心室憩室与心室疝的超声心动图诊断

目的：探讨少见的先天性心室憩室与先天性或获得性心室疝超声心动图特征及鉴别方法。方法：超声心动图诊断的先天性心脏憩室3例，冠状动脉造影正常。先天性心包缺损所致的心室疝1例和部分心包剥离术后心室疝形成2例，其中2例经手术证实。结果：先天性心室憩室的超声心动图共同特征是心室腔局限性向外膨出，口较小，体部较宽较深。可分为有收缩性的肌性心室憩室和纤维性心室憩室。有收缩性的肌性心室憩室部位的室壁较薄，心肌回声与其他部位的心肌大致相同，与室壁呈同步运动。纤维性心室憩室的壁很薄，回声增强，无心肌组织回声，在心动周期中，心室憩室无明显的收缩和舒张运动，大小无明显的变化。心室疝由先天性和获得性心包缺损引起，二维超声心动图见心室缩窄环及心室腔变形弯曲，缩窄环部位室壁运动受限，回声增强，心室壁及心室疝呈同步的收缩和舒张。结论：超声心动图对先天性心室憩室的诊断和分型有重要的作用，对先天性心室憩室、心室疝与室壁瘤的鉴别诊断有重要的指导意义。

Echocardiographic Diagnosis of Cardiac Diverticulum and Ventricular Herniation

Objective:According to our clinical data,we studied on echocardiographic diagnosis of cardiac diverticulum and ventricular herniation.Methods:Echocardiography demonstrated saccular evagination of the ventricular wall in 3 patients.All patients underwent coronary angiography and ventriculography.One patient with congenital pericardial absence was diagnosed by echocardiography and was confirmed by surgery.Two patients with late ventricular herniation after partial pericardiectomy were diagnosed by echocardiography and 1 patient was confirmed by surgery.Results:The echocardiographic characteristics of the left ventricular diverticulum were the saccular evagination of the ventricular wall with the neck of the diverticulum smaller than the body.The diverticulum could be devided into two types:contractile and fibrous type.The saccular wall of the contractile type was very thin,but the myocardial echoes were as similar as those of other normal myocardium,and the motion of the saccular wall was synergetic with the ventricular wall.The saccular wall of the fibrous type was very thin with high echo intensity without myocrdial echoes.No motion and no size change could be seen in the diverticulam wall in the cardiac cysle.The characteristics of ventricular herniation were that echocardiography showed the ventricular constrictive ring with restricted motion and curved deformity of the ventricular cavity.Conclusions:Echocardiography plays an important role in detection of cardiac diverticulum and its classification. Echocardiography can also differentiate cardiac diverticulum from ventricular herniation and ventricular aneurysm.