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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） ›› 2016, Vol. 13 ›› Issue (11) : 865 -871. doi: 10.3877/cma.j.issn.1672-6448.2016.11.014

所属专题： 文献；

心血管超声影像学

2086例右心增大患者病因回顾性分析与超声诊断
王斌1, 谢明星1,†(), 张丽1   
  1. 1. 430000　武汉，华中科技大学同济医学院附属协和医院心血管研究所　超声影像科　湖北省分子影像重点实验室
  • 收稿日期:2016-05-25 出版日期:2016-11-01
  • 通信作者: 谢明星

Retrospective analysis of etiology and echocardiography diagnosis in 2086 cases with right heart enlargement

Bin Wang1, Mingxing Xie1,†(), Li Zhang1   

  1. 1. Department of Ultrasound, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, China
  • Received:2016-05-25 Published:2016-11-01
  • Corresponding author: Mingxing Xie
  • About author:
    Correspongding author: Xie Mingxing, Email:
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引用本文：

王斌, 谢明星, 张丽. 2086例右心增大患者病因回顾性分析与超声诊断[J]. 中华医学超声杂志（电子版）, 2016, 13(11): 865-871.

Bin Wang, Mingxing Xie, Li Zhang. Retrospective analysis of etiology and echocardiography diagnosis in 2086 cases with right heart enlargement[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(11): 865-871.

目的

分析采用超声心动图诊断为单纯性右心增大患者的临床病因，为右心增大的超声诊断提供思路。

方法

回顾性分析华中科技大学附属协和医院2013年1月至2015年5月2086例单纯右心增大患者的超声图像特征及临床资料，总结右心增大的临床病因。

结果

2086例单纯右心增大患者中，先天性心脏病1098例（52.64%），其中简单先天性心脏病804例（38.54%），以房间隔缺损为主674例（32.31%），复杂先天性心脏病294例（14.09%）；先天性心脏病及瓣膜病术后继发右心增大373例（17.88%）；肺心病140例（6.71%）；瓣膜疾病113例（5.42%），其中三尖瓣57例（2.73%），风湿性心脏病36例(1.73%），非风湿性心脏病21例（1.01%），乏氏窦瘤破入右心42例（2.01%），联合瓣膜疾病8例（0.96%），肺动脉瓣关闭不全4例（0.19%）；心肌病30例（1.44%），以致心律失常性右心室心肌病及右心室心肌致密化不全常见；冠心病21例（1.0%）；冠状动脉瘘入右心系统20例（0.96%）；肺栓塞14例（0.67%）；心律失常14例（0.67%）；其他原因265例（12.51%）。

结论

引起单纯性右心增大的主要原因为简单先天性心脏病，以房间隔缺损为主，其次依次为先天性心脏病及瓣膜病术后继发、瓣膜疾病、心肌病、冠心病等。

关键词: 超声心动图, 右心增大, 先天性心脏病
Objective

To analysis the pathogenies which result in the simple enlargement of right heart, to provide ideas about the Echocardiograph diagnosis of this disease.

Methods

This study retrospectively analyzed 2086 patients diagnosed as right heart enlargement by Echocardiography in the Affiliated Union Hospital of Huazhong University of Science and Technology from January 2013 to May 2015, include the characteristics of echocardiography image and clinical data, then summarized the clinical pathogenies of right heart enlargement.

Results

A total of 2086 cases were collected, 1098 cases were congenital heart diseases (52.64%), including 804 cases of simple congenital heart diseases (38.54%), ASD 674 (32.31%), 294 cases of complex congenital heart diseases (14.09%). Three hundred and seventy three cases of secondary enlargement after operation of Congenital heart diseases and valvular diseases (17.88%). One hundred and forty cases of pulmonary heart diseases (6.71%). One hundred and thirteen cases of valvular heart disease (5.42%), including 57 cases of three tricuspid valve diseases (2.73%), 36 cases of rheumatic heart diseases (1.73%), 21 cases of non-rheumatic heart diseases (1.01%), 42 cases of sinus of Valsalva aneurysm ruptured into the right heart (2.01%), 8 cases of combined valvular diseases (0.96%), 4 cases of pulmonary valve regurgitation (0.19%). 30 cases of cardiomyopathy (1.44%), mainly of arrhythmogenic right ventricular cardiomyopathy (ARVC) and noncompaction of right ventricular myocardium (NVM) . Twenty one cases of coronary heart diseases (1.00%). Twenty cases of Coronary artery fistula into the right heart, (0.96%). Forteen cases of pulmonary embolism (0.67%). Forteen cases of arrhythmia (0.67%). Two hundred and sixty five cases of the other reasons (12.51%).

Conclusions

The main clinical pathogeny which results in simple enlargement of right heart was simple congenital heart disease, especially ASD, followed by the secondary enlargement after operation of congenital heart diseases and valvular heart diseases, valvular heart diseases, cardiomyopathy and coronary heart disease et al.

Key words: Echocardiography, Right heart enlargement, Diagnosis thinking
图4 为肺动脉瓣狭窄超声图：左图示肺动脉瓣开放受限，无法贴壁，右图彩色多普勒血流成像显示收缩期通过肺动脉瓣口血流汇聚，呈五彩镶嵌花色
表1 2086例右心增大患者病因分类
分类 例数 构成比（%）
先天性心脏病 1098 52.64
肺源性心脏病 140 6.71
瓣膜疾病 95 4.55
风湿性心脏病 36 1.73
心肌病 30 1.44
冠心病 21 1.01
肺动脉栓塞 14 0.67
心律失常 14 0.67
先心病及瓣膜病术后 373 17.88
其他原因 265 12.70
表2 瓣膜疾病引起右心增大的病因分类
分类 例数 百分比[%（例/例）]
乏氏窦瘤破入右心 42 2.01（42/2086）
? 无冠窦破入右心房 15 ?
? 右冠窦破入右心室 27 ?
三尖瓣疾病 21 1.01（21/2086）
? 赘生物（单纯三尖瓣） 15 ?
? 脱垂 6 ?
肺动脉瓣关闭不全 4 0.19（4/2086）
联合瓣膜疾病（三尖瓣合并肺动脉瓣） 8 0.38（8/2086）
图8 示下腔静脉增宽，内径29 mm，塌陷率<50%
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