超声心动图对完全性肺静脉畸形引流的诊断价值

目的探讨完全性肺静脉畸形引流的超声心动图表现特征。方法搜集因紫绀而就诊超声心动图疑诊为完全性肺静脉移位引流的患儿17例，其中8例经手术证实，4例经心血管造影证实，5例失去随访，超声采用剑突下切面、心尖四腔切面及胸骨上窝切面。结果12例肺静脉畸形引流的患儿中，心上型6例，心内型6例。伴Ⅱ孔型房间隔缺损11例，伴三房心3例，伴动脉导管未闭2例，伴室间隔缺损1例，伴中-重度肺动脉高压10例。结论超声心动图对完全性肺静脉畸形引流有重要的诊断价值，安全无创伤，可重复检查，为外科治疗方案选择提供有意义的资料。     

超声心动图诊断部分性肺静脉异位引流的价值

目的探讨超声心动图对部分性肺静脉异位引流(PAPVC)的诊断价值。方法回顾性分析29例PAPVC患者二维超声及彩色多普勒图像表现并与心血管造影、手术结果对比分析,总结其诊断特点,找出漏诊的原因。结果术前确诊25例,漏诊3例,1例提示诊断。右上肺静脉引流入右心房19例;右上肺静脉引流入上腔静脉2例;右上肺静脉及右下肺静脉均引流入右心房2例;右下肺静脉引流入右心房2例;右上肺静脉及右下肺静脉引流入冠状静脉窦1例;左上及左下肺静脉通过垂直静脉引流入左无名静脉3例。合并房间隔缺损(ASD)27例,其中静脉窦型ASD 20例,继发孔ASD 7例,1例房间隔完整,1例合并卵圆孔未闭。25例超声诊断与心血管造影、手术结果符合。结论超声心动图诊断PAPVC具有较高的准确度,但在成人时期容易漏诊。     

主动脉弓离断三联症合并右室双出口的影像诊断

目的　研究主动脉弓离断三联症合并右室双出口的影像学表现。方法　回顾性分析 2例主动脉弓离断三联症合并右室双出口的X线胸片、超声心动图、心导管检查、心血管造影及 1例电子束CT(EBCT)、另 1例磁共振 (MRI)扫描资料。结果　两例均为主动脉弓离断、室间隔缺损、动脉导管未闭合并右室双出口伴重度肺动脉高压。本组两例行X线胸片、超声心动图检查均被误诊和漏诊。结论　心血管造影是诊断该类复杂畸形最可靠的方法 ,并有助于治疗方案的选择。     

肺静脉畸形引流的超声显象诊断

本文报告了6例肺静脉畸形引流患者,均有房间隔缺损,切面超声心动图上可见右房、右室增大,房间隔连续中断,四心腔图上,5例仅见1～2支肺静脉进入左房,(正常引流组98％3支进入左房),1例完全性肺静脉畸形引流患者,左右肺静脉汇合成肺静脉干经垂直静脉、左无名静脉、上腔静脉再流入右房。左心声学造影时,肺静脉先出现造影剂,而后右心系统显影。     

正常肺静脉经胸超声心动图与64层螺旋CT对比定位观察

目的 探讨经胸超声心动图显示肺静脉及对4条肺静脉定位的有效方法.方法 选取同时行肺静脉CT血管造影检查及超声心动图检查的拟行心房颤动消融患者12例.进行CT三维图像后处理分析,观察4条肺静脉与相邻重要解剖结构的空间位置关系,同时对比分析CT三维图像后处理相关断层与超声心动图切面.结果 12例患者肺静脉螺旋CT血管造影成像均清晰显示,且无结构异常及解剖变异.右上肺静脉开口紧邻房间隔,近端与上腔静脉相邻.右下肺静脉相对于右上肺静脉稍远离房间隔,位于右侧.左上肺静脉紧邻左心耳.左下肺静脉相对于左上肺静脉远离左心耳,靠近胸降主动脉.超声心动图标准切面左心室长轴、大动脉短轴、心尖四腔观在调整探头的基础上可以显示4条肺静脉.结论 经胸超声心动图可以显示4条肺静脉,参照邻近重要的解剖结构可以对4条肺静脉进行空间位置定位.     

肺静脉畸形引流的彩色多普勒超声心动图诊断

肺静脉畸形引流是指肺静脉未与左心房相通而与右心房或体循环连接，是一种较少见的紫纣型无心病，临床较难确诊。本文总结了我院1992～1995年经手术证实的肺静脉畸形引流6例，现报道其彩色多普勒超声心动图表现。所用仪器为HPSONOS1000型彩色多普勒超声诊断仪，探头频率2．SMHZ。患者取仰卧位或左侧卧位，经胸骨旁、心尖部、剑突下及胸骨上窝探查各个标准心脏切面。患者6例，男4例，女2例，年龄2～41岁。完全型肺．静脉畸形引流3例，部分型肺静脉畸形引流3例。结果6例肺静脉畸形引流患者，术前均做彩色多普勒心动图检查，其中5倒彩色多…     

超声心动图诊断肺静脉异位引流的价值研究

目的 探讨超声心动图对肺静脉异位引流的诊断价值。方法 采用回顾性分析法,收集2010年1月至2019年12月驻马店市中心医院收治的56例肺静脉异位引流患者的临床资料,所有患者均经CT血管造影检查及手术确诊,且入院时均给予超声心动图进行检查,以CT血管造影检查及手术结果作为依据,分析超声心动图对诊断肺静脉不同异位引流程度(部分性肺静脉异位引流、完全性肺静脉异位引流)以及病理组织学类型(心上型、心内型、心下型、混合型)的符合情况;分析超声心动图对肺静脉异位引流的诊断价值。结果 以CT血管造影检查及手术结果作为依据,超声心动图检查完全性肺静脉异位引流的符合率为85. 00%(17/20)、部分性肺静脉异位引流的符合率为97. 22%(35/36);超声心动图对不同异位引流程度的检查准确度为92. 86%(52/56);超声心动图诊断肺静脉异位引流的不同异位引流程度与CT血管造影检查及手术结果具有极好一致性(Kappa=0. 841)。超声心动图检查对病理组织学类型诊断的总符合率为91. 07%(51/56),其中对心上型诊断符合率为88. 89%(16/18)、心内型诊断符合率为95. 24%(20/21)、心下型诊断符合率为90. 00%(9/10)、混合型诊断符合率为85. 71%(6/7);超声心动图诊断肺静脉异位引流的病理组织学类型与CT血管造影检查及手术结果具有极好的一致性(Kappa=0. 874)。结论 超声心动图对肺静脉异位引流具有一定诊断价值,可准确评估患者不同异位引流程度以及病理组织学类型,为临床诊治提供重要参考依据。     

时间-空间关联成像联合高分辨率血流显像在产前胎儿静脉系统异常诊断中的应用价值

目的 探讨时间-空间关联成像(STIC)技术联合高分辨率血流显像(HDF)在胎儿静脉系统异常诊断中的应用价值.方法 对50例正常胎儿及48例二维超声心动图检查疑诊先天性静脉发育异常胎儿分别进行HDF显像及STIC数据采集.结果 50例正常胎儿及48例疑诊静脉发育异常胎儿分别成功采集到46个、43个合格的容积图像.正常胎儿组:二维灰阶及彩色血流显像对正常脐静脉、静脉导管、下腔静脉、肺静脉的显示率分别为90％、80％、84％、40％;HDF-STIC对正常脐静脉、静脉导管、下腔静脉、肺静脉的显示率分别为90％,90％,89％、82％.胎儿静脉系统异常者组:永存左上腔静脉畸形20例,彩色多普勒显示16例,HDF-STIC显示20例;脐静脉引流异常7例,彩色多普勒显示6例,HDF-STIC显示7例;下腔静脉畸形6例,彩色多普勒显示5例,HDF-STIC显示6例;肺静脉异位引流10例,彩色多普勒显示5例,HDF-STIC显示7例.结论 HDF-STIC可提供二维超声心动图无法获得的空间结构信息,提高胎儿静脉系统的显示,有助于胎儿静脉系统异常的产前诊断.     

超声心动图在诊断单心室中的价值

目的 探讨单心室的超声诊断价值,分析其超声表现类型.方法 回顾性分析66例单心室患者的经胸超声心动图表现,并结合文献分析超声表现类型.结果 66例患者根据单心室的超声表现分为三型:①A型(左室型)19例,单心室为左室形态,其前方有一发育不良的残余心室;②B型(右室型)38例,单心室为右室形态,其后方有一发育不良的残余心室;③C型(不定型)9例,只有单个心室腔,无合并发育不良的残余心室.66例单心室患者中,31例经手术证实,5例经MRI或心血管造影证实,分型诊断正确率为100%.其合并的畸形中,1例混合型完全性肺静脉畸形引流误诊为心上型完全性肺静脉畸形引流(APVD),降主动脉局限性缩窄并动脉导管未闭(PDA)漏诊1例,其余诊断完全正确.结论 经胸超声心动图能准确诊断单心室分型及其合并畸形,为手术提供准确可靠的信息,是术前诊断的必要检查方法.     

超声心动图诊断左上腔静脉合并先天性心脏病

目的：探讨超声心动图方法诊断左上腔静脉合并先天性心脏病的诊断价值。方法：17例临床诊断或怀疑先天性心脏病的患进行超声心动图检查，冠状静脉窦有扩张的患同时进行超声声学造影检查，以明确有否存在左上腔静脉异位引流。结果：本组17例患存在左上腔静脉合并先天性心脏病，13例患冠状静脉窦扩张，经超声心动图及超声声学造影确诊，4例先天性心脏病患漏诊左上腔静脉。13例患进行了手术治疗。结论：超声心动图的检查发现冠状静脉窦有扩张时，超声声学造影进一步检查可确诊有否存在左上腔静脉异位引流。     

区域血流追踪法在超声诊断胎儿肺静脉异位引流中的应用价值

目的探讨区域血流追踪法在超声诊断胎儿肺静脉异位引流中的价值。 方法回顾性选取2015年1月至2019年12月在河北生殖妇产医院进行胎儿超声心动图检查，诊断为肺静脉异位引流的胎儿41例。超声检查胎儿肺静脉时，应用区域血流追踪法，即将肺组织大致分为4个区域，左侧前上部1/2肺野、左侧后下部1/2肺野、右侧前上部1/2肺野、右侧后下部1/2肺野，应用彩色血流技术对41例肺静脉异位引流胎儿4个区域内肺静脉分支进行追踪并定位，观察其近心端与左心房的关系及最终回流部位。 结果41例肺静脉异位引流胎儿，4个区域内肺静脉远端分支分别引流入左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉。36例完全型肺静脉异位引流胎儿4条肺静脉近心端均未汇入左心房，其中34例呈现左心房后方汇聚征。心上型25例肺静脉最终回流入上腔静脉；心内型7例中6例通过冠状静脉窦回流入右心房，1例直接回流入右心房；心下型2例肺静脉回流入门静脉窦；混合型2例，1例左侧肺静脉汇入上腔静脉，右侧肺静脉汇入下腔静脉，1例左侧肺静脉汇入上腔静脉，右侧肺静脉回流入右心房。5例部分型肺静脉异位引流胎儿，1例右上肺静脉直接回流入右心房，2例右上肺静脉回流入上腔静脉，1例右上、右下肺静脉直接回流入右心房，1例左肺静脉变异为3支，最上支经无名静脉回流入上腔静脉。 结论应用区域血流追踪法可使肺静脉分支检查更全面，定位更加精确，有助于提高胎儿肺静脉异位引流的诊断准确性。     

Diagnostic tools in the preoperative evaluation of children with anomalous pulmonary venous connections

Pulmonary venous abnormalities are generally diagnosed by echocardiography and often confirmed by cardiac catheterization. Although angiography has been the gold standard for evaluation it carries certain inherent risks, especially in small and sick infants. In this study we retrospectively assessed the utility of magnetic resonance angiography (MRA) and computed tomography angiography (CTA) in the evaluation of pulmonary venous abnormalities in pediatric patients. The results were compared with operative findings. We reviewed nine patients with total APVC and four with partial APVC. Twelve patients were infant (age range: 1 day to 8 months) and the other was 16 years old. MRA and/or CTA clearly visualized the anomalous drainage of pulmonary veins in all patients. Cardiac catheterization was performed five patients with one total anomalous pulmonary venous connection and four with partial anomalous pulmonary venous connection. Ten patients were operated on. Diagnoses of patients were confirmed by operative findings. In Conclusions, MR and CT angiography allow detailed and comprehensive evaluation of the APVC and are good diagnostic modalities for use in the preoperative assessment of the anomaly in pediatric patients.     

纵隔静脉异常在胸部增强CT上的表现

目的 进一步了解纵隔静脉异常的CT表现和意义。方法 收集胸部增强CT上出现纵隔静脉异常者34例，均作回顾性重建，成像参数(准直／有效层厚／重建间隔)为2．5mm／3．2mm／1．6mm或5mm／6．5mm／2mm，并作容积成像和曲面重建处理。结果 34例静脉异常可分为5种类型，包括左侧上腔静脉16例、左头臂静脉与奇-半奇静脉系统异常连接14例、左下肺静脉曲张2例、奇静脉瘤l例以及异常引流肺静脉l例。容积成像很好地显示异常，曲面重建有效地补偿前者没有曲面的不足。结论 常规胸部CT增强结合回顾性重建容积成像可以有效显示各种静脉异常，正确认识这些异常有一定的意义。     

Magnetic resonance imaging is the diagnostic tool of choice in the preoperative evaluation of patients with partial anomalous pulmonary venous return

Background Diagnosis of partial anomalous pulmonary venous return is usually suspected by echocardiography and often confirmed by cardiac catheterization. Magnetic resonance imaging is a powerful non-invasive diagnostic tool that can give accurate insight on systemic and pulmonary veins, cardiac anatomy and physiopathology.Aim To test the diagnostic accuracy of magnetic resonance in patient with suspected partial anomalous pulmonary venous return.Case presentation Twenty consecutive patients (10 male, mean age: 27±20 years) with suspected partial anomalous pulmonary venous return underwent a magnetic resonance study comprehensive of Gadolinium-enhanced three-dimensional magnetic resonance angiography and phase-velocity-contrast in order to evaluate pulmonary and systemic venous anatomy and QP/QS. In 14 of them a cardiac catheterization was also performed. Anatomy findings and QP/QS result of both exams were compared. Sixteen patients underwent surgical correction. In the other four patients with QP/QS<1.5, surgical correction was not indicated according to the literature (1).Among patient which performed both magnetic resonance and cardiac catheterization (14 patients) anatomy findings were concordant in 12 of them. In all operated patients, surgical findings were concordant with MRI report. There was a good correlation between magnetic resonance and cardiac catheterization QP/QS evaluation (mean value 2.23 and 2.4, respectively).Conclusion In patients with suspected anomalous pulmonary venous return, magnetic resonance provides a comprehensive evaluation of pulmonary venous return and the amount of shunt, overcoming most of the limitations of echocardiography. Therefore magnetic resonance is a powerful diagnostic tool for indicating therapeutic management and surgical strategies for this group of patients, and can be considered a non-invasive alternative to cardiac catheterization.     

An unusual case of partial anomalous pulmonary venous drainage.

We report a case of partial anomalous pulmonary venous drainage where the left upper and lower pulmonary veins drain into a separate posterior left atrial (LA) chamber before continuing as a vertical ascending vein. The vertical vein then joins the left innominate vein, which eventually drains into a normal right-sided superior vena cava. There was no fenestration or communication between this posterior chamber and the true LA. The true LA contained the fossa ovale and LA appendage. The right upper and lower pulmonary veins drain normally into the true LA. To our knowledge, this is the first case where the left upper and lower pulmonary veins drain into a separate posterior LA chamber before continuing into a vertical vein. The diagnosis was initially made with transesophageal echocardiography and confirmed by magnetic resonance imaging. The patient later underwent successful corrective operation.     

Changes in pulmonary venous Doppler parameters in fetal cardiac defects.

OBJECTIVES: Recent observations in pediatric cardiological studies have prompted discussion on the possible role of intrauterine pulmonary venous changes in neonatal and postoperative outcome of infants with congenital heart defects. This study analyzes changes of Doppler blood flow velocity waveforms in the pulmonary veins of fetuses with different cardiac defects. METHODS: Eighty fetuses (mean gestational age, 27 weeks) with prenatally diagnosed cardiac defects were classified into one of five groups: obstructed left atrium, other left ventricular outflow tract obstruction, right ventricular outflow tract obstruction, miscellaneous cardiac defects and total anomalous pulmonary venous drainage. Doppler examination of the pulmonary veins was performed and the time velocity integral (TVI), end-diastolic (A) velocity, and pulsatility index for veins (PIV) were compared with reference ranges. RESULTS: Fetuses with infradiaphragmatic total anomalous pulmonary venous drainage showed a continuous Doppler flow pattern instead of the typical pulsatile waveform pattern. In fetuses with obstructed left atrium and restrictive foramen ovale, a reversed A-velocity and increased PIV were found. In five of the eight fetuses with left outflow tract obstruction but patent mitral valve, PIV was increased. In the other groups there were no obvious changes in Doppler parameters. CONCLUSIONS: We suggest routine examination of the pulmonary veins with pulsed Doppler ultrasound in every fetus with a prenatally diagnosed heart defect. Such Doppler parameters could be used in future as cut-offs for the recently reported in-utero atrial septostomy to decompress an obstructed left atrium.     

Esophageal varices in congenital heart disease with total anomalous pulmonary venous connection

Total anomalous pulmonary venous connection (TAPVC) is an uncommon congenital anomaly in which the anatomical presentations vary widely among patients. We hereby present two newborns with TAPVC associated with asplenia syndrome; both had severe esophageal varices due to infradiaphragmatic pulmonary venous drainage. Ultrafast computed tomography (CT) scanning was superior to color Doppler echocardiography and cardiac catheterization as it provided a detailed portrait of the pulmonary drainage. The remarkable radiographic manifestations are presented.     

Partial anomalous pulmonary vein drainage of the left lower lobe: incidental diagnostic after central venous cannulation

OBJECTIVE: To report a case of partial anomalous pulmonary vein drainage of the left lower lobe diagnosed after central venous cannulation. DESIGN: Retrospective case review. SETTING: Intensive care unit. PATIENT: A 76-yr-old woman with obstructive acute renal failure requiring hemodialysis. INTERVENTIONS: Central venous cannulation and hemodialysis. MEASUREMENTS AND MAIN RESULTS: The diagnosis was suggested by chest radiography after placement of a central venous catheter through the left internal jugular vein. Pressure measurements at the tip of the catheter showed a venous waveform. Oxygen blood content on samples of blood was higher than on peripheral arterial blood. Computed tomography with intravenous contrast was not conclusive. Diagnosis was confirmed with transcatheter phlebography. CONCLUSIONS: It is important for the intensivist to be aware of this infrequent variant when a central venous catheter takes an abnormal route and drains low-pressure, arterialized blood.     

肺动静脉畸形的影像诊断

目的探讨肺动静脉畸形的影像表现及不同影像诊断方法对肺动静脉畸形的诊断价值。方法回顾性分析3例肺动静脉畸形的影像表现(1例经手术病理证实,2例临床及影像表现典型)并进行对比。结果3例均为单发病灶,分别位于左肺下叶、右肺中叶及左肺舌段胸膜下,有典型的瘤样扩张的血管囊及与之相连的供血动脉和引流静脉。注射对比剂后病灶明显强化,并可见病灶与肺动脉相连。3例均行X线胸片及CT增强扫描,2例行DSA检查。3例CT及DSA均诊断正确,正确率100%。结论X线胸片及CT平扫对典型病例可提示诊断的可能,对不典型病例及多发肺动静脉畸形诊断受到限制,CT增强扫描及DSA可准确地诊断肺动静脉畸形,并为手术或栓塞提供依据。