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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (05) : 394 -408. doi: 10.3877/cma.j.issn.1672-6448.2020.05.003

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肥厚型心肌病超声心动图检查规范专家共识
中华医学会超声医学分会超声心动图学组, 中国超声医学工程学会超声心动图专业委员会   
  • 收稿日期:2020-03-25 出版日期:2020-05-01

Expert consensus on echocardiography in diagnosis of hypertrophic cardiomyopathy

Echocardiography Group of Chinese Medical Association Ultrasound Medical Branch, Specialty Committee of Echocardiography, Chinese Association of Ultrasound in Medicine and Engineering   

  • Received:2020-03-25 Published:2020-05-01
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中华医学会超声医学分会超声心动图学组, 中国超声医学工程学会超声心动图专业委员会. 肥厚型心肌病超声心动图检查规范专家共识[J]. 中华医学超声杂志（电子版）, 2020, 17(05): 394-408.

Echocardiography Group of Chinese Medical Association Ultrasound Medical Branch, Specialty Committee of Echocardiography, Chinese Association of Ultrasound in Medicine and Engineering. Expert consensus on echocardiography in diagnosis of hypertrophic cardiomyopathy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(05): 394-408.

图1 二尖瓣收缩期前向运动SAM征M型超声心动图。图a为正常人二尖瓣前叶曲线；图b为二尖瓣前叶收缩末期贴近肥厚的室间隔，SAM征阳性（箭头所示）
图2 主动脉瓣收缩中期提前关闭。图a为主动脉瓣在左心室射血后很短时间内提前关闭，在收缩中期呈半关闭状态；图b为右冠瓣呈"M"形，无冠瓣呈"W"形（箭头所示）
图3 肥厚型心肌病室壁肥厚和心肌内回声紊乱。图a为胸骨旁左心室长轴切面示舒张期室间隔显著增厚；图b为胸骨旁左心室短轴切面示室间隔、前壁明显增厚，内可见回声紊乱、颗粒粗糙
图4 二尖瓣收缩期前向运动SAM征二维超声心动图。图a为胸骨旁左心室长轴切面示收缩期二尖瓣前叶及瓣下腱索移向室间隔（箭头所示）；图b为心尖三腔切面示收缩期二尖瓣前叶及后叶移向室间隔（箭头所示）
图5 肥厚型心肌病患者不同梗阻部位的彩色多普勒超声表现。图a为左心室流出道可见五彩镶嵌的湍流信号（箭头所示）；图b为左心室流出道以及左心室心腔内可见五彩镶嵌的湍流信号（箭头所示）；图c为左心室心腔内乳头肌水平可见五彩镶嵌的湍流信号（箭头所示）；图d为左心室腔自心尖至二尖瓣水平可见五彩镶嵌的湍流信号（箭头所示）
图6 肥厚型心肌病患者二尖瓣中-大量反流超声图像。图a为心尖四腔心切面显示左心房内五彩镶嵌反流束；图b为心尖三腔心切面显示左心房内五彩镶嵌反流束
图7 肥厚型心肌病患者左心室流出道血流频谱。图a为脉冲波多普勒示非梗阻性肥厚型心肌病收缩期负向层流频谱，呈楔形；图b为连续波多普勒示梗阻性肥厚型心肌病呈倒"匕首样"频谱
图8 肥厚型心肌病患者右心室流出道血流频谱。图a为右心室流出道非梗阻时显示为负向单峰窄带血流频谱；图b为右心室流出道梗阻时显示为收缩期高速血流频谱
图9 肥厚型心肌病患者左心室心尖部室壁瘤形成超声图像
图10 肥厚型心肌病患者左心室心尖部血栓附着（箭头所示）
图11 心尖肥厚型心肌病患者超声图像。图a为心尖四腔心切面显示心尖部心肌肥厚（箭头所示）；图b为左心室短轴切面显示心尖部心肌肥厚
图12 左心室中部肥厚型梗阻性心肌病患者超声图像。图a为左心室中部室壁异常肥厚，伴乳头肌肥大、发育异常；图b为左心室心尖部和基底部心腔之间收缩期高速血流（箭头所示）
图13 梗阻性肥厚型心肌病患者左心室流出道和二尖瓣反流频谱。图a为左心室流出道梗阻频谱峰值压差发生在收缩中晚期，频谱呈倒"匕首样"（箭头所示）；图b为二尖瓣反流频谱峰值较为圆钝且峰值压差明显高于左心室流出道峰值压差
图14 高血压性心肌肥厚患者超声图像。图a~c为胸骨旁左心室长轴、短轴切面和心尖四腔心切面显示左心室对称性肥厚；图d为心尖五腔心切面显示无左心室流出道梗阻
图15 肥厚型心肌病患者左心室流出道梗阻合并主动脉瓣狭窄。图a为胸骨旁大动脉短轴切面显示主动脉瓣增厚、钙化、狭窄，开放受限，瓣口面积缩小；图b为心尖五腔心切面显示左心室肥厚，主动脉瓣开放受限；图c为心尖五腔心切面显示主动脉瓣上血流明显加速；图d为心尖五腔心切面显示左心室流出道梗阻
图16 主动脉缩窄导致左心室肥厚超声图像。图a为胸骨旁左心室长轴切面显示左心室对称性肥厚；图b为胸骨上窝主动脉弓长轴切面显示主动脉峡部缩窄；图c为彩色多普勒血流显示缩窄处呈五彩高速血流信号；图d为连续波多普勒探及缩窄部位负向的高速湍流频谱
图17 运动性心肌肥厚超声图像。图a为心尖四腔心切面显示左心室对称性肥厚，左心室腔略大，左心房大小正常；图b为二尖瓣前向血流频谱E/A比值>1，左心室舒张功能正常；图c为二尖瓣瓣环运动速度正常；图d为左心室心肌纵向应变正常
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