超声心动图诊断心肌致密化不全临床诊断价值分析

Analysis of clinical diagnosis value of ultrasonic cardiogram for noncompaction of reticular myocardium

目的探讨超声心动图对心肌致密化不全(NVM)的诊断价值,提高对左室心肌致密化不全的诊断率,以预防致死性心律失常和栓塞。方法对48例左心室心肌致密化不全患者的超声心动图进行分析总结,参照超声诊断标准,彩色多普勒超声以左心室长轴、左心室短轴、心尖四腔等切面扫查,重点观察近心尖1/3的心肌与心内膜。结果 48例患者的超声心动图均有典型特征:左心室内或单一右心室或双心室内可见多发异常粗大肌小梁,呈网状、蜂窝状,肌小梁间见大小不等的深陷间隙,病变部位以近心尖1/3室壁最为明显,偶见累及基底段下壁心室壁,48例患者中发现1例累及基底段下后壁心室壁,病变部位以左室前壁、侧壁、后壁及右心室的心尖部、游离壁为主,48例左室型31例,右室型2例,双心室型15例。彩色多普勒血流显像显示隐窝内低速血流与心腔内高速血流相通,受累心室增大,左心室心肌收缩及舒张功能减低。48例中40例有不同程度二尖瓣反流及三尖瓣或主动脉瓣反流,2例合并动脉导管未闭(均手术),2例伴有隐窝内血栓的形成。结论彩色多普勒超声心动图可在无症状的早期萌发阶段就可发现心肌结构异常、功能无明显异常的特征性病变,进行有针对性和预防性的干预,多能明显延长患者的生存时限和生存质量;NVM有典型的超声心动图特征性表现,超声心动图是诊断NVM的最佳选择。

Objective To investigate diagnosis value of ultrasonic cardiogram for noncompaction of reticular myocardium（NVM）, and to improve diagnosis rate of left ventricular noncompaction, in order to prevent fatal arrhythmia and embolism. Methods Analysis and summarization were made on ultrasonic cardiogram in 48 patients with left ventricular noncompaction, according to ultrasound diagnosis criteria. Color Doppler ultrasound provided scanning on sections of left ventricular long axis, left ventricular short axis, and apical four-chamber, especially on myocardium and endocardium in 1/3 near apex cordis. Results All the 48 cases had typical characteristics of ultrasonic cardiogram, as multiple thick trabecular with forms of net or honeycomb inside left ventricle, single right ventricle or both ventricles. Deep gaps of various size remained between trabecular. Obvious lesions occurred in ventricular wall in 1/3 near apex cordis, with rarely involved basal segment inferior ventricular wall. There was 1 case among the 48 cases with involved basal segment inferior-posterior ventricular wall. Lesions mainly occurred in left ventricular anterior and side wall, followed by posterior wall, and apex cordis and free wall in right ventricle. Among the 48 cases, there were 31 cases of left ventricle type, 2 cases of right ventricle type, and 15 cases of both ventricles type. Color Doppler flow imaging showed connection between low-velocity flow in recess and high-velocity flow in cardiac chamber, enlarged involved ventricle, and reduced systolic and diastolic function in left ventricular myocardium. There were 40 cases among the 48 cases with mitral, tricuspid or aortic regurgitation, 2 cases complicated with patent ductus arteriosus（underwent surgery）, and 2 cases with thrombus in recess. Conclusion Color Doppler ultrasonic cardiogram can detect lesion with characteristics of normal function and abnormal structure in myocardium during early stage without symptoms. Impelment of targeted and preventive intervention can remarkably improve patients＇ survival duration and quality. Ultrasonic cardiogram is the preferred method in diagnosing NVM, due to its typical characteristic manifestations in ultrasonic cardiogram.