超声心动图检测胎儿心律失常

目的 探讨超声心动图产前诊断胎儿心律失常的临床价值.方法 行常规胎儿超声心动图检查,在二维超声指导下用M型取样线在心脏切面上同时通过心房壁和心室壁,观察每一心动周期房、室壁的运动曲线及相互之间的节律关系.结果 396例胎儿心律失常中,房性期前收缩276例,室性期前收缩42例,窦性心动过速31例,窦性心动过缓14例,室上性心动过速10例,心房扑动10例,完全性房室传导阻滞7例,6例在检查中出现不规则心律.13例伴有胎儿心脏结构异常,以复杂型先天性心血管畸形为主;9例伴心力衰竭、6例伴胎儿水肿. 结论超声心动图产前诊断胎儿心律失常有一定的临床应用价值,但对某些复杂类型心律失常的诊断仍存在困难.     

原位心脏移植术后多普勒超声心动图的动态检测

目的评价多普勒超声心动图的动态检测在原位心脏移植术后的作用。方法应用HP5500型超声诊断仪对3例心脏移植患进行术后床旁动态监测，二维超声观察各房室腔大小、室壁厚度、心包积液，脉冲多普勒观察二尖瓣、三尖瓣血流频谱。结果术后明显特征改变是供、受体心房缝合缘的清楚显示，及上下径增大，右室内径增大，2例术后出现心包积液，例3积液出现一过性增多，3例均出现房室瓣返流。结论多普勒超声心动图的动态监测能随时提供以上各项指标的变化，对心脏移植术后的监测有重要指导意义。     

免疫相关性胎儿心脏病产前超声特征分析

目的分析免疫相关性胎儿心脏病的产前超声心动图特点,提高其产前诊断率。方法回顾性分析我院确诊的22例自身免疫性疾病孕妇胎儿的超声心动图检查资料,对终止妊娠者行病理学检查。结果 22例自身免疫性疾病孕妇中5例胎儿心脏出现异常表现,4例均有房室传导阻滞,其中2例Ⅱ度房室传导阻滞,2例Ⅲ度房室传导阻滞;5例均有三尖瓣反流;3例表现为心室内膜面回声增强、增厚、毛糙,以右室壁为著,其中1例伴有左房壁及原发房间隔回声增强;2例有心包积液。其余17例胎儿超声心动图检查未见异常。结论先天性心脏传导阻滞、瓣膜及心内膜病变是免疫相关性胎儿心脏病的主要表现,心脏传导系统损害是其最常见表现。产前筛查能提高其早期诊断率,及早干预,有助于获得良好妊娠结局,有非常重要的临床价值。     

原位心脏移植后的超声心动图特征及演变

目的：报道原位心脏移植后超声心动图特征及演变的意义。方法：2例患者同种原位心脏移植术后定期彩色超声心动图检查,必要的心肌活检。结果：供体心房与受体心房吻合使左右心房呈“腰征”,心房上下径增大,房室瓣返流,返流可逐渐减轻或消失;术后4－5天出现心包积液,180天内消失,积液量与排斥反应有关;左室收缩功能与房室瓣返流程度及心包积液量无关。结论：原位移植心脏心房形态与自然心脏不同,定期超声心动图检查有重要临床意义。     

多普勒超声心动图对胎儿心功能的研究

我们利用多普勒超声心动图记录76例孕龄从21周到42周的正常胎儿心脏各瓣膜血流频谱,测量 1.最大血流速度;2.血流频谱积分;3.主动脉、肺动脉血流的加速时间、射血时间;4.二尖瓣、三尖瓣血流的E峰、A峰;计算通过各瓣口的每搏量、心排量。结果显示了多普勒超声心动图研究胎儿心功能的可行性,并进一步证实胎儿循环右心占优势,胎儿循环处于高阻力状态及胎儿心室肌舒张功能减低。     

母体抗SSA/SSB抗体阳性胎儿完全性房室传导阻滞超声表现

目的 观察母体抗SSA/SSB抗体阳性胎儿完全性房室传导阻滞（CAVB）超声表现。方法 以二维、M型及多普勒超声技术观察7胎母体抗SSA/SSB抗体阳性CAVB胎儿心脏,获取二尖瓣、左心室流入道及流出道、脐动脉（UA）、静脉导管（DV）及大脑中动脉（MCA）血流频谱。结果 7名孕妇抗SSA抗体、抗Ro52抗体均呈阳性,其中4名抗SSB抗体呈阳性。7胎均见房室分离,心房律正常而心室律缓慢,二尖瓣、UA、DV及MCA血流异常;其中4胎心房壁、房间隔、二尖瓣环或腱索回声增强。7胎均未合并其他心内外结构畸形。结论 母体抗SSA/SSB抗体阳性可致胎儿发生CAVB;超声观察胎儿心脏及血流动力学变化有利于判断胎儿预后。     

超声心动图对单纯性单脐动脉胎儿心功能的定量评价

目的 探讨超声心动图对单纯性单脐动脉(ISUA)胎儿的心功能评价及其临床意义.方法 对常规产科超声检出SUA的胎儿,进行系统胎儿超声心动图检查,内容包括二维测量心胸比,主动脉及肺动脉内径,M型超声心动图测量心室内径及室壁厚度,脉冲多普勒超声心动图(PW)定量半月瓣口及房室瓣口血流速度等系列参数,并采用组织多普勒技术(TDI)评价ISUA胎儿房室瓣环运动;随机选择83例正常胎儿作为对照组并测量相关参数;ISUA胎儿与正常胎儿间评价心脏收缩及舒张功能参数比较采用独立样本t检验.结果 在3 089例进行胎儿超声心动图检查的胎儿中,共检出52例SUA胎儿,其中49例ISUA,3例伴有先天性心血管畸形(法洛四联症1例,右室双出口伴室间隔缺损1例,室间隔缺损1例).49例ISUA胎儿与正常胎儿之间比较,二维及M型超声心动图所测评价心室内径及收缩功能等参数差异均无统计学意义(P＞0.05);半月瓣口及房室瓣口血流频谱及房室瓣环运动速度参数差异均无统计学意义(P＞0.05).结论 ISUA胎儿不伴有明显的血流动力学改变,其左、右心室收缩功能及舒张功能未见明显受累.     

超声心动图诊断胎儿心脏Ⅲ度房室传导阻滞1例

孕妇,28岁.第一胎妊娠31周,因常规产前检查发现胎儿心律不齐,来我院行胎儿心脏超声心动图检查.常规产科超声检查未见明显异常,胎儿超声心动图二维及彩色血流检测胎儿心内结构未见明显异常,示波下可见胎儿心律不齐,房室搏动不一致.采用M型超声心动图检测时,首先显示胎儿四腔心切面,在二维图像指引下,调节取样线依次通过右房壁,室间隔及左室壁结构,见胎儿心房心室收缩频率不同步,右房壁收缩频率约为130～140次/min,而左心室壁收缩频率约为68次/min(图1).     

彩色多普勒超声心动图对中间型房室间隔缺损的诊断

目的 探讨彩色多普勒超声心动图对中间型房室间隔缺损的诊断价值。方法 应用彩色多普勒超声心动图检查15例中间型房室间隔缺损患者，观察其超声心动图特征，与手术所见进行对照。结果 15例患者均经手术治疗并证实术前超声心动图诊断。中间型房室间隔缺损的彩色多普勒超声心动图特征包括：①所有15例患者均存在原发孔型房间隔缺损及流入道室间隔缺损；②所有患者房室瓣分为单独的二尖瓣和三尖瓣，二尖瓣前叶与三尖瓣隔叶位于同一平面，接近半数患者存在二尖瓣或／和三尖瓣裂；③CDFI及频谱多普勒均清晰显示房室水平分流及房室瓣反流。结论 彩色多普勒超声心动图对中间型房室间隔缺损具有重要诊断价值。     

小资料

房室传导阻滞:房室传导阻滞是指心肌冲动从心房到心室的传导过程发生障碍,使冲动部分地或全部不能通过。按其阻滞程度,分为3度。第Ⅰ°房室传导阻滞即房室传导时间延长,超过0.20秒,但所有心房下达的冲动都能传到心室。第Ⅱ°房室传导阻滞为部分心房传下的冲动不能达到心室,引起所谓的心室脱漏搏动。第Ⅲ°房室传导阻滞是所有的心房冲动均不能传到心室,结果阻滞部位以下出现一个节律点,控制心室的活动,产生独立的心室节律。通常将第Ⅰ°或第Ⅱ°房室传导阻滞称为不全性房室传导阻滞,第Ⅲ°房室传导阻滞称为完全性房室传     

组织多普勒成像对心脏内强回声结构胎儿心功能的研究

目的 应用组织多普勒成像(TDI)结合传统超声综合评价心脏内强回声结构(ICEF)胎儿的心功能.方法 应用TDI技术的脉冲方式观察ICEF胎儿房室瓣环运动,测量其舒张早期、舒张晚期及收缩期运动的峰值速度(Em、Am、Sm);并结合传统二维、M型及脉冲多普勒超声测量胎儿心脏大小及血流速度系列参数;对照组房室瓣口血流参数与房室瓣环运动参数进行相关分析;两组间评价心脏收缩及舒张功能参数进行独立样本t检验;两组间Em/Am随孕周的变化进行直线回归分析.结果 研究组房室瓣E/A及Em/Am显著低于对照组,并与孕周呈直线关系;对照组E与Em、A与Am、E/A与Em/Am、左室缩短分数与Sm之间呈正相关;两组评价心脏大小各参数之间、心脏收缩功能参数及不同孕期Sm比较差异无统计学意义.结论 TDI可更为敏感、准确地评价胎儿心脏功能;中晚孕期ICEF胎儿心脏舒张功能下降.     

Cardiac function in fetuses with intracardiac echogenic foci.

OBJECTIVE: To evaluate cardiac dimensions and function in euploid fetuses with intracardiac echogenic foci. STUDY DESIGN: Forty-eight fetuses with a single cardiac echogenic focus situated in the left ventricle had echocardiography performed at 22-24 weeks of gestation. Fifty normal fetuses at 22-24 weeks' gestation served as controls. Two-dimensional and M-mode directed fetal echocardiography were used to exclude cardiac anomalies and measure right and left ventricular free walls and interventricular septal thickness and ventricular systolic and diastolic dimensions. Cardiac size was expressed as a ratio of ventricular wall thickness/biparietal diameter, and cardiac function was expressed as ventricular shortening fraction. Doppler fetal echocardiography measurements included pulmonary and aortic maximum systolic velocities and time to peak velocities as indices of ventricular systolic function, and the ratio between early ventricular filling (E-wave) and active atrial filling (A-wave) peak velocities at the level of the atrioventricular valves as an index of ventricular diastolic function. RESULTS: Early ventricular filling/active atrial filling peak velocity ratios were significantly lower in fetuses with intracardiac echogenic foci than in control fetuses. In the mitral valve the ratio was 0.37 +/- 0.14 (0.039) (mean +/- SD (95% confidence interval for difference between the means)) vs. 0.59 +/- 0.19 (0.052) and in the tricuspid valve it was 0.42 +/- 0.16 (0.045) vs. 0.62 +/- 0.21 (0.058). No significant differences were found in cardiac dimensions, ventricular shortening fraction and Doppler systolic indices. CONCLUSION: Euploid fetuses with intracardiac echogenic foci show low E/A ratio values in midtrimester echocardiography. This finding might indicate cardiac diastolic dysfunction.     

高血压病患者左心室构型的彩色多普勒超声分析

目的分析高血压病患者左心室的不同构型及其发生机制,方法 高血压病组172例,对照组123例,以超声心动图测定左心室重量指数（LVMI）和室壁相对厚度（RWT）;以彩色多普勒检测有无二尖或主动脉瓣反应及其程度,以肱动脉血压和左心排血量计算体循环血管阻力（SVR）,根据LVMI与RWT分析高血压病患者的左心室不同构型,并分析其彩色多普勒超声表现与SVR特征。结果 高血压病组左室正常型占49．42％,向心性重构型9．30％,向心性肥厚型11．63％,离心性肥厚型29．65％,离心性肥厚组中度二尖瓣反流者较多,SVR最高者为向心性重构组,其次为向心性肥厚组,再次为左室正常组,三者与对照组比较差异的均有显著意义（P＜0．01）,结论 在高血压病中层得中,离心性肥厚较向心性肥厚更为常见,向心性重构也占一定的比例,向心性肥厚及向心性重构主要与压力负荷过重有关,离心性肥厚既有压力负荷过重,又有容量负荷过重,向心性重构还可能与容量低负荷有关。     

多普勒超声心动图对胎儿充血性心衰的研究

目的应用多普勒超声心动图研究、探讨胎儿充血性心力衰竭(CHF)的病变机制,为早期宫内诊断和治疗及疗效评价提供准确依据。方法超声心动图检出并诊断41例CHF胎儿及正常对照组50例。结果(1)41例胎儿中先天性心脏病14例;重症心律失常15例,胎儿肿瘤5例,双胎输血综合征5例和胎儿贫血2例;(2)均出现胎儿水肿;心脏显著肥厚扩大,表现为心胸比例增大,心房、心室的不对称增大或心肌肥厚。心室缩短率(FS%)及心输出量(CCO)降低(P<0.001);(3)中至重度二、三尖瓣返流(MRTR),9例肺动脉瓣返流;(4)32例胎儿脐动脉PI值增高或舒张期血流相消失及大脑中动脉PI值降低。37例出现脐静脉搏动性血流及41例均示下腔静脉内径增宽及血流频谱改变。结论应用多普勒超声心动图评价胎儿CHF的导致因素,通过主动脉和肺动脉CO的总和CCO可无创获得心输出量的指标及计算FS以达到量化胎儿心功能的目的。可直观地显示胎儿心脏结构,检测瓣膜返流及评价外周血流动力学变化。     

Right and left ventricular long-axis function in the fetus using angular M-mode.

OBJECTIVE: Long-axis function is determined by the longitudinally oriented myocardial fibers. Postnatally, conventional M-mode is used to assess tricuspid and mitral valve ring movements in relation to the cardiac apex. During fetal life, this is precluded by variable fetal position. We assessed the feasibility of determining right and left ventricular long-axis function in the fetus. METHODS: A prospective, pilot study. The four-chamber view obtained during routine fetal echocardiography was recorded in a cineloop to which B-mode guided M-mode echocardiography was applied using angular M-mode. This allowed retrospective and correct placement of the cursor line from cardiac apex to tricuspid or mitral valve rings. M-mode tracings of the valve ring movements in relation to the apex were derived from the originally stored loop. Data from 18 fetuses (17-29 weeks of gestation) were available for analysis. Total excursion of the valve rings was measured offline. A second cursor line was simultaneously placed in the left ventricular outflow tract during color flow mapping for timing purposes (n = 6). RESULTS: Right and left ventricular long-axis recordings were obtained in 18 and 14 cases, respectively. Total right ventricular excursion was 5.2 mm (SD, 0.9 mm) (range, 3.9-7.2 mm). Total left ventricular free wall excursion was 4.5 mm (SD, 1.1 mm) (range, 3.0-6.8 mm). For paired data, the mean of differences (right ventricle-left ventricle) was 0.8 mm (95% confidence interval 0.5-1.2). The valve rings moved towards the apex during systole (shortening) and away from it during diastole (lengthening). Peak downward movement coincided with cessation of aortic flow and diastolic lengthening with flow through the atrioventricular valves. CONCLUSION: Long-axis function in the fetus is feasible if M-mode angle correction is used. There was no clinically significant difference between tricuspid and mitral valve excursions. The pattern of atrioventricular valve movement is coordinate and similar to that of adults. Long-axis function offers a new avenue to study systolic and diastolic function in the fetus.     

Two-dimensional guided M-mode color tissue Doppler echocardiography in artificial preexcitation models.

The purpose of this study was to analyze the left ventricular contraction patterns in artificial preexcitation models by using 2-dimensional guided M-mode color tissue Doppler echocardiography. Three types of preexcitation models were produced in 12 patients by right atrio-mitral annular sequential pacing, carried out at the left ventricular lateral, posterior, and posteroseptal walls. Tissue Doppler M-mode was recorded at anteroseptal, posterior, lateral, and posteroseptal sites in the parasternal short-axis view. The time interval from the onset of the QRS complex during sinus rhythm or from the annular pacing spike during fusion beats to the beginning of systolic motion was measured. During sinus rhythm, the time interval at the anteroseptal wall was shortest. During fusion beats, the time intervals at the mitral annular pacing sites were shortest. In preexcitation models, tissue Doppler M-mode could clearly distinguish the difference of left ventricular contraction patterns and detect the earliest contraction site of the left ventricle.     

彩色多普勒超声心动图评价胎儿肿瘤与充血性心衰

目的应用多普勒超声心动图探讨胎儿肿瘤与充血性心衰（CHF）的病变机制及其相关性。方法对我院诊断的21例胎儿肿瘤行胎儿产科常规和胎儿超声心动图检查及心功能检测。结果21例胎儿肿瘤中心脏肿瘤12例；颈部水囊瘤4例；肺囊腺瘤2例；骶尾部畸胎瘤2例；肝脏肿瘤1例。其中8例出现胎儿水肿，同时出现心脏肥厚扩大，表现为心胸面积比增大，以及心房、心室的不对称增大或心肌肥厚，心室缩短率（FS）及心输出量（CCO）降低（P〈0．001），伴中至重度二、三尖瓣反流；其中3例出现肺动脉瓣反流；3例出现脐静脉搏动性血流，腔静脉内径增宽及血流频谱改变。结论应用彩色多普勒超声心动图诊断胎儿肿瘤，可探讨与CHF的相关因素。通过主动脉和肺动脉输出量（CO）的总和CCO可无创获得心输出量的指标及计算聆以达到量化胎儿心功能的目的，并可评价心内及外周血流动力学变化。     

Four-dimensional ultrasonography of the fetal heart using color Doppler spatiotemporal image correlation.

OBJECTIVE: To describe clinical and research applications of 4-dimensional imaging of the fetal heart using color Doppler spatiotemporal image correlation. METHODS: Forty-four volume data sets were acquired by color Doppler spatiotemporal image correlation. Seven subjects were examined: 4 fetuses without abnormalities, 1 fetus with ventriculomegaly and a hypoplastic cerebellum but normal cardiac anatomy, and 2 fetuses with cardiac anomalies detected by fetal echocardiography (1 case of a ventricular septal defect associated with trisomy 21 and 1 case of a double-inlet right ventricle with a 46,XX karyotype). The median gestational age at the time of examination was 21 3/7 weeks (range, 19 5/7-34 0/7 weeks). Volume data sets were reviewed offline by multiplanar display and volume-rendering methods. Representative images and online video clips illustrating the diagnostic potential of this technology are presented. RESULTS: Color Doppler spatiotemporal image correlation allowed multiplanar visualization of ventricular septal defects, multiplanar display and volume rendering of tricuspid regurgitation, volume rendering of the outflow tracts by color and power Doppler ultrasonography (both in a normal case and in a case of a double-inlet right ventricle with a double-outlet right ventricle), and visualization of venous streams at the level of the foramen ovale. CONCLUSIONS: Color Doppler spatiotemporal image correlation has the potential to simplify visualization of the outflow tracts and improve the evaluation of the location and extent of ventricular septal defects. Other applications include 3-dimensional evaluation of regurgitation jets and venous streams at the level of the foramen ovale.