心脏超声卢川

Cardiovascular Ultrasonography,School of Radiology, Taishan Medical University 卢 川,Topics: Anatomy of Heart Examination Techniques Normal Sonographic Features of Heart Sonographic Features of Cardiovescular Disorders,Anatomy of Heart,Anatomy of Heart,Anatomy of Heart,Normal Heart 1 Normal ventricle wall width 2 Ventricular septum,Transducer in the Subcostal Position,Transducer in the Parasternal Position,Transducer in the Apical Position,Suprasternal,Normal Sonographic Findings of Heart,Two-Dimensional Echocardiography Cardiac Color Flow Examination M-Mode Imaging of The Cardiac Structures Spectral Analysis,二维超声心动图 (Two-dimensional Echocardiography 切面超声心动图 (Cross-sectional Echocardiography) 观察不同断面上的解剖轮廓,它的结构形态,空间方位,连续关系,房室大小以及室壁与瓣膜的运动.,Parasternal Long-Axis View Short-Axis View Four-Chamber View Apical four chamber view Subcostal four chamber view Suparsternal View,parasternal long axis view parasternal short axis view apical four chamber view,Left parasternal long axis view,The long axis view provides a reliable picture of the function of the basilar portions of the anterior septum and posterior walls. The biphasic diastolic motion of the mitral valve opening is evident. The view of two of the aortic leaflets shows their rapid systolic opening and a diastolic closed position arising from a position at the base of the anterior mitral leaflet.,Left parasternal long axis view,Parasternal short axis view,胸骨旁心尖短轴,Parasternal short axis view,Parasternal short axis view,Parasternal short axis view,Real -time,左室短轴-同时显示MV 和TV,Short-axis of aortic root,Aortic root,Real-time,Apical four chamber view,Apical four chamber view,Suparsternal View,The flow velocity is displayed with faster velocities in brighter colors and slower velocities in darker colors The fastest velocity may be displayed in yellow or white,Subcostal four chamber view,M-Mode Imaging of The Cardiac Structures,Sweep of Transducer From Aorta Toward Apex Area1 心尖波群 Area2 腱索水平 Area2b二尖瓣前后叶 Area 3二尖瓣前叶波 Area 4 心底波群,Echocardiography-M Mode,Area1心尖波群 RVAW= right ventricular anterior wall RVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tract LVPW=left ventricular posterior wall,Area 2a 腱索水平波群 RVAW= right ventricular anterior wall RVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tract LVPW=left ventricular posterior wall,RVAW= right ventricular anterior wall RVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tract AML=anterior mitral valve leaflet PML=posterior mitral valve leaflet LVPW=left ventricular posterior wall,Area 2b二尖瓣前后叶波群,二尖瓣前后叶波群（2b区） E峰:二尖瓣前叶在舒张期的快速开放所致 EF段:左室内血流反冲二尖瓣前叶 FG:舒张期二尖瓣前叶处于半关闭状态 A峰:左房收缩，二尖瓣再开放有关。 B点:二尖瓣恢复原位，再处于半关闭状态 C点:左室收缩，二尖瓣关闭所致 CD 段:二尖瓣在收缩期的关闭期,二尖瓣前后叶波群（3区） 二尖瓣收缩期略向前斜的关闭线称CD段； 舒张期呈双峰状样活动曲线。第一峰称峰，代表舒张期快速充盈期；第二峰称峰，代表舒张期缓慢充盈期,Area 3 二尖瓣前叶波群 RVAW= right ventricular anterior wall RVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tract AML=anterior mitral valve leaflet LAPW=left atrial posterior wall,Area 4 心底波群 RVAW= right ventricular anterior wall RVOT aAoW=anterior aortic wall Aortic valves pAoW-posterior aortic wall LA=left atrium LAPW=left atrial posterior wall,Parallel motion of both aortic walls toward the transducer during systole and away from the transducer during diastole,Echocardiogram of Aortic Root 心底波群,Aortic valve cusps are positioned in middle of aorta during diastole ,open abruptly during systole at onset of ventricular ejection in a “box-like” fashion,多普勒超声心动图,频谱多普勒 Spectral Doppler 脉冲式 Pulsed Wave Doppler (PW) 连续式 Continuous Wave Doppler (CW) 彩色多普勒血流显像 Color Doppler Flow Imaging (CDFI),Color Doppler Flow Imaging (CDFI),心尖四腔心断面可见舒张期经二尖瓣口红色明亮的宽带血流,起自左心房至左心室,左心室流入道血流,左心室流入道血流,在心尖五腔心断面可见收缩期蓝色明亮的宽带血流.起源于左心室,经主动脉瓣口至升主动脉,左心室流出道血流,左心室流出道血流,右心室流出道血流,在心底短轴断面可见收缩期经肺动脉 瓣口篮色明亮的宽带血流,起源于右心室流出道,充盈于肺动脉主干及分支,CDFI of Aortic Arch,频谱多普勒超声心动图 Spectral Doppler,Pulsed Wave Doppler (PW) Continuous Wave Doppler (CW),Pulsed Wave Doppler(PW),将取样容积(Sample Volume, SV)置于心脏大血管的不同部位,可获得该部位的血流频谱曲线,曲线横轴代表时间,纵轴代表血流速度,从频谱曲线上可了解血流的性质、方向 、流速,二尖瓣口血流频谱 PWMitral valve,SV置于心尖四腔心断面二尖瓣口左心室侧 基线上方的正向双峰 第一峰较高，称E峰,舒张早期,左心室快速充盈血流流动形成 第二峰振幅较低，称A峰,位于舒张晚期,心房收缩形成 正常时峰值和射血时间E峰均大于A峰,三尖瓣口血流频 PW-tricuspid valve,SV置于心尖四腔心断面三尖瓣口右心室侧 频谱与二尖瓣口相似，只是速度偏低,受呼吸影像较大 血流频谱呈窄带双峰型 第一峰较大， 称E 峰， 第二峰较小，称A峰,主动脉瓣口血流频谱PW-Aortic valvcusps,在胸骨上窝主动脉长轴切面时，血流频谱向上；在心尖五腔心切面时，血流频谱向下 呈窄带单峰型，加速波陡峭，减速波圆钝，几乎呈不对称三角形,肺动脉瓣口血流频谱PW-Pulmonaryartery,SV置于心底短轴断面肺动脉瓣上方,可见位于基线下方的负相频谱 其形态与主动脉频谱相似，但其速度峰值位于频谱中央 呈收缩期单峰型 加速与减速均较慢几乎呈圆钝型,Ultrasonography of Cardiovascular Disorders,Rheumatic Heart Disease (RHD) Atrial Sepatal Defect (ASD) Cardiomyopathy: Congestive Cardiomyopathy Hypertrophic Cardiomyopathy Restrictive Cardiomyopathy Coronary Heart Disease,RHD:二尖瓣狭窄,二维：二尖瓣叶增厚，粗燥，回声增强活动受限，瓣口面积小于2.5cm ；左房右心室增大，右心室流出道增宽 M超：二尖瓣前叶曲线EF斜率减慢呈“城墙样” CDFI：二尖瓣口可见舒张期以红色为主五彩镶嵌变窄变细的射流束，中心呈明亮的黄色 多普勒频谱:左室流入道可检测到高速湍流频谱,Decreased diastolic separation of leaflets Restricted mobility Relatively immobile leaflets Thickened leaflets Doming of the valve,Restricted mobility= relatively immobile leaflets Thickened leaflets Calcification of the valve,Mmode： Slow initial closure of mitral valve (decreased EF slope)=flattening of EF,Mitral Regurgitation,二维： 瓣叶增厚，反射增强，收缩期瓣口对合欠佳,其间留有缝隙;间接征象是左房左室增大 M超：二尖瓣前叶曲线舒张期可仅见E峰，EF斜率下降速度增快，呈高流量型，收缩期CD段分离。 CDFI：二尖瓣口可见舒张期以红色为主五彩镶嵌(color mosaic)变窄变细的射流束，中心呈明亮的黄色 多普勒频谱：左房内可见收缩期血流返流引起的湍流信号, 多持续全收缩期，速度可达3-4m/s,Incomplete closure of mitral valve Enlarged left ventricular volumes and atrium,CDFI： “Color mosaic”,MR -“Color mosaic”,MR- -“Color mosaic”,频谱多普勒：心尖四腔切面，将取样点置于二尖瓣口，检测到位于基线以下的高速湍流血流频谱，此为返流的血流束；从此频谱图还可见舒张期流经二尖瓣口的血流速度明显加快，超过2M/S，说明并存二尖瓣狭窄,MR,Aortic stenosis,Thickened +calcified aortic valve with restrictive motion Increased thinckness of LV wall,主动脉瓣叶增厚,钙化，开放幅度变小，小于12mm，重者瓣叶及无运动 左心室增厚，流出道增宽 多普勒：瓣口血流频谱明显展宽，流速加快,Thickened +calcified aortic valve with restrictive motion,Aortic regurgitation,Aortic regurgitation is the retrograde flow across the closed aortic valve during diastole. It is caused by abnormalities of one or more of the following structures: aortic cusp, aortic annulus, aortic sinuses.,AR,AR,Aortic regurgitation,风湿性心脏病-联合瓣膜病各自征象的不同组合，因互相之间的影响，与单一瓣膜病变略有不同 二尖瓣狭窄（中度）并关闭不全（轻度） 主动脉瓣狭窄（中度）并关闭不全（轻度） 左心房血栓 图为左心房血栓,风心病主动脉瓣狭窄并二尖瓣狭窄 主动脉瓣和二尖瓣瓣叶增厚、回声增强 提示钙化；左房增大成气球样改变,ASD,心尖位和胸骨旁四腔心示：房间隔中部和上部连续性中断 右房右室扩大和左室流出道增宽 CDFI:分流血流束自左房经缺损流向右房 多普勒频谱：分流处探及连续性湍流频谱,ASD :Before and After Closure divice,ASD封堵术后.avi,Left parasternal long axis view,Lack of echoes in region of interventricular septum with sharp edges LA enlargement Prolapse of aortic valve cusp( in supracristal VSD) Deformity of aortic cusp (in membranous VSD),VDS: Befre and After Closure Device,PDA动脉导管未闭,Tetralogy of Fallot,先天性：室间隔缺损、主动脉骑跨、肺动脉瓣狭窄（常为右室漏斗部） 继发性：右心室肥厚 室缺和肺动脉瓣狭窄为必需 占先天性心脏病50，为右向左分流型,主动脉骑跨50%,TOF-室缺伴主动脉骑跨,Cardiomyopa