彩色多普勒超声心动图对心肌致密化不全诊断价值的探讨

目的:探讨超声心动图对心肌致密化不全(noncompaction of the ventricularmyocardium,NVM)的诊断价值及临床意义,以提高临床及超声医师对该病的认识。方法:采用二维、M型及多普勒超声心动图对疑似NVM患者进行多方位、多切面的探查,以获取其心脏形态、结构及血流信息改变特征。结果:二维显示:病变处心肌内外分为截然不同的两层,外层较薄,表现为回声较强的致密层,内层较厚,显示突出的肌小梁及深陷其间的隐窝,呈"蜂窝状",好发于左心室心尖部、侧壁。左心腔增大,可合并室壁隐窝或房室腔内血栓形成。M型超声心动图显示:该处室壁运动幅度低平,收缩期室壁增厚率下降。多普勒超声心动图显示:深陷于肌小梁间的隐窝内可见血流信息,并与心室腔相通。晚期患者受累心功能减低。结论:NVM具有特征性声像图表现,超声心动图在无明显症状阶段即可诊断,是诊断NVM的较可靠而简便的检查手段。

The value of color echocardiogram in diagnosing noncompaction of ventricularmyocardium

Objective: To explore the diagnostic value and clinical significance of echocardiogram in noncompaction of ventricularmyocardium(NVM) and to improve the recognition of clinical and ultrasonical examinational doctors on NVM. Methods: The suspicious NVM diagnosed patients were studied by two-dimensional M-mode, echocardiography with various postures and sections. The characteristics of NVM cardiac shape, structures and blood flow changeswere obtained to observe and analyze. Results:Two-dimensional echocardiography showed significant difference between inside and outside at the location of hypokineticmyocardium: the outer layer was relatively thin and appeared as a compact layer with stronger echoes, whereas the inner layer was relatively thicker and appeared as prominent myocardial trabeculations and formation of intertrabeculations recesses deeply stucked in between them in the presence of "honeycomb", which tended to take place at cardiac apex and on sidewall of leftventricle. The enlargement of leftventricle and leftatrium, which could accompany the recesses on locularwall or result in formation of thrombosis in ventricle and atrium. M-mode: echocardiogram showed that the motion amplitude of locularwall at the above-mentioned location was relatively flat and the increase rate of locularwall during the period of contraction descended. The Doppler echocardiogram showed the information that there were visible blood streams within the recesses deeply stuck between myocardial trabeculae and they were connected with left ventricle of heartchamber. The function of heartchamber involved declined. Conclusions: NVM has the manifestation of characteristics ultrasonography, which can be diagnosed at the stage of no obvious symptom in the echocardiogram, so echocardiogram is the most reliable, simple and convenient examination method for diagnosis of NVM.