二维超声心动图常用切面及选择

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Schematicdiagramoftheparasternallong-axisviewindiastole,showingtheaorticroot(Ao),sinotubularjunction(STJ),closedrightcoronaryandnoncoronarycuspsoftheaorticvalve(RCCandNCC),theopenanteriorandposteriormitralvalveleaflets(AMVLandPMVL),andtheleftventricularseptumandposteriorwall.Themedialpapillarymusclehasbeenshownforreference,althoughslightmedialangulationisneededtovisualizethistructureinthelong-axisview.Therightventricularoutflowtract(RVOT)isanterior,whilethecoronarysinus(CS)intheatrioventriculargrooveandthedescendingaorta(DA)areseenposteriorly.Therightpulmonaryartery(RPA)liesposteriortotheascendingaorta.Thepositionofthepericardiumisindicatedbythethinline.Normalparasternallong-axis2Dechoimagesatend-diastole(above)andend-systole(below).,2.右室流出道切面,解剖图,3.右室流入道切面,showingtherightventricle(RV)andatrium(RA),tricuspidvalve(TV),andostiaofthecoronarysinus(CS)andinferiorvenacava(IVC).,Schematicand2Dechoimagesinarightventricularinflowview,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Schematicdiagramofaparasternalshort-axisviewattheaorticvalvelevel,showingtherelationshipbetweenthethreecuspsoftheaorticvalve-rightcoronarycusp(RCC),noncoronarycusp(NCC),leftcoronarycusp(LCC)-andtheleftatrium(LA),rightatrium(RA),rightventricularoutflowtract(RVOT),andthepulmonaryartery(PA)withright(RPA)andleft(LPA)branches.Thepositionsoftherightcoronaryartery(RCA),leftmaincoronaryartery(LMCA),pulmonicvalve,andtricuspidvalveareshown.Two-dimensionalechocardiographicimagesattheaorticvalvelevelinsystole(above)anddiastole(below).Notethethreeopenleafletsoftheaorticvalveinsystoleandthenormalperpendicularrelationshipofaorticandpulmonicvalves,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。,Relationshipbetweentheshort-axisplanewithleftventricularwallsegmentsindicated,andtheapicalfour-chamber,two-chamber,andlong-axisimageplanes(perpendiculartotheshort-axisplane).,.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Schematicdiagramoftheapicalfour-chamberview,showingtherelationshipsoftheleftandrightventricles(LVandRV)andatria(LAandRA).Intheleftventricle,thepapillarymuscle,chordae,andanteriorandposteriormitralleaflets(AMVL,PMVL)areseen.Thedescendingaorta(DA)isseeninpartialcrosssectionlateraltotheleftatrium,whiletherightsuperiorpulmonaryvein(RSPV)drainsintotheleftatriumadjacenttotheinteratrialseptum.Intherightventricle,themoderatorband(Mandtheanteriorandseptaltricuspidvalveleaflets(ATVLandSTVL)areseen.Notetheventriculoatrialseptum(VAS)separatingtheleftventriclefromtherightatriuminassociationwiththenormal,slightlymoreapicalpositionofthetricuspidcomparedwiththemitralvalveannulus.Two-dimensionalechoimagesinanapicalfour-chamberviewatend-diastole(above)andend-systole(below).,心尖四腔切面,心尖四腔切面Subcostalviewshowingallfourcardiacchambers,7.心尖两腔切面,8.主动脉弓长轴切面,Schematicand2Dechoimagesoftheaortainalong-axisviewfromthesuprasternalnotchwindow.Theascendingaortic(Ao)archanddescendingthoracicaortaareseenwiththeoriginsoftheleftcarotidandsubclavianarteries.Therightpulmonaryartery(RPA)liesimmediatelyinferiortothearch.,附：心超常见缩写表1,AbbreviationDefinition2-DTwodimensionalimaging3-DThreedimensionalimagingA-ModeAmplitudemodeAAtrialdiastolicvelocitypeakAArea(seeninmathematicalformulas)APEX2CApicaltwochamberviewAPEX3CApicalthreechamberview(alsoknownasApicalLongaxis)APEX4CApicalfourchamberviewAPEX5CApicalfivechamberviewAcTAccelerationtimeAFAtrialfibrillationAMVLAnteriormitralvalveleafletAntAnterior,AoAortaAIAorticinsufficiencyASAorticstenosisAscAscendingASDAtrialseptaldefectASHAsymmetricalseptalhypertrophyATVLAnteriortricuspidvalveleafletAVAorticvalveAVAAorticvalveareaAVRAorticvalvereplacementBAVBalloonaorticvalvuloplastyBPBloodpressureBSABodysurfaceareacpropagationspeedofsoundintissue,附：心超常见缩写表2,dBDecibeldP/dtRateofchangeinpressureovertimeEEnergyECGElectrocardiogramEDEnd-diastoleEDDEnd-diastolicdimensionEDVEnd-diastolicvolumeEFEjectionfractionepiepicardiumEPSSE-pointofseptalseparationESEnd-systoleESDEnd-systolicdimensionESPVREnd-systolicpressure-volumerelationshipESVEnd-systolicvolume,CADCoronaryarterydiseasecathCardiaccatheterizationCBVCatheterballoonvalvuloplastyChChordaeCmCentimetercm/sCentimeterpersecondCOCardiacoutputConteqContinuityequationcosCosineCSCoronarysinusCSACrosssectionalareaCxcircumflexcoronaryarteryDDiameterDADescendingaorta,附：心超常见缩写表3,ETTExercisetreadmilltestFrequencyshiftFrequencyFLFalselumenFnnearzoneForesonancefrequency(operatingfrequency)FsscatteredfrequencyFSVforwardstrokevolumeFttransmittedfrequencyFxfunctionHCMhypertrophiccardiomyopathyHPRFHighpulserepetitionfrequencyHRHeartrateHVHepaticveinIIntensityIASInteratrialseptum,infinferiorIVintravenousIVCInferiorvenacavaIVCTIsovolumiccontractiontimeIVRTIsovolumicrelaxationtimekHzKilohertzLLengthLALeftatriumLAALeftatrialappendageLADLeftanteriordescendingcoronaryarteryLAELeftatrialenlargementLAOLeftanteriorobliquelatLateralLAXXParasternallongaxisLCCLeftcoronarycuspLLDLeftlateraldecubitus,附：心超常见缩写表4,MSMitralstenosisMVMitralvalveMVAMitralvalveareaMVIMitralvalveinsufficiencyMyxmyxomaNCCNoncoronarycuspPchangeinpressurePPressurePAPulmonaryarterypAnPseudoaneurysmPAPPulmonaryarterypressurePDPulsedDopplerPDAPatentductusarteriosisPEPericardialeffusionPEPPre-ejectionperiodPISAProximalisovelocitysurfacearea,LMCALeftmaincoronaryarteryLPALeftpulmonaryarteryLSPVleftsuperiorpulmonaryveinLVLeftventricleLVEDDLeftventricularenddiastolicdimensionLV-EDPLeftventricularenddiastolicpressureLVESDLeftventricularendsystolicdimensionLVHLeftventricularhypertrophyLVILeftventricularinflowLVOLeftventricularoutflowLVOTLeftventricularoutflowtractM-modeMotionmodeMACMitralannularcalcificationMBModeratorbandMIMyocardialinfarction,附：心超常见缩写表5,PMpapillarymusclePMVLPosteriormitralvalveleafletpostposteriorPIPulmonaryinsufficiencyPRFPulserepetitionfrequencyPRFRPeakrapidfillingtimePSPulmonarystenosisPVPulmonicvalvePTCAPercutaneoustransluminalcoronaryangioplastyPVPulmonaryveinPVCPrematureventricularcontractionPWTPosteriorwallthicknessQVolumeflowrateQpPulmonicvolumeflowrateQsSystemicvolumeflowrateRARightatrium,RAERightatrialenlargementRAORightanteriorobliqueRAPRightat