二维超声心动图常用切面及选择.ppt

1.胸骨旁左室长轴切面,(1)正常解剖结构的超声表现： 心底部自前向后分别为右室流出道、主动脉根部及左心房，正常三者内径基本相同。中部由前向后依次为右室前壁、右室流出道、室间隔、左室流出道、左室流入道(二尖瓣前、后叶及腱索)。心尖部自前向后依次为室间隔、左室腔及左室后壁。 (2)选用范围: 1)右主流出道：评价右窒流出道有无狭窄、扩大等。 2)主动脉根部；评价主动脉根都病变，包括有无管壁增厚、夹层，管腔扩大、狭窄;窦部扩大、瘤样膨出或破口;瓣叶(右及无冠瓣)增厚、纤维化或钙化、赘生物、脱垂、梿枷样运动、开放受限或关团不全等，并可分别测量瓣环、窦部、嵴部及开主动脉径， 3)左心房；观察并测量左心房大小、左房内有无血栓、肿瘤、隔膜、左房下后方冠状静脉窦有无扩大，后方异常管道结构(肺总静脉)。 4)右室前壁；评价右室前壁有无液区(心包积液)，心室壁有无增厚、右室腔大小。 5)室间隔：测量室间隔厚度(肥厚或变薄)及运动幅度(减弱或不运动)、回声;室间隔中都连续中断(肌部间隔缺损)，上部与主动脉前壁连续中断(膜周或嵴下型室间隔缺损)，主动脉骑跨于室间隔上(法洛四联症或永存动脉干)，心尖部室间隔连续中断(室壁穿孔)等。 6)左室腔及左室后壁：测心腔大小、后壁厚度及运动幅度、观察心腔形态，有无心尖圆钝(扩大)、室壁膨出(室壁瘤)及附壁血栓等。 7)二尖瓣及瓣器；观察二尖瓣叶的厚度、回声强度弹性、开闭活动、有无增厚、钙化、赘生物等异常，键索有无增厚、粘附着于室间隔等，二尖瓣前叶根部与主脉后壁的纤维连续是否正常，有无肌性连续（右室双出口、大血管转位）。,胸骨旁左室长轴切面,(3)正常值： 主动脉内径：胸旁左室长轴切面，收缩末期径，环部前后径为1.6-2.6cm ，窦部为2.4-3.9cm，主动脉窦上（嵴部）为2.1-3.4cm ，升主动脉为2.2-3.4cm，主动脉弓径为2.2-2.7cm。 左房内径：前后径（收缩末期径、主动脉窦后方垂直距离）为2.4-3.3cm 。,右室内径: 前后径（舒张末期径，腱索水平测）为2.0cm 以下。 左室内径：前后径（腱索水平）：舒张末期为3.7-5.2cm；收缩末期为2.3-3.6cm。 室间隔厚度（舒张末期，腱索水平测）：( 9.4士0.9 ) mm。 左室后壁厚度（舒张末期，腱索水平测）：( 9.4士0 . 8 ) mm 。,胸骨旁左室长轴切面 Schematic diagram of the parasternal long-axis view in diastole,showing the aortic root (Ao), sinotubular junction (STJ), closed right coronary and noncoronary cusps of the aortic valve (RCC and NCC), the open anterior and posterior mitral valve leaflets (AMVL and PMVL), and the left ventricular septum and posterior wall. The medial papillary muscle has been shown for reference, although slight medial angulation is needed to visualize this tructure in the long-axis view. The right ventricular outflow tract (RVOT) is anterior, while the coronary sinus (CS) in the atrioventricular groove and the descending aorta (DA) are seen posteriorly. The right pulmonary artery (RPA) lies posterior to the ascending aorta. The position of the pericardium is indicated by the thin line. Normal parasternal long-axis 2D echo images at end-diastole (above) and end-systole (below).,2.右室流出道切面,解剖图,3.右室流入道切面,showing the right ventricle (RV) and atrium (RA), tricuspid valve (TV), and ostia of the coronary sinus (CS) and inferior vena cava (IVC).,Schematic and 2D echo images in a right ventricular inflow view,4.胸骨旁主动脉根部短轴切面,(1)正常结构的超声表现：图像左侧， 从前向后依次为右室流出道、肺动脉 瓣、肺动脉主干及左右肺动脉。中部 为右室流出道、主动脉根部、左房。 右侧为右室流入道、三尖瓣、右心房,()此切面选用范围： 1)测量主肺动脉及左右肺动脉径，评价肺动脉有无狭 窄或扩大。 2)测量肺动脉瓣环径，观察肺动脉瓣开、闭运动，评 价有无狭窄（法洛三联症、四联症等）、闭锁（肺动 脉闭锁、假性共干等）。 3)观察主、肺动脉的空间位置关系。 4)测量右心室流出道内径及前壁厚度，评价有无狭窄 扩大及增厚，有无异常结构（隔膜、下移的三尖瓣或 肿瘤）。 5)观察主动脉瓣叶数目（二瓣或多瓣畸 形）， 厚度及三个瓣叶的关系及交界处 有无粘连，瓣叶有无狭窄及关闭不全。 6)观察主动脉窦病变（主动脉窦瘤或窦瘤 破裂）。 7)观察左右冠状动脉开口及主干有无病变 （冠状动脉开口异常、扩大、狭窄或闭塞）。 8)观察右房大小及三尖瓣有无病变（狭 窄、关闭不全、Ebstein 畸形、三尖瓣闭锁）。,胸骨旁主动脉根部短轴切面,(3) 正常测值： 1)右室流出道径（自室上嵴至流出道前壁垂 直距离）；舒张末期为1.9-2.5cm。 2)主肺动脉径（胸旁主动脉根部短轴切面， 瓣上1cm 处）：舒张末期为1.5-2.5cm。 3)肺动脉瓣环径为1.1-2.2cm ，右肺动脉径 0.8-1.6cm ，左肺动脉径l.0-1.4cm。,胸骨旁主动脉根部短轴切面 Schematic diagram of a parasternal short-axis view at the aortic valve level,showing the relationship between the three cusps of the aortic valve-right coronary cusp (RCC), noncoronary cusp (NCC), left coronary cusp (LCC)-and the left atrium (LA), right atrium (RA), right ventricular outflow tract (RVOT), and the pulmonary artery (PA) with right (RPA) and left (LPA) branches. The positions of the right coronary artery (RCA), left main coronary artery (LMCA), pulmonic valve, and tricuspid valve are shown. Two-dimensional echocardiographic images at the aortic valve level in systole (above) and diastole (below). Note the three open leaflets of the aortic valve in systole and the normal perpendicular relationship of aortic and pulmonic valves,5胸骨旁腱索水平短轴切面,1)正常结构的超声心动图表现：图右侧 依次显示左室前壁、侧壁、后壁，中 部为室间隔。右前方为右室前壁、右 室腔及右室后壁。,2)此切面选用范围： 测量左室腔径（前后及左右径），评价左室大 小，观察左室壁厚度及室腔形态（正常左室腔呈 圆形），腔内显示乳头肌上缘或键索。 右室腔大小、位置及形态，有无扩大、转位。 3)正常测值：左室横径舒张末期为3.3-5.3cm ，收 缩末期为2.4-4.2cm。,Relationship between the short-axis plane with left ventricular wall segments indicated, and the apical four-chamber, two-chamber, and long-axis image planes (perpendicular to the short-axis plane).,.心尖四腔切面,()正常解剖结构的超声心动图表 现: 图像右侧自上向下依次为左心 室、二尖瓣、左房，左侧为右心 室、三尖瓣、右房，中央为室间 隔、房间隔。,()此切面选用范围: 1)观察与测量心室及心房大小及形态； 2)观察房、室间隔连续情况； 3)观察室壁厚度及运动、有无局部运动异常 （心肌缺血、梗死）或膨出（室壁瘤）； 4)观察二尖瓣与三尖瓣数目、形态及开闭情 况，测量两隔叶根部附着位置间距离 （Ebstein ) ； 5)观察心腔内有无肿物（附壁血栓或心内肿 瘤）及其附着位置、大小、活动情况； 6)观察三条（左上、左下、右上）肺静脉是 否均回入左房（肺静脉异位引流）； 7)左心房内有无隔膜（三房心）； 8)评价心功能。,心尖四腔切面,(3)正常测值 左室长径：舒张末期为7.08.4cm，收缩末期为5.06.4cm 。 左房内径：上下径为3.15.3cm （收缩末期，二尖瓣环联线中点至左房顶部），横径为3.05.3cm。（收缩末期，心房中部）。 右室内径：横径为2.54.2cm（舒张末期径），长径为5.87.8cm（舒张末期径）。 右房内径为3.44,9cm , 横径为2.94,5cm （心尖四腔切面，收缩末期上下径）。,心尖四腔切面 Schematic diagram of the apical four-chamber view,showing the relationships of the left and right ventricles (LV and RV) and atria (LA and RA). In the left ventricle, the papillary muscle, chordae, and anterior and posterior mitral leaflets (AMVL, PMVL) are seen. The descending aorta (DA) is seen in partial cross section lateral to the left atrium, while the right superior pulmonary vein (RSPV) drains into the left atrium adjacent to the interatrial septum. In the right ventricle, the moderator band (M and the anterior and septal tricuspid valve leaflets (ATVL and STVL) are seen. Note the ventriculoatrial septum (VAS) separating the left ventricle from the right atrium in association with the normal, slightly more apical position of the tricuspid compared with the mitral valve annulus. Two-dimensional echo images in an apical four- chamber view at end-diastole (above) and end- systole (below).,心尖四腔切面,心尖四腔切面 Subcostal view showing all four cardiac chambers,7.心尖两腔切面,8.主动脉弓长轴切面,Schematic and 2D echo images of the aorta in a long-axis view from the suprasternal notch window. The ascending aortic (Ao) arch and descending thoracic aorta are seen with the origins of the left carotid and subclavian arteries. The right pulmonary artery (RPA) lies immediately inferior to the arch.,附：心超常见缩写表 1,Abbreviation Definition 2-D Two dimensional imaging 3-D Three dimensional imaging A-Mode Amplitude mode A Atrial diastolic velocity peak A Area (seen in mathematical formulas) APEX 2C Apical two chamber view APEX 3C Apical three chamber view (also known as Apical Long axis) APEX 4C Apical four chamber view APEX 5C Apical five chamber view AcT Acceleration time AF Atrial fibrillation AMVL Anterior mitral valve leaflet Ant Anterior,Ao Aorta AI Aortic insufficiency AS Aortic stenosis Asc Ascending ASD Atrial septal defect ASH Asymmetrical septal hypertrophy ATVL Anterior tricuspid valve leaflet AV Aortic valve AVA Aortic valve area AVR Aortic valve replacement BAV Balloon aortic valvuloplasty BP Blood pressure BSA Body surface area c propagation speed of sound in tissue,附：心超常见缩写表2,dB Decibel dP/dt Rate of change in pressure over time E Energy ECG Electrocardiogram ED End-diastole EDD End-diastolic dimension EDV End-diastolic volume EF Ejection fraction epi epicardium EPSS E-point of septal separation ES End-systole ESD End-systolic dimension ESPVR End-systolic pressure-volume relationship ESV End-systolic volume,CAD Coronary artery disease cath Cardiac catheterization CBV Catheter balloon valvuloplasty Ch Chordae Cm Centimeter cm/s Centimeter per second CO Cardiac output Cont eq Continuity equation cos Cosine CS Coronary sinus CSA Cross sectional area Cx circumflex coronary artery D Diameter DA Descending aorta,附：心超常见缩写表3,ETT Exercise treadmill test Frequency shift Frequency FL False lumen Fn near zone Fo resonance frequency (operating frequency) Fs scattered frequency FSV forward stroke volume Ft transmitted frequency Fx function HCM hypertrophic cardiomyopathy HPRF High pulse repetition frequency HR Heart rate HV Hepatic vein I Intensity IAS Interatrial septum,inf inferior IV intravenous IVC Inferior vena cava IVCT Isovolumic contraction time IVRT Isovolumic relaxation time kHz Kilohertz L Length LA Left atrium LAA Left atrial appendage LAD Left anterior descending coronary artery LAE Left atrial enlargement LAO Left anterior oblique lat Lateral LAXX Parasternal long axis LCC Left coronary cusp LLD Left lateral decubitus,附：心超常见缩写表4,MS Mitral stenosis MV Mitral valve MVA Mitral valve area MVI Mitral valve insufficiency Myx myxoma NCC Noncoronary cusp P change in pressure P Pressure PA Pulmonary artery pAn Pseudoaneurysm PAP Pulmonary artery pressure PD Pulsed Doppler PDA Patent ductus arteriosis PE Pericardial effusion PEP Pre-ejection period PISA Proximal isovelocity surface area,LMCA Left main coronary artery LPA Left pulmonary artery LSPV left superior pulmonary vein LV Left ventricle LVEDD Left ventricular end diastolic dimension LV-EDP Left ventricular end diastolic pressure LVESD Left ventricular end systolic dimension LVH Left ventricular hypertrophy LVI Left ventricular inflow LVO Left ventricular outflow LVOT Left ventricular outflow tract M-mode Motion mode MAC Mitral annular calcification MB Moderator band MI Myocardial infarction,附：心超常见缩写表5,PM papillary muscle PMVL Posterior mitral valve leaflet post posterior PI Pulmonary insufficiency PRF Pulse repetition frequency PRFR Peak rapid filling time PS Pulmonary stenosis PV Pulmonic valve PTCA Percutaneous transluminal coronary angioplasty PV Pulmonary vein PVC Premature ventricular contraction PWT Posterior wall thickness Q Volume flow rate Qp Pulmonic volume flow rate Qs Systemic volume flow rate RA Right atrium,RAE Right atrial enlargement RAO Right anterior oblique RAP Right atrial pressure RCA Ri