超声心动图对感染性心内膜炎的诊断价值

目的：评价超声心动图对感染性心内膜炎的诊断价值。方法：对感染性心内膜炎的患儿23例临床资料分析。结果：血培养阳性率为38％，连续2次血培养阳性且为同一种细菌者仅为1例。超声心动图检出赘生物共17例（73．9％）。结论：超声心动图对感染性心内膜炎的诊断有重要意义。     

三维超声心动图对法洛四联症患者术后右心室功能的评估

目的:探讨实时三维超声心动图（RT-3DE）在评价法洛四联症（TOF）患者手术后右心室功能中的意义。 方法:应用RT-3DE对23例TOF患者术前、术后6个月右心室收缩末期容积（RVESV）、右心室舒张末期容积（RVEDV）及右心室射血分数（RVEF）进行检测。并将TOF患者术后6个月的RVEF与心电图QRS间期进行相关分析。 结果:与术前比较,TOF患者术后6个月RT-3DE所测RVEDV、RVESV无显著增加（P>0.05）;RVEF明显减低（P<0.05）。TOF患者术后6个月RT-3DE超声所测RVEF与QRS间期呈负相关（r=-0.697, P<0.05）。 结论:RT-3DE能准确评价TOF患者术后右心室功能,可以早期发现术后右心室功能不全,对TOF患者预后评估有重要意义。     

超声心动图对感染性心内膜炎的诊断价值

目的评价超声心动图对感染性心内膜炎的诊断价值.方法对感染性心内膜炎的患儿23例临床资料分析.结果血培养阳性率为38%,连续2次血培养阳性且为同一种细菌者仅为1例.超声心动图检出赘生物共17例(73.9%).结论超声心动图对感染性心内膜炎的诊断有重要意义.     

超声心动图对胎儿心脏肿瘤的诊断价值

目的探讨超声心动图对胎儿心脏肿瘤的诊断价值。方法通过超声心动图多切面探查胎儿心脏肿瘤及观察相应的心脏形态、结构及血流动力学的变化。结果 10例病例超声心动图发现心房及心室腔内强回声或稍强回声实质性占位,呈圆球状或椭圆状,境界清晰,肿瘤形态不随心脏收缩舒张改变,胎儿心脏肿瘤无血流受阻征象,心室未见扩大,仅1例见胎儿心动过速,亦无胎儿其它脏器异常。结论胎儿心脏肿瘤极罕见,超声心动图可发现胎儿心脏肿瘤并准确定位,但超声检查不能对心脏肿瘤作出病理分类诊断     

超声心动图对胎儿三尖瓣下移畸形的诊断价值

目的探讨超声心动图对胎儿三尖瓣下移畸形的诊断价值。方法回顾性分析5例经胎儿超声心动图检查诊断为三尖瓣下移畸形的声像图与随访结果,总结其二维及彩色多普勒血流声像图特点。结果 5例胎儿经尸解均证实为三尖瓣下移畸形。胎儿三尖瓣下移畸形的主要声像图特点表现为四腔心不对称,右心房增大,三尖瓣叶附着点下移,三尖瓣重度反流,反流起源点降低,反流面积大、反流速度低。结论超声心动图诊断胎儿三尖瓣下移畸形方法简单、可靠,对胎儿三尖瓣下移畸形的诊断具有重要的临床价值。     

肺血栓栓塞症超声心动图诊断

目的 肺血栓栓塞症是心血管急症，应提高对其认识和超声心动图诊断水平；方法 对12例以超声心动图首先诊断的肺血栓栓塞症进行回顾性总结，6例手术或尸检证实；结果 肺血栓栓塞症临床表现多样化，超声心动图直接依据是肺动脉主干及左右分支内血栓回声；间接征象为右房室腔扩大及肺动脉高压；深静脉血栓是栓子来源常见病因，血管彩色多普勒血流显像对深静脉血栓有确诊价值；结论 超声心动图对肺血栓栓塞症具有重要诊断价值，并有助于临床与急性心肌梗塞、主动脉夹层动脉瘤和心包填塞进行鉴别。     

超声心动图在胎儿先心病诊断中的应用价值

目的研究超声心动图在胎儿先心病产前诊断中的临床应用价值。方法自2007年6月至2008年5月对5312例孕妇进行产前系统彩色多谱勒超声筛查,对心脏病高危胎儿应用超声心动图对其心脏进行检查。结果在彩色多谱勒超声筛查中发现心脏病高危胎儿413例。对心脏病高危胎儿应用超声心动图对其心脏进行检查,诊断为先心病的胎儿为31例,产后追踪随访及尸检确诊的先心病共38例,超声心动图诊断产前检出率为81.6%,漏诊率18.4%。结论超声心动图对产前诊断胎儿先心病具有重要的临床价值。     

心电图上诊断心室肥厚与超声心动图诊断不符的心电图特点分析

目的：对心电图上符合心室肥厚改变但超声心动图诊断不符的心电图特点进行分析，以提高心电图诊断心室肥厚的准确性。方法：用十二导联同步心电图仪检查符合左或右心室肥厚的病人，与超声心动图检查结果进行对比。结果：心电图上诊断心室肥厚与超声心动图诊断不符的心电图有如下特点；1，病人基础心率均为心动过速。2、QRS波振幅增高均反映在胸导联上，3、QRS波振幅增高均反映在胸导联上，3、心电轴偏移度数明显增大。结论；当基础心率较快，或心电轴偏移度数过大时诊断心室肥厚应慎重。     

不同切面超声心动图检查对胎儿心血管畸形的诊断价值

目的评价不同切面超声心动图检查在胎儿心血管畸形筛查中的诊断价值。方法通过对3000例20-28周的孕妇进行不同切面超声心动图检查及部分染色体核型检查及尸检结果,统计分析不同切面超声心动图检查对各种胎儿心脏畸形的检出率及敏感性。结果诊断先天性心脏病34例,发病率为1.1%,其中明确诊断27例,漏诊6例,误诊1例,标准三切面筛查的诊断敏感性为77.8%。结论标准三个切面超声心动图检查对胎心血管畸形筛查有较高的敏感性及特异性,是胎儿心脏心血管畸形筛查的首选方法。     

牛右心室节制索及右束支的解剖观测

目的了解牛右心室节制索及右束支的形态特点及分布规律,为比较解剖学和兽医学积累解剖学资料。方法24例新鲜市售牛心,用大体解剖和墨汁灌注方法显示牛右心室传导系。肉眼观察右心室内各结构的形态和分布,用游标卡尺测量数据,SPSS统计软件处理相关数据。结果节制索多为扁圆柱状(90.5%),长(45.48±1.32)mm,长直径(3.78±1.54)mm,短直径(2.55±1.26)mm,右束支长(65.52±20.78)mm,直径(1.45±0.56)mm。发现1例双节制索。Purkinje纤维的分布第Ⅰ、Ⅱ象限最密集,第Ⅲ三象限较少分布,第Ⅳ象限分布最少。结论牛心节制索的形态与其他哺乳动物相似,其中有右束支穿行,其表面有分布不均的Purkinje纤维。     

Double Outlet Right Ventricle Versus Aortic Dextroposition: Morphologically Distinct Defects

This study concerns the morphological differentiation between double outlet right ventricle (DORV) and aortic dextroposition (AD) defects, namely tetralogy of Fallot and Eisenmenger anomaly. Indeed, despite the similar condition in terms of sequential ventriculo‐arterial connections, DORV and AD are two distinct morphological entities. It is proposed that the borderline between these two groups of malformations is represented by the specific insertion of the infundibular septum into the left anterior cranial division of the septomarginal trabeculation (or septal band) occurring in ADs and lacking in DORV. Furthermore, the spiraliform versus straight parallel arrangement of the great arteries in the two groups of anomalies is emphasized as an additional and distinctive morphological feature. Emphasis is also given to the association of straight parallel great arteries conotruncal malformations, DORV and transposition of the great arteries, with the asplenia type of heterotaxy laterality defects. Within this context, the absence of subaortic ventricular septal defect and concomitantly of spiraliform great arteries in the asplenia group of heterotaxy anomalies, as detected by this study, further substantiates our belief of not mixing collectively the ADs with the DORV in clinico‐pathological diagnosis. Anat Rec, 296:559–563, 2013. © 2013 Wiley Periodicals, Inc.     

Echocardiographic assessment of right ventricular function in responders and non-responders to cardiac resynchronization therapy

Introduction

The aim of this study was to determine whether baseline right ventricular (RV) function assessed by standard echocardiography may indicate patients who will respond to cardiac resynchronization therapy (CRT).

Material and methods

The data of 57 patients (54 men, 95%), aged 66.4 ±8.7 years with heart failure (HF) having a CRT device implanted were collected. All patients had left ventricular ejection fraction (LVEF) ≤ 35% and QRS complex duration ≥ 120 ms. Echocardiographic examination with tissue Doppler imaging techniques and complex RV evaluation were performed at baseline and three months after CRT onset.

Results

Three months after CRT implantation, patients responding to CRT, defined as a reduction of left ventricle end-systolic volume (LVESV) of at least 10% (n = 34), compared to patients with a reduction of LVESV of less than 10% (n = 23), had at baseline a smaller right atrium diameter (47.85 ±11.33 mm vs. 52.65 ±8.69 mm; p = 0.028), higher TAPSE (14.56 ±2.57 mm vs. 13.04 ±2.93 mm; p = 0.030) and lower grade of tricuspid valve regurgitation (1.82 ±0.97 vs. 2.3 ±0.88; p = 0.033).

Conclusions

This study showed that there are differences in baseline right ventricular function between responders and non-responders to CRT. Yet in our study, none of the baseline RV parameters provided any value in identifying patients who would respond to CRT.     

左心辅助对犬右心室的影响

目的 :观察左心辅助对犬右心室的影响。方法 :2 1条健康犬按不同左心辅助流量随机分为 3组 ,每组 7条。Ⅰ组辅助流量为 5 0ml·kg- 1 ·min- 1 ;Ⅱ组辅助流量为 70ml·kg- 1 ·min- 1 ;Ⅲ组辅助流量为 90ml·kg- 1 ·min- 1 。应用气动左心辅助装置行左心房至升主动脉辅助 5h。观察辅助前 ,辅助 5h ,停辅助 10min等时间位点的右心血流动力学变化。结果 :辅助 5h ,Ⅰ、Ⅱ、Ⅲ组左房压 (LAP) ,平均肺动脉压 (MPAP) ,全肺阻力 (TPR) ,右室最大压力上升速率 (Rvdp dtmax)均较辅助前明显减小 (P <0 0 5 ) ,且辅助流量越大下降幅度越明显 (P <0 0 5 ) ,Ⅰ、Ⅱ组右心排血指数 (PCI)较辅助前明显增高 (P <0 0 5 ) ,Ⅲ组无明显变化 (P >0 0 5 ) ,Ⅰ、Ⅱ组右心搏动指数 (RCWI)无明显变化 (P >0 0 5 ) ,Ⅲ组明显减小 (P <0 0 5 ) ,停辅助 10min时各组右心血流动力学指标均恢复至辅助前 (P >0 0 5 )。结论 :左心辅助流量越大对右心血流动力学影响越明显 ,短期左心辅助不会导致右心室的功能减退     

Echocardiographic and morphologic examination of left ventricular false tendons in human and animal hearts

False tendons are thin, fibrous or fibromuscular structures that traverse the cavity of the left ventricle with no connection to the valvular cusps; they may be single or multiple. We retrospectively analyzed echocardiograms for the prevalence of false tendons in the hearts of 368 (231 male, 137 female) newborns, infants, and children (mean age = 6.28 +/- 4.32 years) who were referred for echocardiography because of suspected acquired or congenital heart disease, but in whom no cardiac pathology was found. In addition, we studied the prevalence of false tendons in 90 hearts from three species of animals (dog, sheep, goat) and eight cadaveric human hearts. In our echocardiographic study, false tendons were detected in 97 of 368 hearts (26.4%). In our gross morphologic studies, false tendons were observed in most of the animal and human hearts: they were present in 5 of 8 (62.5%) human hearts, 14 of 20 (70%) dog hearts, 41 of 50 (82%) sheep hearts, and 16 of 20 (80%) goat hearts. The overall prevalence in animal hearts was 71 of 90 (78.8%). Histologic examination showed the false tendons to be composed of cardiac muscle, blood vessels, fibrous tissue, and Purkinje cells. The possible role of false tendons in innocent murmurs, cardiac rhythm disorders, or left ventricular dysfunction is discussed.     

彩色多普勒超声心动图诊断右冠状动脉右室瘘的价值

目的 彩色多普勒超声心动图诊断右冠状动脉右室瘘时,对临床手术具有指导价值.方法 两例心前区双期杂音的患者,经彩色多普勒超声心动图检查.结果 两例手术证实右冠状动脉右室瘘.并且痿口的部位和数目与彩超诊断吻合.结论 说明彩色多普勒超声心动图诊断右冠状动脉右室瘘准确性,并且能明确瘘口的数目和部位,对手术切口位置的选择有重要意义.     

应用右心超声造影诊断无顶冠状静脉窦综合征

目的探讨右心超声造影对无顶冠状静脉窦综合征（UCSS）的诊断意义,提高对该病的诊断率。方法选择2005年3月~2012年6月在内蒙古医科大学附属医院收治并手术UCSS患者12例,其中男性8例,女性4例;年龄16～34岁,平均年龄22.08岁。与其手术结果对照,回顾性分析其二维超声心动图与右心超声造影表现。结果 12例患者行常规经胸超声心动图检查正确诊断5例,漏诊7例,符合率41.67%;同时应用右心超声造影符合率为83.33%;所有患者全部经手术证实。9例UCSS合并永存左上腔静脉患者的右心超声造影的影像学显影顺序与3例单纯UCSS患者存在不同。结论常规经胸超声图怀疑冠状静脉窦间隔缺损的存在时,应用右心超声造影检查可以提高诊断率,避免漏诊。超声造影对该病诊断具有重要意义。     

经纵裂胼胝体入路显微手术切除三脑室肿瘤及囊虫

目的：介绍一种切除三脑室肿瘤的手术入路。方法：显微镜下经纵裂胼胝体入路切除三脑室肿瘤及猪囊虫8例。结果：肿瘤全切除5例、大部切除2例，1例猪囊虫完整摘除。术后死亡1例。5例随访6个月未复发，2例失访。结论：该手术入路可以切除三脑室前、中、后部的肿瘤及猪囊虫，术野暴露清楚，不易造成穹窿、匠脯、大脑内静脉、丘纹静脉的损伤，减少了术后并发症的发生。     

Right ventricular volumes and ejection fraction by MR imaging and stereology: comparison with standard image analysis method

The purpose of this study was to examine the accuracy of the stereological method for estimating right ventricular parameters on cine MR images. The end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were estimated in 19 consecutive patients with suspected or known coronary artery disease employing the stereological point counting method. Stereological measurements were performed with different grids of test points. The RV parameters were also derived by the standard method based on the manual adjustment of automatically obtained endocardial contours. The statistical difference and agreement between the two methods was found. Measurement reproducibility of both methods was determined. The counting of about 100 test points on all MR images provided EDV and ESV with a mean coefficient of error of 7.0 ± 1.3% and 7.4 ± 2.1%, respectively. The volume estimation precision was not significantly improved by counting more points (EDV: P = 0.058; ESV:P = 0.333). Stereological estimations were not significantly different from those by the standard method (EDV: P = 0.093; ESV: P = 0.072; SV: P = 0.291; EF: P = 0.300). The 95% limits of agreement between the two methods were clinically acceptable (EDV: -12.1 cm(3) , 18.9 cm(3) ; ESV: -6.4 cm(3) , 10.4 cm(3) ; SV: -10.5 cm(3) , 13.5 cm(3) ; EF: -7.5%, 6.3%). The repeatability of stereological estimations was better than that of the standard method (coefficient of variability: 3.4-5.3% versus 4.0-7.1%). The measurement time with stereolgy was less than 4 min. The stereological method may be considered as an improvement over the standard method due to its accuracy and repeatability.