摘要
目的探寻老年继发孔房间隔缺损(ASD)彩色多普勒超声心动图(CDE)特征和规律性。方法应用CDE检查50例老年ASD,50例均经心导管对照,47例行封堵术介入治疗,3例行手术修补治疗。结果根据CDE图像特征对50例老年ASD全部做出正确诊断。老年ASD的CDE特征及规律性明显:(1)所有患者二维超声心动图心尖四腔心切面均显示房间隔中部回声中断,直径最小为0.6cm,最大为3.2cm。左心房、右心房、右心室内径不同程度增大,左心室内径变小。所有患者胸骨旁大动脉短轴切面均显示两条大动脉位置关系正常,合并肺动脉高压患者显示肺动脉内径大于主动脉内径,肺动脉瓣关闭时间延长,开放时间缩短。(2)M型超声显示室间隔与左室后壁呈异向运动占40%,呈同向运动占60%。(3)合并肺动脉高压患者连续多普勒测量三尖瓣反流频谱峰值最小为2.65m/s,最大为4.18m/s。(4)所有患者彩色多普勒血流显像均显示过房间隔左向右五彩镶嵌分流束血流信号。合并二、三尖瓣关闭不全于收缩期显示过二、三尖瓣五彩镶嵌反流束血流信号;合并主、肺动脉瓣关闭不全于舒张期显示过主、肺动脉瓣五彩镶嵌反流束血流信号。(5)老年人ASD合并心房纤颤和冠心病明显增多。结论 CDE能比较准确地测定ASD的大小、肺动脉压和心脏各腔室大小,为临床医师选择治疗方案提供依据。
Objective To investigate the characteristics of elderly with secundum atrial septal defect （ASD） in color Doppler echocardiography （CDE）. Methods Fifty elderly patients with ASD were examined with CDE. All patients underwent cardiac catheterization contrast. 47 cases underwent occlusion therapy for associated ASD and 3 cases underwent operation for associated ASD. Results Fifty cases were accurately diagnosed by CDE image.The features of CDE image in elderly ASD were obvious. （1）Two-dimensional echocardiography apical four chamber view measurements showed echo interruption in the middle part of interatrial septum in all cases,with the smallest diameter of 0.6 cm and the largest of 3.2 cm and different degrees of left atrium,right atrium and right ventricle enlargement and obvious shrinkage of left ventricle. Parasternal great artery short axis view showed normal relation of the two great arteries in all cases and larger diameter of pulmonary artery than aorta and markedly longer closure time than opening time in pulmonary valve in those with associated pulmonary hypertension. （2）M-mode echocardiography showed opposite movement in 40% cases and equidirectional movement in 60% cases of the interventricular septum and posterior wall of left ventricle. （3）Continuous-wave Doppler assessments of tricuspid regurgitation showed that the smallest peak value of frequency spectrum was 2.65 m/s and the largest one was 4.18 m/s in patients with pulmonary hypertension. （4）Color Doppler flow imaging showed multicolor shunt across interatrial septum in all cases; multicolor reverse flow across mitral valve and tricuspid valve during systole in patients with associated mitral and tricuspid incompetence and multicolor reverse flow across aortic and pulmonary valve in those with associated aortic and pulmonary incompetence. （5）Elderly ASD combination with atrial fibrillation and coronary artery disease increases dramatically. Conclusions The size of defect,pulmonary artery pressure and the size of cardiac chamber can be measured accuratly by using CDE,which can help the doctor to opt for protocol of ASD closure.
出处
《实用老年医学》
CAS
2010年第3期225-228,共4页
Practical Geriatrics
