患者资料:男,4岁,超声检查提示:先天性心脏病: 1、室间隔缺损(膜部间隔瘤型,部分性左室右房通道) 2、主动脉瓣无冠瓣脱垂并关闭不全(轻度) 3、三尖瓣返流(轻度) 4、卵圆孔未闭 5、局限性心包积液(少量)这是术前的超声图片:患者于2010年4月15日行介入治疗,3天后复查,超声显示室间隔缺损完全被封堵,愈后良好。这是术后的照片:
摘要 目的:探讨经胸彩色超声心动图在膜部瘤形室间隔缺损(VSD)介入治疗术前超声分型的临床应用价值。方法:40例患者行经导管膜部瘤形VSD封堵术,封堵器为国产镍钛合金制成的双盘伞结构封堵器,经胸彩色超声心动图术前筛选分型、术中监测、术后复查。术前超声将膜部瘤 型VSD的解剖特点分为4种类型,1型为囊袋型、2型为漏斗型、3型为菜花型、4型为管形。结果:40例膜部瘤形VSD囊袋型20例,漏斗型10例,菜花型4例,管型6例,全部成功封堵,术中造影证实术前超声测量膜部瘤形VSD部位、形态、大小(包括右室面缺损外口大小数目、左室面缺损内口、膜部瘤深度、宽度)与实际一致,封堵成功,5天后经胸超声检查未见残余分流。结论:经胸彩色超声心动图在膜部瘤形VSD分型封堵术前有着重要的应用价值。关键词:经胸彩色超声心动图 膜部瘤形室间隔缺损 封堵术 分型The Clinical Value of Transthoracic Color Ultrasonic Cardiogram in Typing of Membranous Tuberiform Ventricular Septal Defect before Interventional Therapy Mu Nannan, Zheng Xiaozhou, Zhang Yushun, et al.Abstract: Objective: To investigate the clinical application value of transthoracic color ultrasonic cardiogram in typing of membranous tuberiform ventricular septal defect(VSD) before interventional occlusion. Methods: 40 patients suffered from membranous tuberiform VSD underwent transcatheter occlusion with domestic occluder, which made by nickel- titanium alloy with double-leg sitting tailor-fashion architecture. Preoperative screening and typing, monitoring during operation, and postoperative re-examination were executed through transthoracic color ultrasonic cardiogram. According to the anatomic feature, the membranous tuberiform VSD was typed in 4 groups by ultrasonic cardiogram before operation: sac type, funnel type, fungating type and ductus type. Results: 40 membranous tuberiform VSDs were classified into 4 groups in types: 20 sacs, 10 funnels, 4 fungatings and 6 ductuses, and all VSDs were occluded successfully. The visualization during operation verified that it was conformed in the location, morphous and size(including the size of debouch on left surface of the septum, depth and width of the sack, the number and size of debouch on right surface of the septum) between the preoperative ultrasonometry and the truth. The re-examination was carried out by transthoracic color ultrasonic cardiogram 5 days after operation and there was no residual shunt. Conclusion: Transthoracic color ultrasonic cardiogram possess important clinic value in typing of membranous tuberiform ventricular septal defect before interventional occlusion. Key Words: Transthoracic color ultrasonic cardiogram, Membranous tuberiform VSD, Occlusion, Typing
目的:探讨解剖M型(AMM)超声心动图诊断冠心病的临床价值。材料和方法:402例怀疑为冠心病拟行冠状动脉造影患者术前进行二维和AMM超声心动图检查,根据造影结果把冠状动脉狭窄程度分为5级:无狭窄和轻、中、重度狭窄及完全闭塞。统计分析AMM检测节段性室壁运动异常(RWMA)与相关冠状动脉分支狭窄程度的相关性。结果:当冠状动脉轻度或中度狭窄时,RWMA检出率较低,当冠状动脉重度狭窄或闭塞时,RWMA检出率较高,诊断的准确性较高,结论: AMM是一种简便、无创的诊断冠状动脉重度狭窄的方法,但对轻度或中度的冠状动脉狭窄诊断的敏感性相对较低。关键词:解剖M型超声心动图;冠心病Clinical study of the application of AMM in diagnosis of coronary heart disease Mu Nannan, Zhu YongshengAbstract AIM: To evaluate the clinical application of anatomic M-mode (AMM) echocardiography in diagnosis of coronary heart disease (CHD). METHODS: 402 patients with suspected CHD underwent echocardiography and AMM before CAG (coronary angiography). The severity of stenosis were divided into 5 degrees: no stenosis, mild stenosis, moderate stenosis, severe stenosis and closed, according the outcomes of CAG. Then the relation between the regional abnormal segmentation of ventricle wall motion(RWMA) and the stenostic degree of related coronary artery was statistically analyzed.standard.RESULTS: AMM had low sensitivity in detecting RWMA in patients with mild or moderate coronary artery stenosis, but when stenosis severities more than 90%, were conscerbed, the diagnostic accuracy became high. CONCLUSION: AMM is a convenient, noninvasive method in detecting severe coronary artery, but it not sensitive in detecting mild or moderate stenosis.Key words: Anatomic Motion Mode Echocardiography, Coronary heart disease
牟楠楠主任在心脏超声方面:复杂先心病、瓣膜病、心肌病等疾病的定位、定性上以及先心病介入的超声术前、术中、术后筛查、检测等方面能够作出准确判断。 以下是介入治疗的现场照片:
患者男,5岁,左小腿及臀部紫红色色素沉着,一直未能确诊,遂来我院检查。在超声检查中,牟楠楠主任果断做出诊断,确诊了这个较为罕见的疾病,为病人的下一步治疗指明了方向。 以下是病人的图片:超声提示为:左下肢浅静脉先天性发育异常: 1、左侧大隐静脉小腿段主干及侧枝血管扩张 2、左侧小隐静脉主干及侧枝血管扩张 3、左侧臀部及左下肢皮肤着色处浅静脉迂曲扩张走行紊乱 4、左侧股浅静脉先天性发育异常(为三条变异血管) 5、左侧足底皮下组织明显增厚以下是超声的图片:
患者男,37岁,右大腿巨大肿物,来我科行超声诊断。以上是牟楠楠主任在检查过程中。该患者的超声图像为: