2490名中老年干部钙化性主动脉瓣病的患病情况及超声心动图分析

本文分析了在2490名中老年干部中经超声心动图诊断的104例钙化性主动脉瓣病的超声心动图表现。发现其患病率随年龄增长成倍数递增,男性多于女性。该病不仅可以引起众所周知的AS,也可引起AI,以无冠瓣受累最多。轻—中度CAS及CAI尚不足以引起心脏解剖结构的明显改变,左室收缩功能也保持正常,但舒张功能却发生障碍。     

慢性饮酒对大鼠左心室心肌胶原含量及舒张功能的影响

目的:检测慢性饮酒大鼠左心室心肌胶原含量的变化和舒张功能的损害,并探讨两者的相关关系.方法:雄性8周龄Wistar大鼠24只,随机分为乙醇组和对照组,每组12只.喂养16周后,超声心动图和组织多普勒成像(tissue Doppler imaging,TDI)检测左心室舒张功能,羟脯氨酸测试试剂盒测定心肌羟脯氨酸含量,RT-PCR方法检测心肌Ⅰ型、Ⅲ型胶原mRNA的表达.结果:乙醇组与对照组比较,多普勒二尖瓣E峰峰值降低(P＜0.01)、等容舒张时间(IVRT)延长(P＜0.01);TDI二尖瓣内环舒张早期峰速度Ea降低(P＜0.05),舒张晚期峰速度Aa增高(P＜0.01),乙醇组的Ea/Aa比值＜1,而对照组＞1(P＜0.01).乙醇组的羟脯氨酸含量、Ⅰ型胶原和Ⅲ型胶原的mRNA表达水平及Ⅰ型/Ⅲ型胶原比值都高于对照组(P＜0.01).心肌羟脯氨酸含量、Ⅰ型胶原和Ⅲ型胶原的mRNA表达水平及Ⅰ型/Ⅲ型胶原比值都与IVRT呈正相关(P＜0.05),与Ea/Aa比值呈负相关(P＜0.01).结论:乙醇喂养大鼠16周后左心室心肌胶原合成增加,舒张功能减低,二者呈正相关.     

组织多普勒Tei指数评价三尖瓣返流胎儿右室功能的变化

目的采用组织多普勒Tei指数评价不同程度单纯三尖瓣返流胎儿的右室功能的变化。方法选取经胎儿超声心动图筛查为单纯三尖瓣返流的中晚孕胎儿60例（除外心内及其他部位结构性畸形）,其中轻度返流36例,中度返流24例,另选取其他30例相同孕周不合并三尖瓣返流胎儿为对照,采用组织多普勒技术分别测定各胎儿的右室Tel指数,比较各组间胎儿右室Tei指数的变化情况,并观察其转归。结果轻度三尖瓣返流组右室Tei指数与正常对照组相比差异无统计学意义（P〉0．05）;出生后6周复查4例仍存在三尖瓣轻度返流,肺动脉收缩压19—27mmHg。中度三尖瓣返流组右室Tei指数与正常组及轻度返流组相比均升高（P均〈0．05）,其中1例因孕晚期出现胸腹腔积液引产,余出生后6周复查7例合并中度三尖瓣返流,肺动脉收缩压30—45mmHg,12例合并轻度三尖瓣返流肺动脉收缩压27—36mmHg。结论轻度三尖瓣返流不影响胎儿右室功能,出生后转归良好;中度三尖瓣返流胎儿右室Tei指数升高,右室功能下降,部分转归较差,组织多普勒Tel指数能简便、快捷的评价合并三尖瓣返流胎儿右室整体功能的变化,为临床干预提供指导。     

Safety and Efficacy of Intravenous Contrast Imaging in Pediatric Echocardiography

This study was performed to determine the safety and efficacy of intravenous contrast echocardiography in children attending a tertiary cardiac center. This was a prospective study to evaluate the use of Optison contrast agent in children with severely limited transthoracic echocardiographic windows. Twenty children (median age, 15 years; range, 9–18) underwent fundamental imaging (FI), harmonic imaging (HI), and HI with intravenous contrast (Optison FS-069). Endocardial border delineation was determined based on a visual qualitative scoring system (0, none: 4, excellent). Endocardial border definition was significantly improved in all patients using contrast echocardiography (FI vs Optison, p < 0.001 for each). Improved border definition was most dramatic in the apical and left ventricular (LV) free wall regions. Left ventricular ejection fraction (LVEF) was measurable in 20 patients (100%) using contrast compared to 11 (55%) with FI or HI (p < 0.05). The echocardiographic diagnosis was correctly delineated in 1 patient with a severely dyskinetic LV segment only with use of intravenous contrast and HI. No patients suffered adverse hemodynamic effects, changes in taste, or flushing episodes. Three patients experienced transient headaches. Intravenous contrast echocardiography offers an additional tool in evaluating children with very poor transthoracic echocardiographic windows. Such a strategy increases diagnostic accuracy and allows accurate LVEF determination. Adverse hemodynamic effects related to intravenous contrast are exceedingly rare.     

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目的探讨多层螺旋CT(MSCT)及联合经胸二维超声心动图(TTE)检查在先天性心脏病诊断中的意义。方法收集广东省心血管病研究所自2002年9月至2003年12月间86例儿童先天性心脏病病例,全部患儿接受了MSCT和TTE检查,12例接受心导管检查,其中69例进行了外科手术,将术前MSCT、TTE和心导管检查结果分别与手术诊断进行比较。结果69例患儿共计有129处畸形,TTE正确诊断116处(89.9%),MSCT正确诊断112处畸形(86.8%),两者联合正确诊断127处畸形(98.4%),12例心导管检查未能提供更有价值的资料。结论MSCT对先天性心脏病诊断具有较高的价值,尤其是联合TTE可取代部分心导管检查为外科手术提供正确和充分的术前诊断。对于年龄小或重症不耐受心导管检查的患儿具有更大的意义。     

Left Ventricular Diastolic Filling Patterns Associated with Progressive Anthracycline-Induced Myocardial Damage: A Prospective Study

The objective of this study was to examine changes in diastolic function associated with progressive myocardial damage and their implications. We used prospective sequential Doppler echocardiographic studies of left ventricular (LV) function. The study included 125 consecutive children (median age 6.3 years) receiving anthracyclines to cumulative doses between 45 and 1150 mg/m² (median 270 mg/m²). We measured peak early (E) and atrial (A) phase filling velocities, EA ratio, deceleration and isovolumic relaxation times (EDecT and IVRT), heart rate, and fractional shortening (SF). Results were compared serially and with individually paired control data matched for body surface area. Progressive myocardial damage was evidenced by a mean SF decrease of 1 absolute %/100 mg/m² of anthracycline. Six patients developed cardiac failure. After 1–100 mg/m² of anthracyclines, the EA ratio decreased (mean 1.54–1.40, p= 0.02) and IVRT became prolonged (54 vs 52 msec in controls, p= 0.03). EA ratio increased again with the next dose, usually normalizing thereafter. Twelve patients ended treatment with an EA ratio <1 (1 cardiac death) and 17 with EA ratio >2 (2 cardiac deaths). Diastolic abnormalities were not strongly predictive of reduced SF. Modest changes in left ventricular diastolic filling patterns occur during anthracycline treatment of childhood malignancies. Although 20% of patients have significant abnormalities of diastolic filling by the end of treatment, considerable individual variability renders the pathophysiological and clinical implications of the early changes uncertain.     

超声心动图诊断法洛四联症的临床价值评估

目的评价超声心动图诊断法洛四联症（TOF）的准确性、可靠性和效益,探讨法洛四联症无创伤性术前诊断方法及手术指征。方法以手术后诊断为金标准,评价234例TOF患儿的二维超声心动图（2-DE）诊断及心导管诊断结果。结果对于TOF的诊断,2-DE诊断灵敏度97.9%,特异度99.8%,符合率99.6%;心导管诊断灵敏度99.5%,特异度100%,符合率99.9%;两者的差异无统计学意义。在TOF合并心血管畸形的诊断中,2-DE诊断CA横跨ROVT、侧支血管、PDA的灵敏度、特异度、符合率与手术后诊断存在明显差异。结论2-DE可替代心导管造影检查用于TOF的诊断。如果术前2-DE检查发现冠状动脉显示不清或怀疑走行异常、存在侧支血管、PDA与侧支血管难以鉴别及肺动脉分支发育不良时,需进一步行心导管造影检查。     

贝那普利对高血压病和冠心病左室舒张功能不全的影响

目的 :了解贝那普利对高血压病和冠心病左室舒张功能的影响。方法 :81例左室舒张功能不全病人 (高血压 4 5例 ,冠心病 36例 ;男性 56例 ,女性 2 5例 )应用贝那普利 10～ 2 0mg(冠心病在口服硝酸酯类药基础上加服贝那普利 5mg) ,po ,qd× 5mo ;用药前后用彩色多普勒超声心动图测定舒张早期最大峰值速度 (E峰 )、舒张晚期最大峰值速度 (A峰 )、E/A峰值速度比值及最快充盈率 (PFR)。结果 :治疗后比治疗前E峰、E/A比值、PFR均升高 ,而A峰降低 ,差别均有非常显著意义 (P <0 .0 1)。结论 :高血压病和冠心病病人服用贝那普利 5mo左右 ,对左室舒张功能不全有明显改善作用。     

自动心肌运动定量技术评价蒽环类药物致白血病儿童心脏毒性的价值

目的：探讨自动心肌运动定量（a CMQ）技术评价急性淋巴细胞白血病（ALL）儿童使用蒽环类药物化疗后亚临床左室功能损害的价值。方法：选取2021年11月至2022年1月在温州医科大学附属第二医院育英儿童医院采用DVLD方案诱导化疗的30例ALL患儿作为白血病组,在化疗前和化疗3个月后行超声心动图检查。同期选取性别匹配的26例健康者作为对照组。运用常规超声心动图获取左室射血分数（LVEF）、左室短轴缩短率（LVFS）、二尖瓣口舒张早期峰值流速（E）与晚期最大峰值流速（A）比值（E/A）、E与二尖瓣环舒张早期血流峰值（e’）比值（E/e’）、e’与二尖瓣环舒张晚期血流峰值（a’）比值e’/a’。运用aCMQ技术获得两腔心纵向应变（AP2LS）、三腔心纵向应变（AP3LS）、四腔心纵向应变（AP4LS）及整体纵向应变（LVGLS）,左室短轴基底段环向应变（SAXBCS）、左室短轴中间段环向应变（SAXMCS）、左室短轴心尖段环向应变（SAXACS）及整体环向应变（LVGCS）,并进行比较分析。结果：白血病组与对照组年龄差异无统计学意义（P>0.05）;对照组、化疗前组及化疗后组LVEF...