完全型冠状静脉窦隔缺损的超声心动图诊断

目的 探讨多普勒超声心动图对完全型冠状静脉窦隔缺损 (coronarysinusseptaldefect ,CSSD)的诊断价值。 方法 以经右心导管检查及外科手术治疗的 10例完全型冠状静脉窦隔缺损患者为研究对象 ,回顾性分析其二维及多普勒超声表现。结果 10例完全性CSSD患者中 ,超声诊断 3例 ,诊断正确率 3 0 %;漏诊 7例 ,占 70 %。 10例完全型冠状静脉窦隔缺损患者中 ,10例均合并左侧上腔静脉残存 ,9例合并房间隔缺损 ,其中 4例为房室间隔缺损 ,5例为房间隔缺损或大型房间隔缺损 (近似功能性单心房 )。 10例均合并于复杂型先天性心脏病中 ,其中 7例合并右室双出口、法乐四联症、单心室等紫绀型先心病 ,3例为部分型房室间隔缺损和功能性单心房患者。结论 在复杂型先心病合并左上腔静脉残存或房间隔缺损时应警惕完全型冠状窦隔缺损的存在 ,以免漏诊。

有或无心脏外科手术史患者肺静脉窦隔离术后心房扑动消融的必要性

Objectives: The aim of this study was to assess the incidence of atrial flutter(AFL) after pulmonary vein antrum isolation(PVAI) in patients with previous cardiac surgery(PCS) in comparison to patients without PCS and to assess the need for AFL ablation in both groups. Background: Atrial fibrillation(AF) and AFL often co- exist. Pulmonary vein antrum isolation may be sufficient to control both arrhythmias. However, in patients with PCS, atrial incisions, cannulations, and scar areas may cause AFL recurrence despite elimination of pulmonary vein triggers. Methods: Data from 1,345 patients who had PVAI were analyzed. Patients with a history of AFL ablation and patients who had concomitant AFL ablation during PVAI were excluded from analysis. Sixty- three patients constituted the PCS group(Group 1, age 57± 13 years, 12 female) and 1,062 patients constituted the non- PCS group(Group 2, age 55± 12 years, 212 female). Patients in Group 1 had larger left atria, higher incidence of AFL pre- PVAI, and lower ejection fraction. Results: There was no significant difference in post- PVAI AF recurrence between Groups 1 and 2, but AFL incidence after PVAI was higher in Group 1(33% vs. 4% , p< 0.0001). Ablation of AFL in Group 1 patients resulted in an 86% acute success rate and 11% recurrence over a mean follow- up of 357± 201 days. Conclusions: In patients with PCS, post- PVAI AF recurrence is similar to patients without PCS. However, history of PCS is associated with a higher recurrence of AFL after PVAI. In a significant number of patients with PCS, AFL ablation is required to achieve a cure.

冠状静脉窦隔缺损的超声心动图诊断价值及漏误诊分析

目的探讨冠状静脉窦隔缺损(CSSD)的超声心动图诊断价值,分析漏诊、误诊原因。方法选择2002年3月至2017年10月赣南医学院第一附属医院及上海儿童医学中心经外科手术证实的63例CSSD患儿为研究对象,回顾性分析其二维及彩色多普勒超声心动图表现。结果63例患儿中,超声诊断正确者55例(87.30%);超声漏诊、误诊8例(12.70%)。63例患儿中7例为单纯性CSSD,56例合并其他心血管系统畸形,最常见合并的畸形有房间隔缺损(30例)、左侧上腔静脉残存(28例)、房室间隔缺损(15例)、室间隔缺损(12例)、肺动脉狭窄(12例)、肺静脉异位连接(5例)、单心房(5例)等。结论超声心动图可以诊断CSSD,但容易漏误诊,需与冠状静脉窦口狭窄、左下肺静脉狭窄、原发孔型房间隔缺损等进行鉴别。

双片法冠状静脉窦隔入右心房治疗完全性房室隔缺损

完全性房室隔缺损是一种复杂先天性心脏病。我院于2003年1月至2007年3月共手术治疗完全性房室隔缺损25例，现总结如下。

上颌窦后上筛房的CT观察

目的:探讨上颌窦后上筛房的影像解剖学特征。方法:收集2012-03-2012-10期间门诊行鼻窦CT检查的103例患者,无头颅及鼻窦外伤、手术及肿瘤史。观察其上颌窦后上筛房的出现率及影像解剖特征。结果:上颌窦后上筛房是后组筛房沿着纸样板向眶下气化形成,位于眶下、上颌窦后壁后方。上颌窦后上筛房的出现率为74.3%。在解剖学确认可主要依据是上颌窦筛窦隔的出现,上颌窦筛窦隔后上部的筛房便是上颌窦后上筛房。上颌窦筛窦隔的矢状位成角在22~87°之间,平均(50.34±12.10)°。结论:上颌窦筛窦隔是上颌窦后上筛房解剖识别的重要依据,内镜鼻窦手术术前准确识别上颌窦后上筛房有助于提高后组筛窦的切除。