室間隔缺損的超聲心動(dòng)圖檢測

上海兒童醫(yī)學(xué)中心室間隔缺損的超聲心動(dòng)圖診斷臨床最常見的先心病,占53.9%。復(fù)雜先心多合并室隔缺損。由于胚胎期室隔發(fā)育障礙所致。室間隔缺損的超聲心動(dòng)圖診斷室隔缺損的病理分型膜周型占75%肌部占10-20%雙動(dòng)脈下對位不良型膜周型室間隔缺損膜周流入道膜周流出道膜周融合型膜周小梁部肌部室間隔缺損肌部流入道肌部流出道肌部小梁部“瑞士奶酪”雙動(dòng)脈下室間隔缺損缺損邊緣為主動(dòng)脈瓣與肺動(dòng)脈瓣的纖維環(huán)大多數(shù)伴有肺動(dòng)脈高壓對位不良型室間隔缺損心室流出道與大動(dòng)脈對位錯(cuò)開，二者沒有對合在一條直線上而得名常見于TOF、DORV、PA、Truncks等Diagrammaticrepresentationshowinghowtherightventriclecanbedescribedintermsofthreecomponents

Themembranousseptumisfoundatthebaseoftheinter-leaflettrianglewhichinterposesbetweentherightcoronaryandnon-coronaryleafletsoftheaorticvalve

Four-chambersectionshowingthenormallocationofthesmallmembranousseptum

Theheartillustratedhastricuspid-aorticvalvarcontinuity,thisbeingthediagnosticfeatureofaperimembranousventricularseptaldefect

Fromtherightventricle,theperimembranousdefectopeningtotheinletisseenundertheseptalleafletofthetricuspidvalve

IntetralogyofFallot,theventricularseptaldefect(VSD)usuallyhasaperimembranouspostero-inferiormargin

Thisdiagrammaticrepresentationshowsthepossiblelocationsofmuscularventricularseptaldefects,andtheirrelationshiptotheconductionaxis.(TV=tricuspidvalve,

PV=pulmonaryvalve)Whenviewedfromtherightventricle,thisventricularseptaldefecthasacompletemuscularrim,despitetheoverridingoftheaorticvalve

Thisviewoftherightventricularaspectofthenormalheartshows

theseptomarginaltrabeculation,whichgivesrisetothemoderatorband

ThismuscularventricularseptaldefectisposteriortotheseptomarginaltrabeculationThismuscularventricularseptaldefect,viewedfromitsleftventricularaspect,isseentobeasolitarydefect

Fromtherightventricularaspect,thedefectiscrossedbytheseptomarginaltrabeculationsgivingtheappearanceofmultipledefects

Insomeheartswithacommonatrioventricularvalve,asseenherefromtheleftventricle,theleafletsofthecommonvalveareattachedtotheleadingedgeoftheatrialseptum.Inthiscaseitresultsinshuntingonlyatventricularlevel

Fromtherightventricularaspect,thebridgingleafletscrossthroughtheseptaldefect二維超聲心動(dòng)圖(檢查要點(diǎn))室缺的形態(tài)室缺的數(shù)目與大小室缺的部位圓錐隔有否偏移血流的速度階差室間隔缺損的超聲心動(dòng)圖診斷

室間隔缺損的超聲心動(dòng)圖診斷注意三尖瓣形態(tài)、贅生物、瘤樣組織、三尖瓣返流情況主動(dòng)脈有無狹窄及關(guān)閉不全－－瓣下纖維嵴、主動(dòng)脈瓣脫垂右室流出道－－異常肌束左室流出道二尖瓣－－瓣上環(huán)心腔大小室間隔缺損的超聲心動(dòng)圖診斷彩色多普勒顯象多個(gè)切面可見穿隔血流

室缺的檢出膜周流入道室缺胸骨旁五腔切面劍突下五腔切面室缺的檢出膜周流出道缺損：缺損向前延伸至室上嵴，胸骨旁左室長軸切面主動(dòng)脈下可見，胸骨旁大動(dòng)脈短軸可見。室缺的檢出肌部流入道室缺：又稱房室通道型缺損。二、三尖瓣附著于室隔的相同水平。室缺的檢出肌部小梁部室缺：注意心尖部室隔的顯示。肺動(dòng)脈下室缺肺動(dòng)脈下室缺肺動(dòng)脈下室缺肺動(dòng)脈下室缺室缺的檢出

雙動(dòng)脈下室缺

室缺的檢出對位不良型室缺：左心室長軸切面可以顯示出主動(dòng)脈騎跨在室間隔上。根據(jù)瓣膜返流估測三尖瓣及肺動(dòng)脈瓣返流頻譜根據(jù)心內(nèi)分流估測室間隔缺損

PASP=RVSP=AOSP-4VMAX2

VMAX為室缺的最大分流速度合并畸形的檢出右心室流出道梗阻

合并畸形的檢出主動(dòng)脈瓣下纖維嵴室間隔缺損的超聲心動(dòng)圖診斷室隔缺損程度分類小型室缺：<5mm;或<50%主動(dòng)脈瓣環(huán)大小中型室缺：5