中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
Chinese Journal of General Practitioners
2015年
11期
862-865
,共4页
孔令云%李一丹%吴雅峰%吕秀章
孔令雲%李一丹%吳雅峰%呂秀章
공령운%리일단%오아봉%려수장
憩室%心室%超声心动描记术,多普勒,彩色
憩室%心室%超聲心動描記術,多普勒,綵色
게실%심실%초성심동묘기술,다보륵,채색
Diverticulum%Heart ventricle%Echocardiography,Doppler,color
回顾分析4例临床诊断为左心室憩室患者的临床和超声心动图影像特点.结果显示,4例患者(2例女性)均因非特异心脏症状就诊,心电图无特异表现,超声心动图检查示憩室均位于左室心尖,憩室壁较周围室壁薄弱,但与之连续,且可同步收缩和舒张运动.2例为先天性憩室,均未合并其他心脏或胸腹腔先天性畸形;2例为继发性憩室,均有明确的冠心病病史,且合并左心室心尖运动减低及整体收缩功能减低.1例憩室腔内附壁血栓形成,1例患者死于心力衰竭.提示,成人左心室憩室可由先天或获得性因素引起,前者多为左室心尖孤立性,后者多有局部心肌损伤及左心室内压增高等基础,且位于病变冠状动脉的灌注区.超声心动图可实时动态显示病灶的二维及血流动力学信息,对憩室及憩室样病变的诊断和鉴别诊断有重要价值.
迴顧分析4例臨床診斷為左心室憩室患者的臨床和超聲心動圖影像特點.結果顯示,4例患者(2例女性)均因非特異心髒癥狀就診,心電圖無特異錶現,超聲心動圖檢查示憩室均位于左室心尖,憩室壁較週圍室壁薄弱,但與之連續,且可同步收縮和舒張運動.2例為先天性憩室,均未閤併其他心髒或胸腹腔先天性畸形;2例為繼髮性憩室,均有明確的冠心病病史,且閤併左心室心尖運動減低及整體收縮功能減低.1例憩室腔內附壁血栓形成,1例患者死于心力衰竭.提示,成人左心室憩室可由先天或穫得性因素引起,前者多為左室心尖孤立性,後者多有跼部心肌損傷及左心室內壓增高等基礎,且位于病變冠狀動脈的灌註區.超聲心動圖可實時動態顯示病竈的二維及血流動力學信息,對憩室及憩室樣病變的診斷和鑒彆診斷有重要價值.
회고분석4례림상진단위좌심실게실환자적림상화초성심동도영상특점.결과현시,4례환자(2례녀성)균인비특이심장증상취진,심전도무특이표현,초성심동도검사시게실균위우좌실심첨,게실벽교주위실벽박약,단여지련속,차가동보수축화서장운동.2례위선천성게실,균미합병기타심장혹흉복강선천성기형;2례위계발성게실,균유명학적관심병병사,차합병좌심실심첨운동감저급정체수축공능감저.1례게실강내부벽혈전형성,1례환자사우심력쇠갈.제시,성인좌심실게실가유선천혹획득성인소인기,전자다위좌실심첨고립성,후자다유국부심기손상급좌심실내압증고등기출,차위우병변관상동맥적관주구.초성심동도가실시동태현시병조적이유급혈류동역학신식,대게실급게실양병변적진단화감별진단유중요개치.
To explore the clinical and imaging profiles of left ventricular (LV) diverticulum in adults and review the key points for its differential diagnosis.The clinical and imaging features were reviewed for 2 female and 2 male patients clinically diagnosed with LV diverticulum.Their clinical manifestations and electrocardio graphic presentations were nonspecific.On echocardiography,all diverticula,located at LV apex,had a thinned and weakened wall continuing and contracting synchronously with the adjacent LV wall.Two cases were diagnosed as congenital diverticulum without any other cardiac or thoraco-abdominal anomaly.And the other two had existing coronary artery diseases with significantly reduced global and apical LV systolic function.Mural thrombosis in diverticulum was determined in one congenital case.One patient died of cardiac failue.It suggested that LV diverticulum in adults may be congenital and secondary etiologically.The former is mostly isolated and apically situated while the latter often results from regional myocardial ischemia and elevated intracavitary LV pressure at an ill-perfused area.Echocardiography can demonstrate the 2-dimensional and flow hemodynamics of diverticulum in real time so as to facilitate its diagnosis and differential diagnosis.