胸骨旁左室长轴切面培训课件

胸骨旁左室长轴切面胸骨旁左室长轴切面(3)正常值：

①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。

②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。

③右室内径:前后径（舒张末期径，腱索水平测）为2.0cm以下。

④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。

⑤室间隔厚度（舒张末期，腱索水平测）：(9.4士0.9)mm。

⑥左室后壁厚度（舒张末期，腱索水平测）：(9.4士0.8)mm。2胸骨旁左室长轴切面胸骨旁左室长轴切面

Schematicdiagramoftheparasternallong-axisviewindiastoleshowingtheaorticroot(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).

3胸骨旁左室长轴切面2.右室流出道切面

解剖图4胸骨旁左室长轴切面3.右室流入道切面

showingtherightventricle(RV)andatrium(RA),tricuspidvalve(TV),andostiaofthecoronarysinus(CS)andinferiorvenacava(IVC).Schematicand2Dechoimagesinarightventricularinflowview5胸骨旁左室长轴切面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(２)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）。

6胸骨旁左室长轴切面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。

7胸骨旁左室长轴切面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：

①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。

②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).9胸骨旁左室长轴切面６.心尖四腔切面

(１)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。

(２)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。

10胸骨旁左室长轴切面心尖四腔切面(3)正常测值

①左室长径：舒张末期为7.0～8.4cm，收缩末期为5.0～6.4cm。

②左房内径：上下径为3.1～5.3cm（收缩末期，二尖瓣环联线中点至左房顶部），横径为3.0～5.3cm。（收缩末期，心房中部）。

③右室内径：横径为2.5～4.2cm（舒张末期径），长径为5.8～7.8cm（舒张末期径）。

④右房内径为3.4～4,9cm,横径为2.9～4,5cm（心尖四腔切面，收缩末期上下径）。

11胸骨旁左室长轴切面心尖四腔切面

Schematicdiagramoftheapicalfour-chamberviewshowingtherelationshipsoftheleftandrightventricles(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).12胸骨旁左室长轴切面心尖四腔切面13胸骨旁左室长轴切面心尖四腔切面

Subcostalviewshowingallfourcardiacchambers14胸骨旁左室长轴切面7.心尖两腔切面

15胸骨旁左室长轴切面8.主动脉弓长轴切面

Schematicand2Dechoimagesoftheaortainalong-axisviewfromthesuprasternalnotchwindow.Theascendingaortic(Ao)archanddescendingthoracicaortaareseenwiththeoriginsoftheleftcarotidandsubclavianarteries.Therightpulmonaryartery(RPA)liesimmediatelyinferiortothearch.16胸骨旁左室长轴切面附：心超常见缩写表1AbbreviationDefinition

2-DTwodimensionalimaging

3-DThreedimensionalimaging

A-ModeAmplitudemode

AAtrialdiastolicvelocitypeak

AArea(seeninmathematicalformulas)

APEX2CApicaltwochamberview

APEX3CApicalthreechamberview(alsoknownasApicalLongaxis)

APEX4CApicalfourchamberview

APEX5CApicalfivechamberview

AcTAccelerationtime

AFAtrialfibrillation

AMVLAnteriormitralvalveleaflet

AntAnterior

AoAorta

AIAorticinsufficiency

ASAorticstenosis

AscAscending

ASDAtrialseptaldefect

ASHAsymmetricalseptalhypertrophy

ATVLAnteriortricuspidvalveleaflet

AVAorticvalve

AVAAorticvalvearea

AVRAorticvalvereplacement

BAVBalloonaorticvalvuloplasty

BPBloodpressure

BSABodysurfacearea

cpropagationspeedofsoundintissue

17胸骨旁左室长轴切面附：心超常见缩写表2dBDecibel

dP/dtRateofchangeinpressureovertime

EEnergy

ECGElectrocardiogram

EDEnd-diastole

EDDEnd-diastolicdimension

EDVEnd-diastolicvolume

EFEjectionfraction

epiepicardium

EPSSE-pointofseptalseparation

ESEnd-systole

ESDEnd-systolicdimension

ESPVREnd-systolicpressure-volumerelationship

ESVEnd-systolicvolume

CADCoronaryarterydisease

cathCardiaccatheterization

CBVCatheterballoonvalvuloplasty

ChChordae

CmCentimeter

cm/sCentimeterpersecond

COCardiacoutput

ConteqContinuityequation

cosCosine

CSCoronarysinus

CSACrosssectionalarea

Cxcircumflexcoronaryartery

DDiameter

DADescendingaorta

18胸骨旁左室长轴切面附：心超常见缩写表3ETTExercisetreadmilltest

ΔƒFrequencyshift

ƒFrequency

FLFalselumen

Fnnearzone

Foresonancefrequency(operatingfrequency)

Fsscatteredfrequency

FSVforwardstrokevolume

Fttransmittedfrequency

Fxfunction

HCMhypertrophiccardiomyopathy

HPRFHighpulserepetitionfrequency

HRHeartrate

HVHepaticvein

IIntensity

IASInteratrialseptum

infinferior

IVintravenous

IVCInferiorvenacava

IVCTIsovolumiccontractiontime

IVRTIsovolumicrelaxationtime

kHzKilohertz

LLength

LALeftatrium

LAALeftatrialappendage

LADLeftanteriordescendingcoronaryartery

LAELeftatrialenlargement

LAOLeftanterioroblique

latLateral

LAXXParasternallongaxis

LCCLeftcoronarycusp

LLDLeftlateraldecubitus

19胸骨旁左室长轴切面附：心超常见缩写表4MSMitralstenosis

MVMitralvalve

MVAMitralvalvearea

MVIMitralvalveinsufficiency

Myxmyxoma

NCCNoncoronarycusp

ΔPchangeinpressure

PPressure

PAPulmonaryartery

pAnPseudoaneurysm

PAPPulmonaryarterypressure

PDPulsedDoppler

PDAPatentductusarteriosis

PEPericardialeffusion

PEPPre-ejectionperiod

PISAProximalisovelocitysurfacearea

LMCALeftmaincoronaryartery

LPALeftpulmonaryartery

LSPVleftsuperiorpulmonaryvein

LVLeftventricle

LVEDDLeftventricularenddiastolicdimension

LV-EDPLeftventricularenddiastolicpressure

LVESDLeftventricularendsystolicdimension

LVHLeftventricularhypertrophy

LVILeftventricularinflow

LVOLeftventricularoutflow

LVOTLeftventricularoutflowtract

M-modeMotionmode

MACMitralannularcalcificationMBModeratorband

MIMyocardialinfarction

20胸骨旁左室长轴切面附：心超常见缩写表5PMpapillarymuscle

PMVLPosteriormitralvalveleaflet

postposterior

PIPulmonaryinsufficiency

PRFPulserepetitionfrequency

PRFRPeakrapidfillingtime

PSPulmonarystenosis

PVPulmonicvalve

PTCAPercutaneoustransluminalcoronaryangioplasty

PVPulmonaryvein

PVCPrematureventricularcontraction

PWTPosteriorwallthickness

QVolumeflowrate

QpPulmonicvolumeflowrate

QsSystemicvolumeflowrate

RARightatrium

RAERightatrialenlargement

RAORightanterioroblique

RAPRightatrialpressure

RCARightcoronaryartery

RCCRightcoronarycusp

RFRegurgitantfraction

RJRegurgitantjet

ROARegurgitantorificearea

RPARightp