6.心脏超声-卢川1.ppt

Cardiovascular Ultrasonography School of Radiology,Taishan Medical University 卢 川 Topics:Anatomy of Heart Examination Techniques Normal Sonographic Features of Heart Sonographic Features of Cardiovescular Disorders Anatomy of Heart Anatomy of Heart Anatomy of Heart Normal Heart 1 Normal ventricle wall width 2 Ventricular septum Examination Techniques Suprasternal Subcostal Apical Parasternal Long-Axis Short-Axis Four-Chamber Transducer in the Subcostal Position Transducer in the Parasternal Position Transducer in the Apical Position Suprasternal Normal Sonographic Findings of Heart Two-Dimensional Echocardiography Cardiac Color Flow Examination M-Mode Imaging of The Cardiac Structures Spectral Analysis 二维超声心动图二维超声心动图 (Two-dimensional Echocardiography 切面超声心动图切面超声心动图 (Cross-sectional Echocardiography)观察不同断面上的解剖轮廓观察不同断面上的解剖轮廓,它的结构形态它的结构形态,空间方位空间方位,连续关系连续关系,房室大小以及室壁与瓣膜房室大小以及室壁与瓣膜的运动的运动.Parasternal Long-Axis View Short-Axis View Four-Chamber View Apical four chamber view Subcostal four chamber view Suparsternal View parasternal long axis view parasternal short axis view apical four chamber view Left parasternal long axis viewLeft parasternal long axis view The 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 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.Left parasternal long axis view Parasternal short axis view Parasternal short axis view 胸骨旁心尖短轴胸骨旁心尖短轴 Parasternal short axis view Parasternal short axis view Parasternal short axis view Real-time 左室短轴左室短轴-同时显示同时显示MV 和和TV Short-axis of aortic root Aortic root Real-time Apical four chamber view Apical four chamber view Suparsternal View The 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 white Subcostal four chamber view M-Mode Imaging of The Cardiac Structures Sweep of Transducer From Aorta Toward Apex Area1 Area1 心尖波群心尖波群 Area2 Area2 腱索水平腱索水平 Area2bArea2b二尖瓣前后叶二尖瓣前后叶 Area 3Area 3二尖瓣前叶波二尖瓣前叶波 Area 4 Area 4 心底波群心底波群 Echocardiography-M Mode Area1心尖波群心尖波群 RVAW=right ventricular anterior wall RVOT=right ventricular outflow tract IVS=interventricular septum LVOR=left ventricular outflow tract LVPW=left ventricular posterior wall Area 2a 腱索水平波群腱索水平波群 RVAW=right ventricular anterior wall RVOT=right ventricular outflow tract IVS=interventricular septum LVOR=left ventricular outflow tract LVPW=left ventricular posterior wall RVAW=right ventricular anterior wall RVOT=right ventricular outflow tract IVS=interventricular septum LVOR=left ventricular outflow tract AML=anterior mitral valve leaflet PML=posterior mitral valve leaflet LVPW=left ventricular posterior wall Area 2b二尖瓣前后叶波群二尖瓣前后叶波群 二尖瓣前后叶波群（二尖瓣前后叶波群（2b2b区）区）E E峰峰:二尖瓣前叶在舒张期的快速开放二尖瓣前叶在舒张期的快速开放所致所致 EFEF段段:左室内血流反冲二尖瓣前叶左室内血流反冲二尖瓣前叶 FG:FG:舒张期二尖瓣前叶处于半关闭状舒张期二尖瓣前叶处于半关闭状态态 A A峰峰:左房收缩，二尖瓣再开放有关。左房收缩，二尖瓣再开放有关。B B点点:二尖瓣恢复原位，再处于半关闭二尖瓣恢复原位，再处于半关闭状态状态 C C点点:左室收缩，二尖瓣关闭所致左室收缩，二尖瓣关闭所致 CD CD 段段:二尖瓣在收缩期的关闭期二尖瓣在收缩期的关闭期 二尖瓣前后叶波群（二尖瓣前后叶波群（3 3区）区）二尖瓣收缩期略向前斜的关闭线称二尖瓣收缩期略向前斜的关闭线称CDCD段；段；舒张期呈双峰状样活动曲线。第一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；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第二峰称峰，代表舒张期缓慢充盈期期 Area 3 Area 3 二尖瓣前叶波群二尖瓣前叶波群 RVAW=right ventricular anterior wall RVOT=right ventricular outflow tract IVS=interventricular septum LVOR=left ventricular outflow tract AML=anterior mitral valve leaflet LAPW=left atrial posterior wall Area 4 Area 4 心底波群心底波群 RVAW=right ventricular anterior wall RVOT aAoW=anterior aortic wall Aortic valves pAoW-posterior aortic wall LA=left atrium LAPW=left atrial posterior wall Parallel motion of both aortic walls toward the transducer during systole and away from the transducer during diastole Echocardiogram of Aortic Root 心底波群心底波群 Aortic valve cusps are positioned in middle of aorta during diastole,open abruptly during systole at onset of ventricular ejection in a “box-like”fashion 多普勒超声心动图多普勒超声心动图 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)Color Doppler Flow Imaging (CDFI)心尖四腔心断面可见舒张期经二尖瓣口红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色明亮的宽带血流,起自左心房至左心室起自左心房至左心室 左心室流入道血流左心室流入道血流 左心室流入道血流左心室流入道血流 在心尖五腔心断面可见收缩期蓝色明亮的宽带在心尖五腔心断面可见收缩期蓝色明亮的宽带血流血流.起源于左心室起源于左心室,经主动脉瓣口至升主动脉经主动脉瓣口至升主动脉 左心室流出道血流左心室流出道血流 左心室流出道血流左心室流出道血流 右心室流出道血流右心室流出道血流 在心底短轴断面可见收缩期经肺动脉在心底短轴断面可见收缩期经肺动脉 瓣口篮瓣口篮色明亮的宽带血流色明亮的宽带血流,起源于右心室流出道起源于右心室流出道,充盈充盈于肺动脉主干及分支于肺动脉主干及分支 CDFI of Aortic Arch 频谱多普勒超声心动图频谱多普勒超声心动图 Spectral Doppler Pulsed Wave Doppler(PW)Continuous Wave Doppler(CW)Pulsed 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 二尖瓣口血流频谱二尖瓣口血流频谱 PWMitral valve SVSV置于心尖四腔心断面二置于心尖四腔心断面二尖瓣口左心室侧尖瓣口左心室侧 基线上方的正向双峰基线上方的正向双峰 第一峰较高，称第一峰较高，称E E峰峰,舒张舒张早期早期,左心室快速充盈血左心室快速充盈血流流动形成流流动形成 第二峰振幅较低，称第二峰振幅较低，称A A峰