto 286±39 MS (n = 11; p0.001), starting from a somewhatlower value than P before withdrawal, reaching an insignificantlyhigher level and returning to the levels of P. During withdrawalof P stable values were encountered. Twelve weeks after withdrawal,there were no longer significant differences between M and Pgroups. In conclusion, after a one week gradual withdrawal ofM in patients with ischaemic heart disease, a transient increaseof both isovolumetric contraction and relaxation phases occur,suggesting depressed myocardial function, despite a transientrebound increase in heart rate.     

三房心的外科治疗——附4例报告

目的 探讨三房心的临床诊断和外科治疗方法。方法 总结1994年至2000年,4例三房心患施行外科手术的情况。结果 本组4例患畸形矫治满意,术后恢复好。结论 超声心动图对于三房心的诊断具有较高的价值;三房心是一种罕见的心脏畸形,多合并其他心内畸形,手术切除左房内隔膜并同时矫治其他心内畸形可获得满意的效果。     

经食道超声诊断主动脉夹层

目的 :评价经食道超声对主动脉夹层的诊断价值。方法 :采用经食道超声心动图 (TEE)检查了 30例经手术证实的主动脉夹层患者。结果 :TEE对主动脉夹层的诊断符合率 10 0 % ,DeBakey型分型符合率 90 % ,在检出主动脉瓣返流方面优于经胸超声心动图 (TTE)。结论 :TEE对主动脉夹层具有独特的诊断价值。     

胎儿心脏血流动力学特征及其形态结构的超声心动图检测

目的 运用超声心动图技术对中国高危孕妇的胎儿心脏结构、血流动力学的时相性变化特征进行探测,了解其在胚胎心脏发育中动态变化的规律;对选择性样本的胎儿先天性心脏畸形及其他心脏异常的检出率进行描述性研究。方法 1998～1999年间,对233例胎龄19～39周的胎儿,运用前瞻性研究设计,采用国际标准的详细化超声心动图方法对胎儿的心脏结构和血流动力学特征进行了系统探测。结果 满意获取了各胎龄期心房、心室、主动脉、肺动脉的内径参数,左、右心室内径基本相同,各类参数与胎龄显示高度的正相关关系。整个胎儿阶段二尖瓣、三尖瓣血流模式中a峰始终占主导地位,a、e峰的比例随胎龄增长呈现缓慢下降趋势。主动脉、肺动脉口流速在不同胎龄期的变化无显著意义。超声诊断疑有先天性心脏畸形胎儿的病理检查或生后检查显示,本组人群先天性心脏病检出率为13例（5.7%）,以复杂畸形为多数。同时发现14例有心律紊乱占6%,房性早搏占多数。结论 胎儿超声心动图可用以非创伤性的探测胎儿各期的心腔和大血管的内径,以及血流动力学的特征,这不仅对了解不同胎儿时期心脏正常的解剖和生理发育特征有直接的实践意义,而且对胎儿先天性心脏病的筛查和诊断提供了有效的手段。     

常压氧治疗胎儿-胎盘循环功能降低疗效的多普勒超声心动图观察

目的评价常压氧在胎儿-胎盘循环功能降低治疗中的疗效.方法应用超声心动图观察52例胎儿胎盘循环功能降低在常压氧治疗前后的变化情况并与45例普通吸氧组及41例未治疗组进行对照.结果52例胎盘循环功能降低胎儿中43倒常压氧治疗后胎盘循环功能恢复正常,有效率82.7%.明显高于对照组(P＜0.01).结论常压氧是治疗胎儿胎盘循环功能降低安全、有效的方法.     

Intraoperative epicardial echocardiography: technique and imaging planes

With the recent innovations in cardiac surgical techniques, there is need for an immediate and reliable way to assess results in the operating room. Intraoperative epicardial echocardiography with Doppler color flow mapping provides an accurate and rapid imaging modality to assess the anatomical and functional results of cardiac surgery. This gives the surgeon a way to determine whether the hemodynamic abnormality has been successfully eliminated, prior to closure of the chest. After enclosure in a sterile sheath, a standard echocardiographic transducer is placed directly onto the epicardial surface. The heart is imaged in multiple tomographic planes developed specifically for intraoperative use: the parasternal equivalent; aortopulmonary sulcus; subcostal equivalent; and aorta-superior vena cava transducer positions. Two-dimensional echocardiography is useful to assess the morphology of valves and the size and function of cardiac chambers. Doppler color flow mapping provides a semi-quantitative assessment of the severity and physiological mechanism of valvular regurgitation. Continuous-wave Doppler echocardiography is used to estimate gradients across stenotic valves. This comprehensive appraisal of cardiac anatomy and flow is useful in the pre- or postcardiopulmonary bypass phase of cardiac surgery. This review focuses on the technique of intraoperative echocardiography and its applications in valve reconstruction operations with specific emphasis on the epicardial imaging planes.     

组织多普勒成像和血流多普勒频谱研究冠心病患者左室舒张功能

目的：将组织多普勒成像（TDI）和彩色多普勒超声技术结合研究冠心病虱的左室舒张功能（LVDF）。方法：在心尖四腔心切面上用彩色多普勒超声检测80例心病患和79例相同年龄组正常人舒张早、晚期二尖瓣口血流频谱的最大速度（Vmax)时间速度积分（TVI）,同时用TDI技术检测左室外侧壁心肌收缩、舒张期运动频谱的Vmax和TVI,所有数据进行统计学分析。结果：两种技术所检测的正常人舒张早期峰的Vmax和TVI随着年龄的增长而降低,而舒张晚期峰的Vmax和TVI逐渐增高,冠心病患的数据变化与年龄关系不明显,主要与其心肌的病理变化程度有关,当二尖瓣口血流频谱出现“假性正常”、无法准确判断LVDF时,TDI技术的敏感性较高,它还可按检查的设计任意测量某一部位的心肌运动。结论：用血流多普勒频谱判断LVDF在一般情况下简单、方便。TDI技术可同时对左室收缩、舒张功能进行全面判断。     

白血病病人心脏功能的超声检测

（１）目的 探讨白血病病人心脏功能的超声显像变化及意义。（２）方法 应用彩色多普勒超声（ＣＤＥ）动态检查５０例白血病病人治疗前,完全缓解（ＣＲ）后心脏功能、血流动力学及心脏解剖结构的变化,并与３０例健康人（对照组）进行比较。（３）结果 治疗前白血病病人左心室收缩功能指标呈代偿性增强,其中心排量,心指数,心率,每搏量,左室射血分数及主动脉最大血流速度与对照组比较差异有显著性（Ｆ＝１．８９￣１４１．５     

多巴酚丁胺负荷超声心动图中血流动力学变化对冠心病预后评价的意义

目的　探讨多巴酚丁胺负荷超声心动图 (DSE)中血流动力学变化对冠心病预后评价的意义。方法　用DSE方法观察 2 8例正常人 (A组 )和 80例冠心病 (CAD)病人 (B组 )血流动力学变化 ,通过长期随访 ,比较 2组的预后与血流动力学变化的关系。结果　随访 10 8例 ,B组共发生心脏事件 33例 ,其中硬性事件 14例 ,软性事件19例 ,而A组无心脏事件发生。A、B两组免于事件的累积生存率有显著性差异 (P <0 .0 1)。B组中发生心脏事件者 (BⅠ亚组 )与未发生心脏事件者 (BⅡ亚组 )血流动力学指标具有明显差异 (P <0 .0 1)。B组中最大负荷时收缩压 /收缩末期容积指数 (SBP/ESVI)正常者与低于正常值范围者累积生存率具有显著性差异 (P <0 0 1)。结论DSE期间诱发心肌缺血的因素如SBP/ESVI、室壁应力增加 ,外周血管阻力指数 (TVRI)轻度下降 ,HR、SBP、RPP增加等可以提供CAD病人发生心脏事件的预测信息 ,尤其是B组中最大负荷时SBP/ESVI低于正常值范围者 ,对于判断预后具有重要意义。     

选择性PTCA逆转左室重构疗效观察

观察经皮冠脉腔内成形术能否逆转冠心病患的左室重,方法以二维超心动图测量１５例成功实施ＰＴＣＡ的左室收缩功能围术期演变,结果ＬＶＲＭ的ＣＨＤ患术后左室收缩末溶积首先缩小,随后ＬＶＥＳＶ及左室舒张末容积均缩小显;而无ＬＶＲＭ,术后ＬＶＥＳＶ及ＬＶＥＤＶ均无变化。