| 摘要: |
| 目的 探讨常规经胸超声心动图（TTE）和左心腔声学造影（LVO）在诊断冠状动脉粥样硬化性心脏病（以下简称冠心病）伴室壁瘤中的应用价值。方法 回顾性分析101例经冠状动脉造影证实为冠心病患者的超声检查资料，比较TTE和LVO对冠心病伴室壁瘤的检出率、大小及其超声图像特征。结果 101例冠心病患者，TTE检出伴室壁瘤者12例（共12个），检出率为11.9%，其中心尖部7个，基底部宽度为（16.8±3.6）mm；其他部位5个，基底部宽度为（25.4±5.2）mm。LVO检出伴室壁瘤者43例（共48个），检出率为42.6%，其中心尖部35个，基底部宽度为（11.7±1.1）mm；其他部位13个，基底部宽度为（14.3±6.1）mm。两种方法的检出率和基底部宽度比较，差异均有统计学意义（均P＜0.05）。室壁瘤的TTE主要声像图特征为：①室壁局部变薄，呈瘤样膨出，其开口的内径大于瘤体内径，瘤体壁与心室壁互为延续；②瘤体收缩期基本无运动或呈反向运动，部分瘤体内可有附壁血栓。室壁瘤的LVO主要声像图特征为：声学造影剂充填于整个左室心腔，使左心系统心内膜边界能够清晰识别，室壁瘤局部室壁变薄和瘤样膨出，瘤体内充满造影剂，其在收缩期呈反向运动或运动明显减弱。其中，功能性室壁瘤的局部室壁形态可在舒张期恢复正常形态，而解剖性室壁瘤的局部室壁在收缩期及舒张期均可见瘤样膨出。结论 TTE和LVO均可无创检测室壁瘤，且对于心尖部室壁瘤和小室壁瘤的诊断，LVO优于TTE，具有重要的临床价值。 |
| 关键词: 经胸超声心动图 左心腔声学造影 室壁瘤 冠心病 |
| DOI： |
| 投稿时间：2017-07-12修订日期：2018-01-05 |
| 基金项目:国家国际科技合作专项项目(2015DFA30920),重庆市科技研发基地建设计划(国际科技合作)项目(cstc2014gjhz110004),第三军医大学西南医院临床创新基金(SWH2015LC10)作者单位400038重庆市,第三军医大学西南医院超声科(江璐璐、王文婷、黄海韵、柳强维、郭燕丽),心血管内科(张志辉、宋治远)通讯作者郭燕丽,Email: guoyanli71@aliyun.com |
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| Clinical value of left ventricular opacification in the diagnosis of coronary heart disease with ventricular aneurysm |
| JiangLuLu,GUO Yanli |
| () |
| Abstract: |
| Objective To evaluate the application value of transthoracic echocardiography （TTE） and left ventricular opacification （LVO） in the diagnosis of coronary heart disease with ventricular aneurysm. Methods A total of 101 patients with coronary heart disease that had been confirmed by coronary angiography were included in this study. Comparison their ultrasound image characteristics and the detection rate of ventricular aneurysm by TTE and LVO. Results Twelve of 101 patients with coronary heart disease were determined with ventricular aneurysm by TTE, 7 in apex whose base width of ventricular aneurysms were （16.8±3.6）mm and 5 in the other part whose base width were （25.4±5.2）mm, the detection rate was 11.9%. 43 patients were determined with ventricular aneurysm by LVO，5 cases were multiple ventricular aneurysm，every of whom had 2 ventricular aneurysms. There were all 48 ventricular aneurysms，including 35 in apical ,whose base width of ventricular aneurysms were （11.7±1.1）mm, and 13 in the other part, whose base width were （14.3±6.1）. Compare the two methods of detection rate and the base width ,the differences had statistical significance(P＜0.05). The main features of ultrasound image of TEE：①Regional ventricle wall was thinned and aneurysmal bulged. The internal diameter of aneurysmal opening was larger than the diameter of aneurysmal body，and aneurysmal wall was connected to ventricular wall. ②Aneurysmal wall showed no movement or paradoxical movement during systole，and mural thrombus was found in some aneurysms. The main features of ultrasound image of LVO：Contrast agent was filled in left ventricular，which made left ventricular endocardial border more clearly identified. Regional ventricle wall was thinned and aneurysmal bulged. Aneurysm was filled with contrast agent，which showed reverse movement or decreased movement during systole. Aneurysmal wall of functional ventricular aneurysm could restore to normal morphology during diastole，while aneurysmal wall of anatomical aneurysm bulged during systolic and diastolic. Conclusion TTE and LVO both can detect ventricular aneurysm in noninvasive. The diagnosis of ventricular aneurysm in apical and tiny aneurysm by LVO is superior to TTE. LVO could show the fine anatomical structure of ventricular wall clearly，and dynamically show the motion state of ventricular aneurysm during systolic and diastolic，which is beneficial to distinguish functional ventricular aneurysm and anatomical ventricular aneurysm. |
| Key words: Transthoracic echocardiography Left ventricular opacification Ventricular aneurysm Coronary artery heart disease |
