Background Smoking is one of the main risk factors for atherosclerosis and the decrease of arterial elasticity is the early change,so it is important to analyze the effect of smoking and its related risk factors on arterial elasticity. Echo - tracking(ET)technique can detect the decrease of arterial elasticity before the apparent morphological changes of the blood vessels. Objective To explore the effect of smoking and its related factors to Chinese male pure smokers' common carotid artery(CCA)elasticity. Methods From the survey data of Chinese pure smokers from 46 hospitals in China,915 male pure smokers who met the inclusion criteria were selected as the smoking group from August 2009 to August 2011. During the same period,1 920 healthy Chinese men without history of smoking were selected as the normal group from the Chinese people's normal manual. The data of age,elasticity parameters of CCA〔arterial wall stiffness index( β),pressure - strain elasticity modulus (Ep),arterial compliance(AC),augmentation index(AI)and pulse wave velocity(PWVβ)〕of both groups,and smoking- related factors(average daily cigarette consumption,smoking years,age of smoking initiation,nicotine dependence score), intima media thickness(IMT)of left and right CCA of the smoking group were recorded. Results In the smoking group,β, Ep,PWVβ of left and right CCA were significantly higher while AC and AI were lower than those in the normal group( P ﹤0. 05). The β of left and right CCA in age groups of 20 - 29,30 - 39,40 - 49,50 - 59 and ≥60 in the smoking group was higher than that in the normal group(P ﹤ 0. 05). Ep of left CCA in 10 - 19 age group,and Ep of left and right CCA in age groups of 20 - 29,30 - 39,40 - 49,50 - 59 and ≥60 in the smoking group were higher than those in the normal group(P ﹤0. 05). AC of left and right CCA in age groups of 20 - 29 and ≥60,AC of left CCA in age group of 30 - 39,AC of right CCA in age group of 50 - 59 in the smoking group were lower than those in the normal group(P ﹤ 0. 05). AI of left and right CCA in age groups of 10 - 19 and 20 - 29,AI of right CCA in age groups of 30 - 39 and 50 - 59 in the smoking group were lower than those in the normal group(P ﹤ 0. 05). PWVβ of right CCA in age groups of 10 - 19 and ≥60,PWVβ of left and right CCA in age group of 20 - 29,PWVβ of left CCA in age groups of 30 - 39 and 40 - 49 in the smoking group were higher than those in the normal group(P ﹤ 0. 05). In the smoking group,average daily cigarette consumption was positively correlated with IMT,β, Ep,PWVβ of CCA,and negatively correlated with AC of CCA( P ﹤ 0. 05);smoking years,age of smoking initiation, nicotine dependence score were positively correlated with IMT,β,Ep,AI,PWVβ of CCA,and negatively correlated with AC of CCA( P ﹤ 0. 05) . Multivariate stepwise linear regression analysis showed that average daily cigarette consumption and smoking years were the influencing factors for IMT of CCA(P ﹤ 0. 05);average daily cigarette consumption,smoking years, nicotine dependence score were the influencing factors for β,Ep,AC,PWVβ of CCA(P ﹤ 0. 05);smoking years was the influencing factor for AI of CCA(P ﹤ 0. 05). Conclusion The CCA elasticity of smokers is significantly lower;the increase of average daily cigarette consumption,smoking years,nicotine dependence are the risk factors for the decrease of CCA elasticity in smoking population.

目的:应用经食管实时三维超声心动图(RT-3 D-TEE),结合QLAB后处理分析软件对比分析右心室收缩功能减低患者的三尖瓣环形态变化.方法:收集少量或者无三尖瓣反流患者15例,作为对照组;有中-重度三尖瓣反流患者23例,作为反流组;将有中-重度三尖瓣反流患者按照右心室射血分数(RVEF)进行分组,RVEF≥50％,12例;RVEF≤45％,11例.所有患者均行经食管实时三维超声心动图检查,获取全容积图像,应用QLAB后处理分析软件的MVQ技术手动描记三尖瓣环,获得三尖瓣环最大投影面积、最大周长、最大高度、最大瓣环左右径及前后径、投影面积变化率、周长变化率.结果:①对照组与反流组间有明显变化,瓣环最大投影面积及最大周长、瓣环最大左右径及前后径、最大投影面积变化率、最大周长变化率及瓣环高度差异均有统计学意义(P＜0.05);②在反流组内,右心室收缩功能减低组与右心室收缩功能正常组间,瓣环最大投影面积及最大周长、瓣环最大左右径及前后径、最大投影面积变化率、最大周长变化率及瓣环高度没有差异,差异无统计学意义(P＞0.05).结论:经食管实时三维超声心动图结合分析软件能定量评价三尖瓣环形态及运动变化规律,严重三尖瓣反流较正常对照组的瓣环结构发生变化,严重三尖瓣反流组内右心功能减低与右心功能正常的患者三尖瓣环结构没有明显变化.

Objective To analyze the relationships among the left ventricular remodeling,global strain,and systolic function in patients with dilated cardiomyopathy (DCM) using speckle tracking imaging and conventional echocardiography.Methods Twenty five patients with DCM and 30 healthy subjects were included.All the participants underwent transthoracic echocardiography.All images were stored digitally and analyzed off-line.Results There were a very significant differences in left ventricular systolic indices (LVEF,Sm) and Sphericity indices (SID,SIs) between the two groups.Global longitudinal strain (GSL),global circumferential strain (GSC),and global radial strain (GSR) in patients with DCM were all different very significantly from the controls.There were strong correlations between the three global strain and LVEF,Sm,SID,SIs.GSL was the independent predictor of LVEF.Conclusions The relationships among the deformation ability,LV remodeling,and global systolic function are inseparable.GSL is the independent predictor of LVEF.

Objective To evaluate the early effect of cardiac resynchronization therapy (CRT)on right heart functions in patients with heart failure (HF).Methods Forty three patients with HF undergoing CRT from Juanary 2005 to November 2013were enrolled.Before and 1 week after CRT,the right ventricular diameter (RVD),right atrial area (RAA),tricuspid annular plane systolic excursion (TAPSE),area of tricuspid regurgitation (TRA) and systolic pulmonary artery pressure (SPAP) were measured by echocardiography to analyze the right heart function.Results The triple chamber pacemakers were successfully implanted in all the patients.After CRT,RAA and TRA were significantly decreased compared with those before CRT [(17 ± 6)cm2 vs (18 ± 7) cm2,(2.4±1.9) cm2 vs (3.2±2.1) cm2] (P＜0.05);theTAPSE and SPAPwere improved[(12.9± 2.8) mmvs (11.6±2.6) mm,(32±10) mmHg vs (37±15) mmHg](P＜0.01).Conclusion The right heart function can be improved in an early stage after CRT in HF patients.

RESULTS Of all seven fetuses with APVS, all of which demonstrated cardiac enlargement, the axis of the heart was to the left and the main pulmonary artery or branches were significantly dilated. The pulmonary valve was absent or rudimentary. Color Doppler flow imaging demonstrated severe pulmonary regurgitation. Spectral Doppler imaging showed stenosis of the pulmonary annulus. Four fetuses associated with tetralogy of Fallot, one case of which associated with small foci in the left ventricle and one case associated with single umbilical artery. Two fetuses associated with right aortic arch. Two fetuses associated with double outlet of right ventricle. One fetus associated with atresia of mitral valve, right-ventricle typed single ventricle. One fetus associated with double outlet of right ventricle. One fetus associated with ventricular septal defect. Three fetuses associated with absent ductus arteriosus.

目的 探讨孕20～34周正常胎儿各孕周心脏房室瓣口、大动脉瓣口、胎儿静脉系统及重要生理通道的血流峰值速度随孕龄增长的变化规律.方法 回顾性分析2529名孕龄20～34周的正常单胎胎儿超声心动图资料,应用回归分析检测各参数与孕龄的相关性.结果 正常胎儿二尖瓣口和三尖瓣口舒张早期E峰、舒张晚期A峰和E峰/A峰,主动脉瓣口和肺动脉瓣口收缩期峰值流速,主动脉弓横弓部和动脉导管收缩期峰值流速和舒张期峰值流速,肺静脉左心房开口处收缩期S峰、舒张期D峰和心房收缩期A峰均随孕周增加略有增加;下腔静脉收缩期S峰、舒张期D峰及心房收缩期A峰无明显变化.上述胎儿血流动力学参数均与孕周存在相关关系(P均＜0.05).结论 胎儿超声心动图技术可评价心脏血流动力学状态,为胎儿超声心动图检查提供指导.

Background: Currently available echocardiographic reference values are derived mainly from North American and European population studies, and no echocardiographic reference values are available for the Chinese population. The aim of this study was to establish normal values of echocardiographic measurements of the cardiac chambers and great arteries in a nationwide, population-based cohort of healthy Han Chinese adults.Methods: A total of 1,586 healthy Han Chinese volunteers aged 18 to 79 years were screened at 43 collaborating laboratories throughout China. Standard M-mode and two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries. The impacts of gender and age on all echocardiographic measurements were analyzed.Results: A total of 1,394 qualified healthy subjects (mean age, 47.3 +/- 16.0 years; 678 men) were ultimately enrolled. Except for left ventricular ejection fraction, values of cardiac chamber and great arterial dimensions were significantly higher in men than in women. Most measurements of the atrial and great arterial dimensions, left ventricular wall thickness, and left ventricular mass increased with age in both men and women.Conclusions: Normal reference values of cardiac dimensional parameters were established for the first time in a nationwide, population-based cohort of healthy Han Chinese adults. Because most of these parameters were found to vary with gender and age, reference values stratified for gender and age should be used in clinical practice.

目的 本研究通过对辅助生育技术(ART)受孕胎儿与自然受孕胎儿的心脏形态、功能进行对比,探究ART受孕胎儿是否存在心脏形态及功能改变.方法 于我院行胎儿超声心动图检查的孕龄与孕周匹配的ART孕妇与自然受孕孕妇各35例,记录两组病例心脏形态及心脏功能指标.结果 ART组胎儿表现出了心血管系统重塑,包括左、右房面积增大,左、右室呈球形并球形指数减低,左室游离壁、室间隔、右室游离壁厚度增加,主动脉、肺动脉增宽,左室FS减低,左室Tei指数增加,二尖瓣、三尖瓣瓣环位移减低,二尖瓣、三尖瓣E峰减速时间降低.结论 ART在胎儿期就已经表现出心脏形态及功能的改变,在早期发现这一改变,能够给临床的早期干预提供重要依据.

目的 探讨右侧胸骨旁经胸超声心动图对升主动脉疾病诊断的应用体会.方法 在我院诊断为A型主动脉夹层和升主动脉及主动脉根部瘤的患者118例,其中A型主动脉夹层86例,升主动脉瘤32例,行右侧及左侧胸骨旁二维超声及彩色多普勒超声心动图检查.结果 对于累及升主动脉的疾病,右侧胸骨旁超声切面均能清楚显示,其中14例A型主动脉夹层患者显示较左侧胸骨旁超声切面显示更加清楚,2例左侧胸骨旁超声图像并未见剥脱内膜回声,右侧胸骨旁超声图像可以清晰显示剥脱内膜回声;右侧胸骨旁超声对升主动脉及主动脉根部瘤显示瘤体的形态与结构更加完整.结论 右侧胸骨旁超声切面对升主动脉疾病的检出有重要的辅助诊断价值.

AIMS Currently, available Doppler echocardiographic reference values are derived mainly from North American and European population studies, which may not applicable to the Chinese population. We aimed to establish normal reference values of Doppler echocardiographic parameters in a nationwide, population-based cohort of healthy Han Chinese adults. METHODS AND RESULTS A total of 1394 qualified healthy subjects (mean age 47.3 ± 16.0 years, 678 men) were enrolled at 43 collaborating laboratories, 37 transvalvular flow and tissue Doppler parameters were obtained, and the impacts of gender and age on each parameter were analysed. Significant differences were found between men and women in 48.6% (18/37) of the parameters analysed, and among different age groups in 83.8% (31/37) of the parameters in men and in 86.5% (32/37) of the parameters in women. CONCLUSIONS Normal reference values of Doppler echocardiographic parameters were established for the first time in a nationwide, population-based cohort of healthy Han Chinese adults. Since most of these parameters differed by gender and/or age, reference values specified for gender and age should be recommended in clinical practice.

Cardiac resynchronization therapy (CRT) is a proven therapy for selected patients with heart failure, it has been shown to improve symptoms and left ventricular (LV) function and prolong survival. Despite proven benefit of CRT, a significant proportion of patients fail to respond to CRT. Multiple factors contribute to the non-response such as patient selection and device implantation including LV lead placement. Speckle tracking echocardiography (STE) derived strain imaging offers detailed characterization of LV function and provides indices of mechanical dyssynchrony, in addition, STE systolic strain could be used to identify area of scar, therefore applications of STE-derived strain imaging in CRT warrant a closer inspection. This review considers and summarizes different indices of mechanical dyssynchrony generated by STE-derived strain imaging and their relevance in patient selection for CRT and their prognostic values in predicting response to CRT. This review further examines applications of STE-derived strain imaging in optimizing LV lead position by detecting site of latest mechanical activation and presence or absence of transmural scar in a particular segment.

目的:应用二维斑点追踪显示技术与右心漂浮导管对照研究右心室收缩功能(RVEF),寻找右心功能的无创有效超声检测方法.方法:在安贞医院心外科行瓣膜手术的患者18例,男性11例,女性7例,平均年龄(45.4±5.1)岁,术中放置右心漂浮导管,获得右心室收缩功能参数(RVEF).结果:三尖瓣位移与右心室收缩功能的相关系数为r =0.910,P=0.001二者有很好的相关性.结论:超声心动图检测技术很容易获得三尖瓣瓣环收缩期位移,与作为测量右心室收缩功能的金标准的右心漂浮导管有很好的相关性,可以作为临床估测右心功能的无创指标.

目的 探讨超声心动图在肺动脉肉瘤和慢性血栓栓塞性肺动脉高压鉴别诊断中的临床应用价值.方法 回顾分析我院2008年3月～2013年5月收治的11例经手术并病理证实的肺动脉肉瘤患者的经胸超声心动图检查情况,并与29例慢性血栓栓塞性肺动脉高压的超声心动图结果进行对照,详细分析肺动脉肉瘤和慢性血栓栓塞性肺动脉高压的超声特征.结果 肺动脉肉瘤多为不均质强回声,并可见包膜回声;瘤体部位多在主肺动脉或左右分支;慢性血栓栓塞性肺动脉高压患者肺动脉血流频谱加速支上升时间与收缩期肺动脉射血时间均缩短(P＜0.05).结论 肺动脉肉瘤是由于肺动脉内的占位效应而导致的肺动脉栓塞.肺动脉肉瘤与慢性血栓栓塞性肺动脉高压除存在一些超声心动图共同特点外,二者亦存在一定差别.因此,超声心动图检查可以为二者的鉴别诊断提供一定依据.

目的：探讨三维超声心动图评价微创外科方法植入左室心外膜电极的 CRT的可行性和疗效。方法应用三维超声心动图对左室心外膜多点电极起搏器植入13例心衰模型小型中华猪行左室心肌同步性检测。经Q-lab后处理软件分析，得到术前与术后3w的左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、每搏量( SV)、射血分数( LVEF)、17节段时间-容积曲线。结果对照术前与术后3 w的 LVEDV、LVESV、LVEF、SV、LVEF、CO数据，术后实验组较对照组 LVEDV、LVESV减小，实验组较对照组LVEF、SV、CO提高，统计学具有显著性差异( P<0.01)。术后3 w Teil指数显著改善，统计学有明显差异（P<0.01）。结论左室心外膜多点电极起搏器植入可以提高左心室的收缩与舒张功能，应用三维超声心动图可对左室同步性进行准确定位指导，并评价手术疗效。

目的:探讨彩色多普勒超声在腹主动脉夹层及肾动脉真、假腔供血的检测价值.方法:对75例腹主动脉夹层及150支肾动脉血流的二维及彩色多普勒超声特点进行分析,确定腹主动脉夹层真假腔,将真腔供血及假腔供血的肾动脉及肾段间动脉各分为二组,对血流动力学进行比较.结果:肾动脉真腔供血与假腔供血两组间收缩期峰值流速(Vmax)、平均流速(Vmean)及舒张末期流速(Vmin)均差异有统计学意义(P＜0.05);阻力指数(RI)与收缩期加速时间(AT)差异无统计学意义(P＞0.05);真腔供血段间动脉与假腔供血段间动脉的Vmax、Vmean及AT,均差异有统计学意义(P ＜0.05);Vmin及RI间差异无统计学意义(P＞0.05).结论:彩色多普勒超声是腹主动脉夹层肾动脉血供初步诊断及监测的最佳无创检查方法.

胎儿左心发育不良综合征严重影响新生儿的生长发育[1-2],随着胎儿超声心动图及小儿心脏外科的快速发展,对引起胎儿左心系统发育偏小病因有了深入认识,不同的病因其预后不同.本研究旨在总结胎儿左心系统发育偏小的病因,为胎儿左心系统发育偏小的产后风险评估提供依据.资料与方法一、研究对象选取在河南省人民医院及北京安贞医院行胎儿超声心动图检查的2 590例孕妇,孕妇年龄17～46岁,平均(29.33±4.87)岁,孕龄16～40周,平均(25.98±3.45)周.入选标准为获得胎儿超声心动图,产后超声心动图、相关检查、外科手术及术后随访资料、引产后尸检资料完整者.排除标准为不能获得完整资料者.所有研究对象均告知详情,签署知情同意书.胎儿心脏尸检的研究对象由孕妇及家属签署尸检同意书。

目的 室壁瘤切除术中应用三维经食管超声心动图(3D-TEE)导航,定量分析手术前后室壁瘤患者左心室功能,探讨对患者远期愈后的作用.方法 64例行左心室室壁瘤切除手术患者,分2组,每组32例.行3D-TEE为试验组,其中男性29例,女性3例；年龄46～ 76岁,平均年龄59.9岁.对照组术中未行3D-TEE检查,其中男性29例,女性3例；年龄38 ～ 79岁,平均年龄60.0岁.在患者手术前3d内、术后1年分别行3D-TTE检查,对照分析同期行室壁瘤切除手术患者心功能,并记录分析两组患者手术时间、术后辅助治疗、术后不良事件发生及治疗前后左心室结构与功能改善的情况.结果 术后试验组左心室射血分数为(45.88±6.60)％,每搏量(49.95±7.18)mL,心指数(2.17±0.44) L/(min·m2)；对照组左心室射血分数为(37.88±6.82)％,每搏量(40.54±10.12)mL,心指数(1.68±0.38)L/(min·m2)；试验组明显高于对照组,二者差异有统计学意义(P＜ 0.05).两组左心室舒张末容积差异无统计学意义(P＞0.05),但试验组左心室收缩末容积明显低于对照组,二者差异有统计学意义(P＜0.05).两组患者手术时间相差无统计学意义.结论 术中应用3D-TEE检查能够安全、便捷地评价室壁瘤形成患者的左心室.在术中应用3D-TEE为导航,更利于外科医生的判断和处理,对患者的远期效果应该更好.

目的 探讨永存左上腔静脉与胎儿心脏畸形,尤其是主动脉缩窄及发育不良之间的关系.方法 回顾性分析4 664例胎儿超声心动图结果,计算左上腔静脉和先天性心脏畸形的比值比(OR值)与左上腔静脉和先天性主动脉缩窄及发育不良的比值比等.结果 4 664胎儿超声心动图结果中,无结构性胎儿心脏畸形4 004例,合并左上腔静脉(LSVC) 38例(0.95％);结构性心脏畸形660例,合并LSVC 62例(9.39％)(OR=10.8).660例心脏畸形中,主动脉缩窄和主动脉发育不良47例,同时合并LSVC 17例(36.17％)(OR=7.15).结论 胎儿永存左上腔静脉同样提示胎儿结构性心脏畸形的危险性明显增加.并且胎儿患主动脉缩窄及发育不良的可能性亦增加.提示如果发现LSVC,应追踪观察,除外先天性心脏畸形,尤其是主动脉缩窄及发育不良.

Mitral valve (MV) dysplasia syndrome is a rare and distinctive fetal cardiac malformation combination. The main characteristics of MV dysplasia syndrome include MV dysplasia, severe mitral regurgitation (MR), aortic outflow obstruction, a restrictive foramen ovale or an intact atrial septum, and marked left ventricular (LV) and left atrial (LA) dilatation. Patients with this malformation usually have high neonatal mortality with or without intervention.1–2 A case of a fetus with gradual development of MV dysplasia syndrome is reported. The pathologic anatomy confirmed the abnormalities in the mitral apparatus, aortic valve, and intact atrial septum. The sonographic changes at different gestational ages suggest that MV dysplasia syndrome may be a continuously developing disease. A fetus with MV dysplasia syndrome was reported at 30 weeks’ gestation. The maternal and pregnancy medical histories were normal. The first conventional obstetric sonographic examination performed at 23 weeks’ gestation showed no obvious abnormality. Four weeks later, during the second pregnancy check, a large LA, severe mitral regurgitation, and a small aortic artery were observed. To find the primary heart deformity, the patient was sent to our center for a detailed fetal heart echocardiographic examination. The most notable anatomic and physiologic features included an MV apparatus abnormality, in which the tips of leaflets and the chordae tendineae were thickened, with echo enhancement and motion amplitude reduction (Figure 1A). Color Doppler flow imaging showed severe mitral regurgitation in systole (Figure 1B). The aortic valve and aortic artery were dysplastic: the valve appeared thickened, fused, and immobile; the root and ascending aorta were small. No forward flow was detected across the aortic valve, and retrograde flow was visible in the ascending aorta. The atrial septum was intact in different views (Figure 1A). The LV, LA, and LA appendage were all dilated (Figure 1A). Left ventricular wall motion was decreased. Pulsed Doppler imaging showed that the pulmonary venous spectrum was abnormal, and double-reversal wave was detected in both systole and late diastole (atrial systole). After being informed of the results, the woman opted to terminate the pregnancy. The cardiac autopsy and pathologic findings verified our fetal echocardiographic discoveries: The heart weighed 26.7 g, which was about twice the weight expected for its age. The LV, LA, and LA appendage were dilated, and the atrial septum was intact. The myocardium was abnormally thickened, with endocardial fibroelastosis. The MV apparatus was abnormal, with dysplastic and nodular leaflets, a hypoplastic orifice, and thickened, short chordae (Figure 1, C and D). The aortic annulus and ascending aorta were severely hypoplastic. The aortic valve showed commissural fusion, with a stenotic valve orifice. Mitral valve dysplasia syndrome is a congenital fetal heart anomaly. It is characterized by MV dysplasia, severe aortic valve stenosis, substantial mitral regurgitation, left heart dilatation, an intact atrial septum, and a restrictive foramen ovale. The primary anatomic anomaly in MV dysplasia syndrome is thought to be the dysplastic MV, resulting in severe mitral regurgitation and mild mitral stenosis. These lesions in turn result in an increased LA volume and LA hypertension. Given that fetuses with MV dysplasia syndrome often have a restrictive or absent foramen ovale, the mitral regurgitation may alter septal morphologic characteristics by promoting premature adherence between the septum primum and septum secundum.2 The accompanying aortic valve stenosis may be due to decreased flow through the LV as the LA abnormalities worsen and foraminal flow decreases, or it may simply accompany the mitral abnormalities. The aortic valve stenosis is thought to lead to increased wall stress, initial LV dilatation, and endocardial fibroelastosis. Aortic outflow obstruction compounds severe mitral regurgitation by disallowing adequate forward blood through the LV, contributing to LV dilatation. The resultant left heart dilatation likely leads to compression of the right side of the heart, which may impede both

Objective To evaluate the diagnostic value of color doppler ultrasound of Parkes-Weber syndrome (PWS).Methods We retrospectively analyzed results of color doppler ultrasound examination of 21 cases of PWS diagnosed by clinical and imaging methods in our hospital and lesions of arteries and veins were compared.Results Lower extremity ultrasound examination revealed wine-colored skin vascular nevi or hemangioma and thickening of the involved limb in 21 of the PWS patients (100.0％) ; lower extremity ultrasound examination revealed varicose of the superficial veins and dysplasia and malformations of the deep and superficial veins in 20 of the PWS patients (95.2％) ;the diameter of the dysplasia veins were significantly less than artery accompanied.78.0％ (32/41) orifice of arteriovenous fistula cases could be revealed by ultrasound.The arteriovenous fistula were multiple.Color flow signals could be seen in the orifice of the fistula,diameter of the proximal segment of the vein near the orifice vein dilated and flow rate increased with mixed arteriovenous doppler spectrum.Conclusion Color doppler ultrasound is the best noninvasive examination methods for preliminary diagnosing and monitoring PWS.