医学精品课件6.心脏超声-卢川1

1、Cardiovascular UltrasonographySchool of Radiology,Taishan Medical University 卢 川2021/7/15 星期四1 Topics:Anatomy of HeartExamination TechniquesNormal Sonographic Features of HeartSonographic Features of Cardiovescular Disorders2021/7/15 星期四2Anatomy of Heart2021/7/15 星期四3Anatomy of Heart2021/7/15 星期四4An

2、atomy of Heart2021/7/15 星期四5Normal Heart1 Normal ventricle wall width2 Ventricular septum2021/7/15 星期四6Examination Techniques2021/7/15 星期四7SuprasternalSubcostal ApicalParasternal Long-Axis Short-Axis Four-Chamber 2021/7/15 星期四8Transducer in the Subcostal Position2021/7/15 星期四9Transducer in the Paras

3、ternal Position2021/7/15 星期四10Transducer in the Apical Position2021/7/15 星期四11Suprasternal 2021/7/15 星期四12Normal Sonographic Findings of Heart2021/7/15 星期四13Two-Dimensional EchocardiographyCardiac Color Flow ExaminationM-Mode Imaging of The Cardiac StructuresSpectral Analysis2021/7/15 星期四14 二维超声心动图

4、(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. 2021/7/15 星期四15 Parasternal Long-Axis View Short-Axis View Four-Chamber ViewApical four chamber viewSubcostal four chamber view Suparsternal View2021/7/15 星期四16 parasternal long

5、 axis view parasternal short axis view apical four chamber view 2021/7/15 星期四17 Left parasternal long axis viewThe 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

6、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.2021/7/15 星期四18Left parasternal long axis view2021/7/15 星期四19 Parasternal short axis view2021/7/15 星期四20 Parasterna

7、l short axis view2021/7/15 星期四21胸骨旁心尖短轴2021/7/15 星期四22 Parasternal short axis view2021/7/15 星期四23Parasternal short axis view2021/7/15 星期四24Parasternal short axis viewReal -time2021/7/15 星期四25左室短轴-同时显示MV 和TV2021/7/15 星期四26Short-axis of aortic root2021/7/15 星期四27Aortic root Real-time2021/7/15 星期四28 Ap

8、ical four chamber view2021/7/15 星期四29Apical four chamber view2021/7/15 星期四30 Suparsternal ViewThe 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 white2021/7/15 星期四31Subcostal four chamber

9、view2021/7/15 星期四32 M-Mode Imaging of The Cardiac Structures2021/7/15 星期四33 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 Mode2021/7/15 星期四34 Area1心尖波群 RVAW= right ventricular anterior wallRVOT=right ventricular outflow trac

10、t IVS= interventricular septumLVOR=left ventricular outflow tractLVPW=left ventricular posterior wall 2021/7/15 星期四35Area 2a 腱索水平波群RVAW= right ventricular anterior wallRVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tractLVPW=left ventricular posterior

11、 wall2021/7/15 星期四36RVAW= right ventricular anterior wallRVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tractAML=anterior mitral valve leafletPML=posterior mitral valve leaflet LVPW=left ventricular posterior wallArea 2b二尖瓣前后叶波群2021/7/15 星期四37二尖瓣前后叶波群

12、（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 2021/7/15 星期四38二尖瓣前后叶波群（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2021/7/15 星期四39Area 3 二尖瓣前叶波群RVAW= right ventricular anterior wallRVOT=right vent

13、ricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tractAML=anterior mitral valve leaflet LAPW=left atrial posterior wall 2021/7/15 星期四40Area 4 心底波群 RVAW= right ventricular anterior wall RVOTaAoW=anterior aortic wall Aortic valvespAoW-posterior aortic wall LA=left atriu

14、mLAPW=left atrial posterior wall 2021/7/15 星期四41 Parallel motion of both aortic walls toward the transducer during systole and away from the transducer during diastoleEchocardiogram of Aortic Root心底波群Aortic valve cusps are positioned in middle of aorta during diastole ,open abruptly during systole a

15、t onset of ventricular ejection in a “box-like” fashion 2021/7/15 星期四42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)2021/7/15 星期四43Color Doppler Flow Imaging (CDFI)2021/7/15 星期四44 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

16、心房至左心室左心室流入道血流2021/7/15 星期四45左心室流入道血流2021/7/15 星期四46 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2021/7/15 星期四47左心室流出道血流2021/7/15 星期四48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2021/7/15 星期四49CDFI of Aortic Arch2021/7/15 星期四50 频谱多普勒超声心动图 Spectral Doppler Pulsed Wave Doppler (PW

17、) Continuous Wave Doppler (CW)2021/7/15 星期四51Pulsed 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2021/7/15 星期四52 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20

18、21/7/15 星期四53三尖瓣口血流频 PW-tricuspid valveSV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2021/7/15 星期四54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2021/7/15 星期四55肺动脉瓣口血流频谱PW-PulmonaryarterySV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

19、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2021/7/15 星期四56Ultrasonography of Cardiovascular DisordersRheumatic Heart Disease (RHD)Atrial Sepatal Defect (ASD)Cardiomyopathy: Congestive Cardiomyopathy Hypertrophic Cardiomyopathy Restrictive CardiomyopathyCoronary Heart Disease2021/7/15 星期四57RHD:二尖瓣狭窄二维：二

20、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2021/7/15 星期四58Decreased diastolic separation of leaflets Restricted mobilityRelatively immobile leafletsThickened leafletsDoming of the valve 2021/7/15 星期四59Restricted m

21、obility= relatively immobile leafletsThickened leafletsCalcification of the valve2021/7/15 星期四60Mmode： Slow initial closure of mitral valve (decreased EF slope)=flattening of EF2021/7/15 星期四61Mitral 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。

22、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/s2021/7/15 星期四62Incomplete closure of mitral valveEnlarged left ventricular volumes and atrium 2021/7/15 星期四63CDFI： “Color mosaic” 2021/7/15 星期四64MR -“Color mosaic”2021/7/15 星期四65MR- -“Color mosaic”2021

23、/7/15 星期四66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 2021/7/15 星期四67MR2021/7/15 星期四682021/7/15 星期四692021/7/15 星期四70Aortic stenosis 2021/7/15 星期四71Thickened +calcified aortic valve with restrictive motion Increased thinckness of LV wall 主动脉瓣叶增厚,钙化

24、，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2021/7/15 星期四72Thickened +calcified aortic valve with restrictive motion2021/7/15 星期四73 Aortic regurgitationAortic regurgitation is the retrograde flow across the closed aortic valve during diastole. It is caused by abnormalities of one or more of

25、 the following structures: aortic cusp, aortic annulus, aortic sinuses.2021/7/15 星期四74AR2021/7/15 星期四75AR2021/7/15 星期四76 Aortic regurgitation2021/7/15 星期四77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2021/7/15 星期四78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；

26、左房增大成气球样改变2021/7/15 星期四79 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2021/7/15 星期四80ASD :Before and After Closure divice ASD封堵术后.avi2021/7/15 星期四81Left parasternal long axis viewLack of echoes in region of interventricular septum with sharp edges LA enlargement P

27、rolapse of aortic valve cusp( in supracristal VSD)Deformity of aortic cusp (in membranous VSD)2021/7/15 星期四82VDS:Befre and After Closure Device2021/7/15 星期四83PDA动脉导管未闭2021/7/15 星期四84Tetralogy 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2021/7/15 星期四85主动脉骑跨50%2021/7/15 星期四86TOF-室缺伴主动脉骑跨2021/7/15 星期四87CardiomyopathyCongestive Car