少见类型肥厚型心肌病的超声心动图诊断与鉴别诊断

The Diagnosis and Differentiation of Rare Cases of Hypertrophic Cardiomyopathy with Echocardiography

分析少见类型肥厚型心肌病患者的超声心动图特点 ,提高超声心动图对该病诊断的准确性。利用Acuson12 8XP10彩色电脑声像仪分析了 38例经临床及超声心动图诊断为肥厚型心肌病患者的有关资料 ,采取二维超声心动图多切面、多角度观测室间隔、游离壁厚度和活动幅度以及二尖瓣活动特点 ;M型超声心动图Ⅱa区、Ⅳ区测量房室腔内径及室壁厚度 ;多普勒超声心动图记录左室流出道血流速度、二尖瓣频谱形态及二尖瓣返流速度。 38例肥厚型心肌病患者中 ,以Ⅲ型最为多见 ,占 4 5%。少见类型中心尖肥厚型 2例 ,心尖最厚达 33mm ;后下壁及下间隔肥厚型各 1例 ;对称型肥厚者 2例 ;高血压合并肥厚型心肌病者 2例。肥厚型心肌病的肥厚心肌分布比较复杂 ,少见类型肥厚型心肌病的诊断更应注意多切面、多角度进行探查 ,避免漏诊及误诊。

The paper was to analyze the echocardiographic characteristics of rare cases of hypertrophic cardiomyopathy and improve the diagnostic accuracy of this disease with echocardiography.The distribution of left ventricular hypertrophy of 38 patients diagnosed as hypertrophic cardiomyopathy clinically and echocardiographically was analyzed with echocardiography. We adopted all kinds of cross sections to observe both the thickness and multitude of the interventricle and the free wall.The systolic anterior motion of mitral valve were evaluated with both M-mode and two-dimensional echocardiography.The size of the atrium and the ventricle was measured on Ⅱa and Ⅳareas with M-mode echocardiography.Doppler echocardiography was used to measure the velocity of left ventricular outflow tract and the velocity across the mitral valve and the regurgitant velocity of the mitral valve. Four patterns of distribution of left ventricular hypertrophy were identified and most commonly(45% of patients) have extensive ventricular hypertrophy with normal wall thickness seen only in the basal segment of the posterior wall(typeⅢ).Rare cases including three patients with apical hypertrophy,one patient with posterior ventricular septum hypertrophy and another patient with the inferoposterior left ventricular wall hypertrophy by echocardiography were depicted and discussed in length.Two patients with symmetric hypertrophy and another two patients with systemic hypertention were also discussed.The distribution of hypertrophy varies greatly.Accurate evaluation of the thickness and position of the hypertrophic cardiomyopathy with all kinds of cross sections is very important to the correct diagnosis of this disease especially for the rare ones.