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1、Cardiovascular UltrasonographySchool of Radiology,Taishan Medical University 卢 川Topics:lAnatomyofHeartlExaminationTechniqueslNormalSonographicFeaturesofHeartlSonographicFeaturesofCardiovescularDisordersAnatomy of HeartAnatomy of HeartAnatomy of HeartNormal Heart1Normalventriclewallwidth2Ventriculars
2、eptumExamination TechniqueslSuprasternallSubcostallApicallParasternalLong-AxisShort-AxisFour-ChamberTransducer in the Subcostal PositionTransducer in the Parasternal PositionTransducer in the Apical PositionSuprasternalNormalSonographicFindingsofHeartlTwo-DimensionalEchocardiographylCardiacColorFlow
3、ExaminationlM-ModeImagingofTheCardiacStructureslSpectralAnalysis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. lParasternalLong-AxisViewShort-AxisViewFour-Chamber
4、ViewlApicalfourchamberviewlSubcostalfourchamberviewlSuparsternalViewparasternal long axis view parasternal short axis view apical four chamber view Left parasternal long axis viewThe long axis view provides a reliable picture of the function of the basilar portions of the anterior septum and posteri
5、or 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 viewParasternal shor
6、t axis viewParasternal short axis view胸骨旁心尖短轴胸骨旁心尖短轴 Parasternal short axis viewParasternal short axis viewParasternal short axis viewlReal-time左室短轴左室短轴-同时显示同时显示MV 和和TVShort-axis of aortic rootAortic root lReal-timeApical four chamber viewApical four chamber view SuparsternalViewlTheflowvelocityisdi
7、splayedwithfastervelocitiesinbrightercolorsandslowervelocitiesindarkercolorslThefastestvelocitymaybedisplayedinyelloworwhiteSubcostal four chamber viewM-ModeImagingofTheCardiacStructures 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 Are
8、a 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 wallRVOT=right ventricular outflow tract IVS= interventricular septumLVOR=left ventricular outflow tractLVPW=left ventricular posterior wall Area 2a 腱索水平波群腱索水平波群RVAW=rightventricularan
9、teriorwallRVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tractLVPW=left ventricular posterior wallRVAW= right ventricular anterior wallRVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tractAML=anterior mi
10、tral valve leafletPML=posterior mitral valve leaflet LVPW=left ventricular posterior wallArea2b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
11、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。第一峰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峰称峰，代表舒张期缓慢充盈期Area 3 Area 3 二尖瓣前叶波群二尖瓣前叶波群RVAW= right ventricular ante
12、rior wallRVOT=right ventricular outflow tract IVS= interventricular septum LVOR=left ventricular outflow tractAML=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 RVOTaAoW=anterior aortic wall Aortic valvespAoW-posterior aorti
13、c wall LA=left atriumLAPW=left atrial posterior wall ParallelmotionofbothaorticwallstowardthetransducerduringsystoleandawayfromthetransducerduringdiastoleEchocardiogram of Aortic Root心底波群心底波群Aorticvalvecuspsarepositionedinmiddleofaortaduringdiastole,openabruptlyduringsystoleatonsetofventriculareject
14、ionina“box-like”fashion多普勒超声心动图多普勒超声心动图l频谱多普勒 SpectralDoppler 脉冲式 PulsedWaveDoppler(PW) 连续式 ContinuousWaveDoppler(CW)l彩色多普勒血流显像ColorDopplerFlowImaging(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
15、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,充充盈于肺动脉主干及分支盈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 Dopplerl PulsedWaveDoppler(PW)l C
16、ontinuousWaveDoppler(CW)Pulsed Wave Doppler(PW)将取样容积(SampleVolume,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 lSVSV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l基线上方的正向双峰基线上方的正向双峰l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 l第二峰振幅较低，称第二峰振
17、幅较低，称A A峰峰, ,位于舒张晚期位于舒张晚期, ,心房收缩心房收缩形成形成l正常时峰值和射血时间正常时峰值和射血时间E E峰均大于峰均大于A A峰峰三尖瓣口血流频三尖瓣口血流频 PW-tricuspid valvelSV置于心尖四腔心断面三尖瓣口右心室侧l频谱与二尖瓣口相似，只是速度偏低,受呼吸影像较大l血流频谱呈窄带双峰型l第一峰较大， 称E 峰，l第二峰较小，称A峰主动脉瓣口血流频谱主动脉瓣口血流频谱PW-Aortic valvcuspsl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l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肺动脉瓣口血流
18、频谱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UltrasonographyofCardiovascularDisorderslRheumaticHeartDisease(RHD)lAtrialSepatalDefect(ASD)lCardiomyopathy:CongestiveCardiomyopathyHypertrophicCardiomyopathyRestrictiveCardiomyopathylCoronaryHear
19、tDiseaseRHD:二尖瓣狭窄二尖瓣狭窄l二维：二尖瓣叶增厚，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lM超：二尖瓣前叶曲线EF斜率减慢呈“城墙样”lCDFI：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l多普勒频谱:左室流入道可检测到高速湍流频谱lDecreaseddiastolicseparationofleafletslRestrictedmobilitylRelativelyimmobileleafletslThickenedleafletslDomingofthevalveRestricted mobility=
20、 relatively immobile leafletsThickened leafletsCalcification of the valveMmode： Slow initial closure of mitral valve (decreased EF slope)=flattening of EFMitralRegurgitation l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lM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。lCDFI：二尖瓣口可见舒张期以红色为主五彩镶嵌(color mosaic
21、)变窄变细的射流束，中心呈明亮的黄色l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/sIncomplete closure of mitral valveEnlarged left ventricular volumes and atrium CDFI： “Color mosaic” MR -“Color mosaic”MR-“Colormosaic”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 MRAort
22、ic stenosis Thickened +calcified aortic valve with restrictive motion Increased thinckness of LV wall l主动脉瓣叶增厚,钙化，开放幅度变小，小于12mm，重者瓣叶及无运动l左心室增厚，流出道增宽l多普勒：瓣口血流频谱明显展宽，流速加快Thickened +calcified aortic valve with restrictive motion AorticregurgitationlAorticregurgitationistheretrogradeflowacrossthecloseda
23、orticvalveduringdiastole.lItiscausedbyabnormalitiesofoneormoreofthefollowingstructures:aorticcusp,aorticannulus,aorticsinuses.ARAR Aorticregurgitationl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l二尖瓣狭窄（中度）并关闭不全（轻度）l主动脉瓣狭窄（中度）并关闭不全（轻度）l左心房血栓 图为左心房血栓风心病主动脉瓣狭窄并二尖瓣狭窄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、回声增强主动脉瓣和二尖
24、瓣瓣叶增厚、回声增强提示钙化；左房增大成气球样改变提示钙化；左房增大成气球样改变 ASDl心尖位和胸骨旁四腔心心尖位和胸骨旁四腔心示：房间隔中部和上部示：房间隔中部和上部连续性中断连续性中断l右房右室扩大和左室流右房右室扩大和左室流出道增宽出道增宽lCDFI:CDFI:分流血流束自左房分流血流束自左房经缺损流向右房经缺损流向右房l多普勒频谱：分流处探多普勒频谱：分流处探及连续性湍流频谱及连续性湍流频谱ASD :Before and After Closure divice ASD封堵术后.aviLeftparasternallongaxisviewlLackofechoesinregionof
25、interventricularseptumwithsharpedgeslLAenlargementlProlapseofaorticvalvecusp(insupracristalVSD)lDeformityofaorticcusp(inmembranousVSD)VDS:Befre and After Closure DevicePDA动脉导管未闭动脉导管未闭Tetralogy of Fallotl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）l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，为右向左分流型主动脉骑跨主动脉骑跨50%TOF-室缺伴主动脉骑跨室缺
26、伴主动脉骑跨CardiomyopathylCongestiveCardiomyopathylHypertrophicCardiomyopathylRestrictiveCardiomyopathyHypertrophic Cardiomyopathyl心脏短轴切面乳头肌水平：心脏短轴切面乳头肌水平：l左室壁、室间隔增厚，回声不均。心腔变小左室壁、室间隔增厚，回声不均。心腔变小心脏短轴切面心脏短轴切面Hypertrophic Cardiomyopathy:HCM室间隔呈区域性明显增厚，与左室后壁之比 大于 1.3室间隔增厚部分向左心室腔内凸出，使左室流出道明显狭窄 室间隔增厚并向左室流出道室间隔
27、增厚并向左室流出道局限性膨出，致左室流出道梗阻局限性膨出，致左室流出道梗阻Congestive cardiomyopathylEnlargedLVwithgloblehypokinesislIVSandLVPWofequalthicknesswithdecreasedamplitudeofmotionl“Miniaturized”mitralvalvelMildlyenlargedLAlEnlargedhypokineticrightventricleCongestive CardiomyopathyPericarditis 心包炎心包炎l于心前区扫查时，在右室及右室流入道及胸壁间出现液性暗区
28、l或于左室后壁与肺之间出现液性暗区，均为心包积液的可靠征象 左冠状左冠状A A开口于主动脉根部的左冠状开口于主动脉根部的左冠状A A窦，在主窦，在主A A根部短根部短轴的左侧轴的左侧3 34 4点钟部位，可以找到左冠状点钟部位，可以找到左冠状A A及其开口。小及其开口。小心旋转探头，使扫描平面与左主冠状心旋转探头，使扫描平面与左主冠状A A长轴平行，可以显长轴平行，可以显示出左主冠状示出左主冠状A A口和左主干。口和左主干。 右冠状A:右冠状A开口于主A根部的右冠状A窦，在主A短轴的1011点钟部位，呈两条平行的线状回声。箭头所指为右冠状A。 粘液瘤粘液瘤Thank You for Your Attention
