超声心动图在心血管病诊断中的应用评价

超声心动图在心血管病诊断中的应用评价中国医科大学第一临床学院（１１０００１）龚传斌超声心动图自５０年代初用于临床以来，已成为诊断心血管病的重要工具，临床上常用于以下几种疾病的诊断．１心脏瓣膜病在心脏瓣膜病的检查诊断上，超声心动图是值得首选的一种方法。...     

退行性心脏瓣膜病的临床与超声心动图研究

退行性心脏瓣膜病的临床与超声心动图研究吴曼华退行性心脏瓣膜病是心脏瓣膜纤维层的退行性病变及钙盐沉积的结果，诊断主要由超声心动图检查而确立。我们在心脏超声检查中发现退行性心脏瓣膜病并不罕见，且其发生率随增龄而增高。现将我院１９９０年１月至１９９２年１２...     

探讨超声心动图诊断慢性风湿性心脏联合瓣膜病的临床应用价值

目的探讨超声心动图诊断慢性风湿性心脏联合瓣膜病的临床应用价值。方法选取我院2014年1月~2016年6月收治的慢性风湿性心脏联合瓣膜病患者60例为研究对象,分为常规组与实验组,各30例。其中对常规组采取X线检查,对实验组采取超声进行检查,对比两组患者的诊断准确率与临床分型。结果实验组与常规组的诊断准确率分别为96.67%与60.00%,差异有统计学意义(P0.05);进行X线检查后仅仅能够显示二尖瓣处于病变部位,且伴有主动脉瓣病变、肺动脉瓣病变、三尖瓣病变,进行超声心动图诊断后显示15例为重度狭窄,12例为中度狭窄及3例为轻度狭窄。结论对慢性风湿性心脏联合瓣膜病患者采用超声心动图进行诊断的临床意义重大,可对患者病情进行全面评估,利于疾病的诊断与治疗。     

经食管实时三维超声心动图诊断先天性心脏瓣膜病的可行性及临床价值

目的:探讨经食管实时三维超声心动图诊断先天性心脏瓣膜病的可行性及临床价值。方法:选择本院收治的先天性心脏瓣膜病患者135例为研究对象,均接受手术治疗,术前7 d内先后进行经胸超声心动图(TTE)和经食管实时三维超声心动图(RT-3D TEE)检查,观察心脏瓣膜病变情况,并将二者的诊断结果与手术结果进行对比分析。结果:RT-3D TEE可多角度、立体、清晰地显示先天性心脏瓣膜病患者心脏瓣膜的形态结构、病变程度及周围血流情况,发现在TTE检查中难以明确的心脏瓣膜病变,并纠正其诊断偏差。以手术结果为"金标准",RT-3D TEE检查的诊断符合率显著高于TTE检查的诊断符合率(97.04%比91.11%,P=0.039)。RT-3D TEE与TTE诊断先天性心脏瓣膜病具有中等程度一致性(Kappa=0.477,P=0.001)。结论:经食管实时三维超声心动图能为先天性心脏瓣膜病的诊断提供更多的影像学信息,可作为术前经胸超声心动图检查的有效补充。     

多巴酚丁胺超声心动图诊断冠心病的敏感性、特异性及预测心脏事件的价值

本文回顾性评估多巴酚丁胺超声心动图对冠心病及可疑冠心病患者的临床诊断和心脏事件的预测价值。 方法 77例病人进行多巴酚丁胺超声心动图检查,原因是胸痛23例,术前心脏评估30例,缺血评估18例,怀疑再狭窄6例。所有病人先做常规超声心动图,后做多巴酚丁     

超声心动图在老年钙化性心脏瓣膜病诊断中的应用价值研究

目的探析超声心动图在老年钙化性心脏瓣膜病诊断中的应用价值。方法回顾相关资料,选取我院2014年12月至2016年3月进行诊断的老年钙化性心脏瓣膜病患者70例,由于检查方法不同,随机分为对照组和实验组各35例,实验组患者采用超声心动图检查,对照组应用常规心电图进行检查,对比观察各组患者的心功能检测指标及诊断诊断准确率。结果经检查后,实验组患者的诊断准确率高于对照组,且左室射血分数值(LVEF)远低于对照组,实验组患者的左房内径值(LAD)和左室舒张末期内径值(LVDd)均高于对照组,各组间患者的统计数据进行比较后,存在较大的差异性,有统计学意义(P0.05)。结论针对老年钙化性心脏瓣膜病患者应用超声心动图检查诊断的准确性较高,该检查为临床疾病的诊断提供了有效的理论依据,值得患者信赖和在临床上推广。     

心脏瓣膜病诊治进展

<正> 心脏瓣膜病是一种缓慢进展型疾病,从血流动力学轻度受累发展至重度受累常需要经历一个漫长过程,最终可出现相关临床症状或死亡。近年来,心脏瓣膜病的诊治日益引起重视并取得了显著进展。1 流行病学尽管心脏瓣膜病是导致心力衰竭和心源性猝死的重要原因,长期以来一直认为,与高血压、冠心病和心力衰竭等相比,心脏瓣膜病发病率相对较低。但仅根据临床表现诊断心脏瓣膜病,常低估其发病率;而且流行病学资料大多仅来源于住院患者。随着超声心动图检查技术的成熟和广泛应用,     

老年退行性心脏瓣膜病超声心动图的临床应用

目的 探讨超声心动图在老年退行性瓣膜病中的应用价值,评价超声心动图对老年退行性心脏瓣膜病的检查价值.方法 回顾分析2010-2011年600例60岁以上老年人的彩色多谱勒超声心动图及临床资料.通过超声观察心脏瓣膜的形态、回声、厚度、活动度、室间隔、左室后壁厚度、心腔大小及左心功能.结果 检出退行性钙化瓣病350例,总患病率58.3％,其中男性检出150例(42.9％),女性检出200例(57.1％).随着年龄的增长,男、女的检出率变化差异无统计学意义(P＞0.05),但检出率逐渐增高,差异有统计学意义(P＜0.01).结论 随着年龄的增长,老年退行性瓣膜病呈递增趋势,超声心动图可及早发现,为临床早期治疗提供诊断依据.     

老年退行性心脏瓣膜病的临床与超声研究

老年退行性心脏瓣膜病［ｓｅｎｉｌｅｄｅｇｅｎｅｒａｔｉｖｅｈｅａｒｔｖａｌｖｕｌａｒｄｉｓｅａｓｅ（ＳＤＨＶＤ）］是老年期常见的心脏瓣膜病，在老年心脏病学中的地位已日益受到重视。本文对１９９３年１月至１９９５年１２月在我院住院的经超声诊断的ＳＤＨＶＤ３７３例的临床和超声心动图作一分析。　　一、资料与方法　　（一）病例来源：３年中在我院住院的５０岁以上患者，做过心脏彩色多普勒超声心动图检查，经分析病史和各项检查结果排除了其他病因所致的心脏瓣膜病，符合ＳＤＨＶＤ者共４０６例，年龄５２～９０岁。将其…     

超声心动图对新生儿肺动脉高压的诊断价值及疗效评价

目的探究新生儿肺动脉高压患儿应用超声心动图对于其病情诊断和临床预后质量评估价值。方法纳入本院2014年~2016年收治确诊为新生儿肺动脉高压患儿30例为此次研究对象,所有患儿均接受超声心动图检查诊断以及评估临床疗效,对研究患儿对象相关临床基线资料以回顾性方法分析,归纳超声心动图对此类患儿的诊断价值与疗效评价价值。结果以患儿肺动脉压力情况对其病情进行评估并分为轻度、中度、重度,超声心动图检查提示患儿心脏各个腔室随着肺动脉压的提升而对应增大,而肺动脉压越高的表示患儿病情越重,临床预后质量越差。结论新生儿肺动脉高压应用超声心动图诊断能够帮助医生了解患儿病情发展程度,在给予对应治疗干预措施后可利用超声心动图对预后质量进行评估,合理调整治疗措施,保障患儿临床疗效和生命安全,值得重视。     

Morphologic features of carcinoid heart disease as assessed by three-dimensional transesophageal echocardiography

Background: Carcinoid heart disease (CHD) is a rare cause of valvular heart disease and carries a poor prognosis. CHD has a unique morphology and echocardiographic features that predominantly involve right‐sided valvular structures. The diagnosis of CHD is usually made by two‐dimensional transthoracic echocardiography (TTE). With the superior spatial resolution of real time three‐dimensional transesophageal echocardiography (3DTEE), structural changes that occur in patients with CHD‐associated valvular heart disease can be examined in greater detail. We undertook this study to examine the incremental value of 3DTEE in the diagnosis of CHD. Methods: A total of four patients with CHD underwent TTE, transesophageal echocardiography (TEE), and 3DTEE as part of their routine clinical evaluation. Results: TTE and TEE for all four patients revealed thickened, fibrosed, retracted, and malcoapted tricuspid leaflets with wide‐open tricuspid valve regurgitation. 3DTEE en face imaging of the tricuspid valve demonstrated the characteristic morphologic features of CHD more clearly in all four patients. Conclusions: 3DTEE provides substantial incremental value over TTE in the assessment of characteristic CHD pathology and thus enhances the echocardiographic diagnosis of CHD. (Echocardiography 2010;27:1098‐1105)     

Tricuspid and pulmonic valve echoes in tricuspid and pulmonary atresia.

An echocardiographic pattern of normal tricuspid valve motion in a patient with tricuspid atresia, and pulmonic valve motion in a patient with transposition of the great vessels and pulmonary atresia were documented. The recordings of the valve motion resulted in an initial erroneous diagnosis. Although M-mode echocardiography is very useful for the initial diagnostic evaluation of critically ill newborn infants with complex congenital heart diseases, on occasion recording of valvular echoes may result in conflicting clinical and pathologic correlation.     

"Carcinoid-like" tricuspid valvulopathy associated with nephrogenic systemic fibrosis

We present a case of a patient with end-stage renal disease and nephrogenic fibrosing dermopathy (NFD) whose echocardiogram demonstrated rare tricuspid valve abnormality with malcoaptation due to tethering and restricted motion of the leaflets causing severe tricuspid regurgitation. The cardiac abnormalities developed 3 years after her initial diagnosis of NFD was made by skin biopsy. The echocardiographic appearance of the tricuspid valve resembled that seen in patients with carcinoid heart disease; however, an evaluation for carcinoid tumor in our patient was negative. Myocardial biopsy performed at the time of right heart catheterization demonstrated trace gadolinium within the lysosomes of one cardiac fibroblast. This report is the first to describe the association between nephrogenic systemic fibrosis and severe valvular heart disease requiring valve replacement.     

Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease

Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data.     

Correlation between Murmurs and Echocardiographic Findings; From an Imaging Cardiologist Point of View

A heart murmur in adults is a common reason for referral for echocardiography at most general cardiology clinics in Europe. A murmur may indicate either a mild age-related valvular calcification or regurgitation, or represent a significant heart valve disease requiring valvular intervention. Generally, the correlation between murmurs by auscultation and severity of heart valve disease by echocardiography is poor. Particularly, the severity and characterization of diastolic murmurs by auscultation may poorly correlate with echocardiographic findings. This narrative review aims to summarize the differential diagnoses of physiological and pathological murmurs, describes the current referral practice of murmur patients for echocardiography, and presents a single-center experience on the correlation of auscultation and echocardiographic findings with a particular focus on aortic and mitral valve diseases. A careful auscultation of the heart prior to the echocardiogram is mandatory and may help to predict the echocardiographic findings and their interpretation in view of the clinical information. The correlation between clinical examination, point of care ultrasound and standard echocardiography is a matter of continued exploration.     

Acute aortic regurgitation with congestive heart failure due to bacterial endocarditis: diagnosed by echocardiogram and treated successfully by surgery (a case report).

A 23-year-old Japanese male with no evidence of previous heart disease was presented with bicuspid aortic valve and a life threatening acute aortic regurgitation due to subacute bacterial endocarditis. By echocardiographic techniques, a precise diagnosis was made based on the following findings: 1) premature mitral valve closure, 2) snowfall-like echoes between the systolic aortic cusps, 3) eccentricity of a diastolic aortic valvular echo. The echocardiographic diagnosis was confirmed on surgery, in which aortic valve replacement was performed with satisfactory postoperative results.     

Echocardiography of the mitral valve

Mitral valve disease is the second most common valvular heart disease after the aortic valve worldwide. Mitral valve has historically been a structure of interest by pioneers in echocardiography. One of the earliest applications of echocardiography was in the diagnosis of valvular heart disease, particularly mitral stenosis. In this review we wish to take the reader through the structural and hemodynamic evaluation of the normal mitral valve.     

Clinical evaluation versus Doppler echocardiography in the quantitative assessment of valvular heart disease

We tested the hypotheses that Doppler echocardiography has a higher accuracy than clinical evaluation in the detection of significant aortic and mitral valvular heart disease and that Doppler echocardiography is highly accurate as compared with cardiac catheterization for the assessment of valvular disease severity. Thus, cardiac catheterization for the assessment of valve lesion severity may be unnecessary in selected patients. We prospectively evaluated 75 consecutive patients, ages 20-74 years (mean, 52 years), with clinically suspected valvular heart disease. Specific clinical and Doppler echocardiographic criteria were used to categorize each valve lesion as absent, insignificant, or significant. Criteria for a significant lesion at cardiac catheterization was an aortic or mitral valve area less than 1.1 or 1.5 cm2, respectively, or equal to or greater than 3+ cm2 aortic or mitral regurgitation at angiography. In all valve lesions, Doppler echocardiography had a higher overall accuracy than clinical evaluation. Increases in accuracies of 28%, 19%, 15%, and 7% occurred for mitral stenosis, aortic stenosis, aortic regurgitation, and mitral regurgitation, respectively, resulting in overall accuracies of 97%, 100%, 95%, and 96%. Clinical evaluation alone made 28 errors (37% of patients and 19% of valve lesions assessed), and 17 of these errors (23% of patients and 12% of valve lesions) would have resulted in inappropriate management. In only four (24%) of these 17 patients, the attending cardiologist would not have proceeded to assess the valve at cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinically guided use of Cardiac CT in Valvular heart diseases

IntroductionValvular heart diseases are one of the central topics of echocardiography and general cardiology. Recent advances like 3D echo and deformation imaging have substantially improved our understanding of the disease and the evaluation of patients. Cardiac computed tomography applied to valvular diseases is a new and promising tool with the potential to overcome echocardiography limitations in complex patients or complex scenarios like transcatheter aortic implantation.ObjectivesIn this article we will review the literature data related to cardiac computed tomography in valvular diseases with a special focus on practical clinical application.ConclusionCardiac CT can be useful in the evaluation of valvular patients, especially in complex scenarios like aortic stenosis or transcatheter aortic valve implantation when echocardiographic evaluation is not enough.     

Assessment of trans‐aortic pressure gradient using a coronary pressure wire in patients with mechanical aortic and mitral valve prostheses

Accurate evaluation of trans‐aortic valvular pressure gradients is challenging in cases where dual mechanical aortic and mitral valve prostheses are present. Non‐invasive Doppler echocardiographic imaging has its limitations due to multiple geometric assumptions. Invasive measurement of trans‐valvular gradients with cardiac catheterization can provide further information in patients with two mechanical valves, where simultaneous pressure measurements in the left ventricle and ascending aorta must be obtained. Obtaining access to the left ventricle via the mitral valve after a trans‐septal puncture is not feasible in the case of a concomitant mechanical mitral valve, whereas left ventricular apical puncture technique is associated with high procedural risks. Retrograde crossing of a bileaflet mechanical aortic prosthesis with standard catheters is associated with the risk of catheter entrapment and acute valvular regurgitation. In these cases, the assessment of trans‐valvular gradients using a 0.014? diameter coronary pressure wire technique has been described in a few case reports. We present the case of a 76‐year‐old female with rheumatic valvular heart disease who underwent mechanical aortic and mitral valve replacement in the past. She presented with decompensated heart failure and echocardiographic findings suggestive of elevated pressure gradient across the mechanical aortic valve prosthesis. The use of a high‐fidelity 0.014? diameter coronary pressure guidewire resulted in the detection of a normal trans‐valvular pressure gradient across the mechanical aortic valve. This avoided a high‐risk third redo valve surgery in our patient. © 2017 Wiley Periodicals, Inc.