复杂先天性心脏病心血管数字造影和超声诊断的对比研究

目的　评价心脏大血管数字造影和超声心动图在复杂性先天性心脏病（简称先心病）诊断中的作用。方法　选择１９９５ 年９ 月至１９９８ 年１２ 月间有完整资料的复杂性先心病６５ 例，全部进行了数字造影、二维超声心动图和彩色多普勒血流图检查。其中３５ 例有手术结果的对照资料。经右股静脉及动脉分别行选择性右心室、肺动脉、左心室及主动脉多体位数字造影，其采集矩阵为５１２×５１２，显示矩阵为１ ０２４×１ ０２４。结果　血管数字造影与临床诊断符合率为８９ ％ （５８／６５），与手术符合率为８９％ （３１／３５）；超声与临床诊断符合率为６８％ （４４／６５），超声与手术符合率为８０ ％（２８／３５） 。超声检查能准确清楚地显示心腔内结构，如瓣膜、瓣环、房室间隔的改变以及异常血流。数字造影技术能全面地显示心腔内外结构，尤其是大动脉、冠状动脉以及体肺侧支循环的改变。两种技术均存在一定程度的误诊率。结论　心脏超声心动图与数字造影有机结合，能大大提高复杂性先心病的诊断准确率。     

复杂先心病EBT与心脏超声和心血管数字造影的对比研究

目的　评价经胸心脏超声 (TTE)、心脏数字造影 (CVDI)和电子束CT(EBT)在诊断复杂性先天性心脏病 (先心病 )中的作用。方法　资料完整的复杂性先心病患者 2 1例 ,其中男 12例 ,女 9例 ,年龄 1～ 2 1岁 ,平均 8岁 4个月 ,行外科手术治疗 14例。 2 1例患者均行TTE、彩色多普勒血流显像和EBT检查 ,其中实施CVDI 11例。结果　EBT检查先心病与CVDI的符合率为 93 .3 % (2 8/3 0 ) ;TTE对复杂先心病的诊断准确率为 77.8% (3 5 / 45 ) ,EBT的诊断准确率为 93 .3 % (4 2 / 45 )。结论　把EBT显示心外结构的优势与TTE显示心内结构的优势结合起来 ,可以部分取代有创伤性的CVDI。     

复杂先天性心脏病心血管数字造影和超声诊断和对比研究

目的 评价心脏大血管数字造影和超声心动图在复杂性先天性心脏病诊断中的作用。方法 选择１９９５年９月至１９９８的１２月间有完整资料的复杂性先心病６５例，全部进行了数字造影、二维超声心动和彩色多普勒血流图检查。其中３５例有手术结果的对照资料。经右股静脉及动脉分别行选择性右心室、肺动脉、左心室及主动脉多体位数字造影，其采集矩阵为５１２×５１２，显示矩阵为１０２４×１０２４。结果 血管数字造影与临床诊断符     

儿童完全性大动脉错位的X线诊断──附心血管造影152例报道

本文报道１５２例经心血管造影证实的完全性大动脉错位，患儿的年龄从３天到１１岁。１５２例中４７例为室间隔完整不伴肺动脉狭窄的单纯型完全性大动脉错位，４４例为室间隔缺损不伴肺动脉狭窄型，６０例为室间隔缺损伴肺动脉狭窄型，１例为室间隔完整伴肺动脉狭窄型。本文详细讨论了完全性大动脉错位的Ｘ线平片诊断、心血管造影技术及造影诊断，作者认为长轴斜位左心室造影是完全性大动脉错位心血管造影的最佳投照体位。     

儿童安全性大动脉错位的X线诊断—附心血管造影152例报道

本文报道１５２例经心血管造影证实的完全性大动脉错位，患儿的年龄从３天到１１岁。１５２例中４７例为室间隔完整不伴肺动脉狭窄的单纯型完全性大动脉错位，４４例为室间隔缺损不伴肺动脉狭窄型，６０例为室间隔缺损伴肺动脉狭窄型，１例为室间隔完整伴肺动脉狭窄型。本文详细讨论了完全性大动脉错位的Ｘ线平片诊断、心血管造影技术及造影诊断，作者认为长轴斜位左心室造影是完全性大动脉错位心血管造影的最佳投照体位。     

矫正型大动脉错位的MRI诊断

矫正型大动脉错位的ＭＲＩ诊断陈新王锦玲王天骄郑铭刘振春笔者详尽分析了１６例矫正型大动脉错位（ＣＴＧＡ）的ＭＲＩ表现，并与超声心动图（ＵＣＧ）和心血管造影（ＣＡＧ）进行比较，以探讨ＭＲＩ在诊断中的作用和价值。材料和方法ＣＴＧＡ１６例，男８例，女８例。年...     

完全性大动脉转位的多普勒超声心动图诊断

目的:分析多普勒超声心动图诊断完全性大动脉转位(C-TGA)的准确性,提高超声心动图的首次检出率。方法:经外科手术证实为C-TGA的118例患者为研究对象,回顾性分析其超声心动图表现。结果:118例患者中,心房正位,心室右袢大动脉右转位112例,占94.9%;心房反位,心室左袢大动脉左转位6例,占5.1%。常见的合并畸形有房间隔缺损/卵圆孔未闭85例(72.0%)、动脉导管未闭68例(57.6%)、室间隔缺损35例(29.7%)、肺动脉狭窄29例(24.6%)、不典型冠状动脉13例(11.0%)。超声诊断正确者113例,占95.8%;误诊5例,占4.2%。在合并畸形中,误诊、漏诊不典型冠状动脉7例(53.8%)、动脉导管未闭2例(2.9%)。结论:多普勒超声心动图技术可以比较准确地诊断完全性大动脉转位。     

主动脉弓中断的超声心动图诊断

主动脉弓中断(interrupted aortic arch,IAA)为升主动脉与降主动脉之间没有直接连接的先天性主动脉弓的畸形,发生率占活产婴儿的0.002%~0.003%,约占婴儿严重先天性心脏病的1%,80%以上的儿童生后1个月内死亡,所以早发现、早治疗十分重要。由于IAA为极少见的先天性心脏病,且绝大多数合并其它心血管系统畸形,临床容易漏诊、误诊[1~3]。本文回顾性分析我院主动脉弓中断患者的超声心动图特征,旨在提高超声对主动脉弓畸形的诊断水平。1材料与方法1.1研究对象1994年11月~1999年12月在新华医院、2000年1月~2004年4月在上海儿童医学中心住院检查及…     

超声心动图评价完全性大动脉转位快速二期大动脉调转术中左心室血流动力学

目的:观察完全性大动脉转位(D-TGA)患者快速二期大动脉调转术(ASO)中左心室血流动力学变化,评价肺动脉环缩对左心室的影响。方法:15例室间隔完整或合并小型室间隔缺损的D-TGA患者,应用多普勒超声心动图观察快速二期ASO手术前、后左心室舒张期直径(LVDD)、舒张期左心室后壁厚度(LVPWT)、舒张期室间隔厚度(IVST)的变化,计算左心室质量及射血分数。结果:15例均行肺动脉环缩及体肺分流术,13例在肺动脉环缩后10±3.5天行ASO。肺动脉环缩后左、右心室压力比从0.42±0.18上升至0.83±0.08,左心室质量指数从29.0±10.6g/m2上升至69.6±18.6g/m2(P<0.01),平均每天上升4.06g/m2。肺动脉环缩后左心室射血分数从75.3%±15.4%下降至51.9%±19.2%(P<0.05),大约3~4天后恢复正常(65.7%±5.1%)。结论:肺动脉环扎后,左室质量明显增加;左心功能明显下降,但可迅速恢复正常;快速二期大动脉调转术对大年龄室间隔完整或合并小型室间隔缺损的D-TGA患者是可行的。     

超声心动图评价血液透析对心血管系统影响的进展

近年来血液透析患者生存率及生存期明显提高,但心血管并发症的发生率并未减少且仍为主要死亡原因。血液透析对心血管系统的影响日益受到关注。本文综述血液透析对血管内皮功能、动脉粥样硬化、心脏结构功能等的影响与超声心动图在这些方面的应用。     

IDD型矫正性大动脉转位的彩色多普勒超声心动图诊断

目的：探索ＩＤＤ型矫正性大动脉转位（ＣＴＧＡ）的彩色多普勒超声心动图（ＣＤＥ）图像特征。材料和方法：应用ＣＤＥ检查１１例ＩＤＤ型ＣＴＧＡ,均经心血管造影和手术证实。结果：１０例诊断正确,１例误诊为ＴａｕｓｉｎｇＢｉｎｇ综合征。结论：用ＣＤＥ诊断ＩＤＤ型ＣＴＧＡ检查者必须熟练掌握本病解剖;在ＣＤＥ检查中,应用二维超声心动图（２ＤＥ）判断心房反位、心室右袢和大动脉右转位是正确诊断本病的关键;ＣＤＥ诊断本病心内合并畸形有一定难度,但对外科拟定手术方案具有重要临床价值     

完全性大动脉转位多排螺旋CT临床价值

目的探讨多排螺旋CT(MSCT)诊断完全性大动脉转位(complete transposition of the great arteries,CTGA)的临床价值。资料与方法回顾性分析2006年1月至2010年7月46例接受CT血管造影(CTA)检查的完全性大动脉转位(TGA)患者的影像资料。均行MSCT扫描,其中对于<6岁、不能合作或心功能不全的患儿,检查前由麻醉师进行麻醉。结果 MSCT诊断TGA S,D,A型30例,S,D,D型12例,S,D,L型3例,I,L,A型1例,合并肺动脉瓣及瓣下流出道狭窄28例,室间隔完整7例。左侧三房心1例,永存左上腔静脉4例,下腔静脉肝段缺如1例。房间隔缺损(ASD)12例,动脉导管未闭(PDA)10例,卵圆孔未闭(FO)2例,主动脉右弓右降3例。室间隔增厚1例。左侧并列心耳3例,右主支气管重度狭窄2例。28例行手术矫治。结论 MSCT可准确诊断TGA心内及心外异常结构,为外科手术提供直观信息,为手术方式的选择提供依据。     

Non-physiological Aortic Flow and Aortopathy in Adult Patients with Transposition of the Great Arteries after the Jatene Procedure: A Pilot Study Using Echo Planar 4D Flow MRI

PurposeDilated aortic root and ascending aorta (AAO) with progressive aortic regurgitation is a well-known sequela after arterial switch operation (ASO) in adults with transposition of the great arteries (TGA). We aimed to quantitatively assess aortic flow profiles in adults with TGA after ASO (Jatene procedure with LeCompte maneuver) using echo planar imaging (EPI) 4D flow MRI.MethodsProspectively, 9 consecutive adults (30.2 ± 6.6 years) after ASO (Jatene operation with LeCompte technique), 13 consecutive adults (34.3 ± 7.2 years) after the atrial switch operation with Senning procedure, and 8 age-matched control patients, who underwent turbo field echo (TFE) EPI 4D flow MRI (average scan time of approximately 4 min), were enrolled.ResultsTGA after ASO showed a markedly dilated sinus of Valsalva, compared to TGA after atrial switch operation (26.6. ± 4.9 vs. 18.6. ± 1.5 mm/cm²). Vorticity, helicity, wall share stress (WSS), and energy loss (EL) in the aortic root and the AAO in TGA were greater than in the controls. Vorticity, helicity, WSS, and EL in the aortic root and the AAO were also greater in TGA after ASO than after atrial switch operation. More acute aortic arch angle correlated with greater vorticity of the aortic root, and the significant diameter ratio of the sinus of Valsalva and the AAO was relevant to greater vorticity, helicity, and EL in TGA after ASO.ConclusionA non-physiological blood flow pattern of the aortic root was identified in TGA adults after the ASO (Jatene procedure with LeCompte maneuver). Missing spiral looping of the great arteries and the unique structure after the Jatene procedure may play an adjunctive role in promoting aortopathy. The evaluation of aortic flow profile using EPI 4D flow MRI may be useful for risk stratification for aortopathy in this population.     

Coronary Events and Anatomy After Arterial Switch Operation for Transposition of the Great Arteries: Detection by 16-Row Multislice Computed Tomography Angiography in Pediatric Patients

The purpose of this study was to evaluate the feasibility of multislice computed tomographic (MSCT) angiography as a noninvasive method for detecting ostial, proximal, and middle segment coronary stenosis or occlusion and anatomy in patients with transposition of the great arteries who had undergone arterial switch operation (ASO). Sixteen-detector-row MSCT angiography was performed in 16 patients treated with ASO for transposition of the great arteries. The median age was 10.3 years (range, 6.2–16.3 years). Sixteen-detector-row MSCT angiography was performed in 16 patients who had undergone ASO. CT imaging was performed in the craniocaudal direction from 2 cm above the carina up to the heart basis. Noninvasive assessment of coronary artery stenosis and anatomy were investigated by MSCT angiography. Two patients were excluded from the study because of artifacts. Of 14 evaluated patients, 1 patient had ostial stenosis (7.1%). A coronary artery anatomy variant was present in six patients: left main artery (LMA) and right coronary artery (RCA) originating from the right sinus as a single orifice (n = 2); left circumflex artery (LCX) originating from the RCA (n = 1); LMA and RCA, after branching to the LCX, originating separately from the right sinus (n = 1); and LMA (n = 1) and left anterior descending artery (LADA; n = 1) originating directly from the right sinus. Intramural bridging in the LAD (n = 2) was detected. Five patients were normal. In conclusion, MSCT angiography, as a noninvasive, feasible technique for assessing coronary stenosis or occlusion and anatomy, can be used in the follow-up of patients who have undergone ASO. This study was accepted as a poster presentation at ESPR 2008.     

完全性肺静脉畸形连接X线与超声心动图的对照研究

本文对１９例手术证实的完全性肺静脉畸形连接进行了Ｘ线（平片、造影）及超声心动图的对照研究，结果表明平片对引流入左上腔静脉者有相当的价值，心内型者无特异性。Ｍ型超声心动图诊断本症限度大，双维超声既能定性亦能做出分型诊断。对混合型完全性肺静脉畸型连接以及其他诸型亚型的诊断，仍以造影检查最佳。     

“Complete-transposition-like” coronary arterial pattern in single ventricle with inverted infundibulum and transposition of the great arteries

In 19 out of 28 cases of single ventricle with inverted infundibulum and 1-transposition of the great arteries the right coronary artery arose from the posterior aortic sinus, the right anterior aortic sinus being the noncoronary one. This coronary arterial pattern was described before only in association with d-transposition of the great arteries. We suggest that angiocardiographic demonstration of this coronary arterial pattern in association with an 1-positioned aorta favors the diagnosis of single ventricle.