目的 应用左房扩张指数(LAEI)联合三维斑点追踪技术(3 D-STI)评价心房纤颤(房颤)患者左心房功能.方法 健康体检者 49 例、阵发性房颤患者 43 例、持续性房颤组患者 45 例,分别作为对照组、阵发性房颤组、持续性房颤组.测量左房最大容积(Volmax)和最小容积(Volmin)并计算 LAEI及 3D-STI测量左心房三维整体应变(GLS、GCS)及各达峰时间标准差(SD-TPLS、SD-TPCS、SD-TPRS),比较 3 组各指标差异及 LAEI与 3D-STI各参数的相关性.结果 3 组比较,阵发性房颤组与持续性房颤组 LAEI 及 3D-STI 的应变指标 GLS、GCS 均减低,SD-TPLS、SD-TPCS、SD-TPRS相对增加(P<0.05),持续性房颤组较阵发性房颤组,GLS、GCS 与 LAEI 减低,SD-TPLS、SD-TPCS 增加(P<0.05).LAEI与 GLS、GCS呈正相关(P<0.01),与 SD-TPLS、SD-TPCS呈负相关(P<0.01).结论 LAEI及 3D-STI GLS均与房颤的进展呈负相关.应用 LAEI 及 3D-STI 可早期发现房颤患者左心房结构和功能的改变,准确评价房颤的进展程度和治疗疗效.

•Artificial valve displacement is a rare serious complication in TAVI.•Mitral chordae tendineae rupture is a complication of valve displacement in TAVI.•Displaced TAVI devices may abrade the mitral chordae, causing rupture.

目的:探讨三维斑点追踪成像技术(3D-STI)早期评价慢性肾脏病(CKD)患者心肌功能的价值.方法:90例CKD按肾小球滤过率(GFR)分为GFR轻度降低组(Ⅰ组)、中度降低组(Ⅱ组)、重度降低组(Ⅲ组)各30例;40例健康志愿者作为对照组.测量并比较4组的常规超声心动图参数,以及3D-STI应变参数,即左心室整体径向应变(GRS)、整体纵向应变(GLS)、整体圆周应变(GCS)及左心室旋转.结果:与对照组比较,Ⅰ组左心室射血分数(LVEF)降低,左心室质量指数(LVMI)增加,差异均有统计学意义(均P<0.01),其他常规超声心动图参数差异均无统计学意义(均P>0.05).与对照组比较,Ⅱ组和Ⅲ组左心室舒张末期内径(LVEDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及LVMI均增加,LVEF均减低,差异均有统计学意义(均P<0.01或P<0.05).与对照组比较,Ⅲ组左心室收缩末期内径(LVESD)增加,差异有统计学意义(P<0.01).与Ⅰ组比较,Ⅱ组LVPWT、LVMI增加,LVEF降低,差异均有统计学意义(均P<0.01或P<0.05);Ⅲ组LVEDd、LVESD、IVST、LVPWT及LVMI均增加,LVEF降低,差异均有统计学意义(均P<0.01).与Ⅱ组比较,Ⅲ组LVEDd、IVST、LVPWT及LVMI均增加,差异有统计学意义(均P<0.01或P<0.05),LVESD及LVEF差异无统计学意义(P>0.05).与对照组比较,患者组GLS、GRS均降低(均P<0.05),左心室扭转增加(均P<0.05),而GCS差异无统计学意义(P>0.05).与Ⅰ组比较,Ⅱ组GLS、GRS均显著降低(均P<0.01);Ⅲ组GLS、GCS及GRS均显著降低(均P<0.01).与Ⅱ组比较,Ⅲ组GLS、GCS及GRS均显著降低(均P<0.01).结论:CKD患者,病程早期由于圆周方向心肌功能的保持和心肌旋转代偿加强,LVEF可维持正常,但心肌纵向和径向功能降低;3D-STI可早期识别心肌损害,更加敏感地反映左心室收缩功能的改变,为临床决策和疗效评价提供依据.

患者女,48岁.因体检发现右肺占位入院.CT提示:右肺上叶前段见斑片状磨玻璃影,边界模糊,大小约2.2 cm×1.5 cm×1.3 cm,拟行右肺上叶切除+淋巴结切除术.术前于右肺肿瘤处在CT引导下置入Hookwire定位针,但术中未发现定位针.遂行紧急胸部CT检查显示:左心房及左心室内见探针样金属密度影,总长度约6 cm,心包腔内微量积液(图1).急诊超声心动图示:左室腔内见金属定位针回声,总长度约3.5 cm,一端位于近心尖的左室后壁心内膜处,另一端靠近二尖瓣下方,随心动周期轻微摆动,二尖瓣瓣叶启闭未受影响,微量心包积液(图2).遂行急诊心外科手术,术中见一细针自左心房经二尖瓣进入左心室,心房段较细,末端位于右肺上、下静脉之间,未穿透左房壁,心室段较粗,末端位于左心室近心尖处,二尖瓣结构未受损.手术将定位针完整取出(图3).

Objective:To explore the differences of left ventricular (LV) diastolic dysfunction between eccentric and concentric left ventricular hypertrophy (LVH) in hypertensive patients using Doppler Echocardiography,so as to provide the basis for LV diastolic function damage evaluation. Methods:A total of 246 patients with essential hypertension were selected and divided them into four groups. LV diastolic function was assessed by measurements of peak early transmitral flow velocity (E)/peak late transmitral flow velocity (A) by adopting PW-Doppler (the E/A ratio),peak early diastolic mitral annular velocity (Em) by adopting tissue Doppler and the E/Em ratio. Results:Compared with the normal LV geometry group,the eccentric and concentric LVH groups had significantly lower values for two parameters reflecting LV diastolic function (E/A,P<0.01;Em,P<0.01). E/Em was significantly higher in the concentric LVH group compared with the eccentric LVH group (P<0.01). Conclusion:Among hyperten-sive patients with LVH,those with concentric LVH have more severe LV diastolic dysfunction than those with eccentric LVH.

患者女，16岁，因胸闷5 d入院。体格检查：血压90/70 mm Hg （1 mm Hg=0.133 kPa），双肺呼吸音欠清，心界扩大，律齐，三尖瓣听诊区闻及3～4级收缩期杂音。超声心动图示：三尖瓣前叶发育冗长，隔叶及后叶发育不良，隔叶下移，距离二尖瓣前叶附着点约3.1 cm；后叶下移，距离三尖瓣环约3.9 cm，三尖瓣关闭不全，收缩期见中度反流。右房、右室扩大，房化右室大小约（纵径×横径）2.9 cm×4.2 cm，功能右室缩小，纵径约2.5 cm。三尖瓣后叶根部房化右室面向功能右室下壁外侧瘤样膨凸，直达右室心尖外侧，范围约7.9 cm×4.6 cm（图1）。房间隔卵圆窝处回声中断约1.1 cm。超声心动图诊断：先天性心脏病，三尖瓣下移畸形，房间隔缺损（卵圆窝型），房化右室瘤样膨凸（从三尖瓣后叶根部直至右室心尖部）。

Objective To calculate left ventricular twist in essential hypertension(EH)patients by 2 dimension speckle tracking echocardiography(2DSTE).Methods 170 EH patients and 50 healthy control subjects were included.Peak rotation on basal plane(Prot-base) and apical plane(Prot-apex),peak twist angle(Ptw)and prot-untwisting velocity(PUV)were measured by 2DSTE.Results Compared with control group,the Ptw was significantly increased in concentric remodeling group and concentric hypertrophy group(P＜0.01).The Ptw was decreased in eccentric remodeling group(P＜0.01).Regarding LV untwisting rate,compared with control group,the PUV were increased in concentric remodeling and concentric hypertrophy groups.In eccentric remodeling group,there was no significant difference in PUV(P＞0.05).Conclusions Enhanced LV twist appears to be a compensatory mechanism in hypertensive patients during the earlier stages of concentric remodeling and concentric hypertrophy,this hyper-torsion is inevitably loss in the more advanced stage of eccentric hypertrophy.

Objective:Obstructive sleep apnea (OSA) may predispose patients to and heart failure.The aim of this study was to determine the index of myocardial performance ( IMP) reflecting left ventricular global function in uncomplicated OSA pa-tients.Methods:Fifty-eight subjects without hypertension,diabetes mellitus, and any cardiac or pulmonary disease referred for evaluation of OSA underwent overnight polysomnography and complete echocardiographic assessment.According to the apnea hy-popnea index ( AHI) , subjects were divided into three groups: group 1, control subjects with nonapneic snorers ( AHI<5,n=16) ;group 2, patients with mild to moderate OSA (AHI:5–30,n=23) ;and group 3, severe OSA (AHI>30, n=19) . Basic echocardiographic measurements LVM index were measured. Left ventricular IMP was calculated as ( isovolumic contraction time+isovolumic relaxation time) /aortic ejection time by Doppler echocardiography. Results:There were no significant differ-ences in age, sex, body mass index, heart rate, and systolic and diastolic blood pressure among the three groups. Left ventricular IMP was significantly higher in severe OSA patients than in controls ( P<0.01) . There was no significant difference between controls and mild to moderate OSAHS and between mild to moderate OSA and severe OSA. Conclusion:The present study demonstrates that patients with severe OSA have global left ventricular dysfunction.

患儿男,7岁,因活动后胸部不适1年入院.体格检查:血压80 mmHg/50 mmHg,双肺呼吸音清,心界不大,心率98次/分,律齐,各瓣膜听诊区未闻及病理性杂音.心电图:窦性心律,I、aVL、V5和V6导联T波低平.超声心动图:各房室腔大小正常,心瓣膜未见异常,主动脉和主肺动脉未见异常,房室间隔完整.二维超声:左心室侧后壁基底部心肌显著变薄(约0.1～0.2 cm),局部室壁轻微膨出,形成一个囊状结构,口较小(约0.8 cm),体部较宽大(约2.5cm×1.5 cm),多个与室壁紧密连结的条索状结构突入囊腔内;收缩时囊腔扩大,舒张时变小(图1A、1B).