6 异常大血管观汇总.docx

1、6 异常大血管观汇总Module 5: Abnormal great artery views异常大血管观Abnormalities of positionIn the normal heart: the pulmonary artery is to the left, anterior and cranial to the origin of the aortaAbnormal positions of great arteriesAortic valve rightwards, anterior and above the pulmonary valve Double outlet rig

2、ht ventricle Transposition of the great arteriesAortic valve leftwards, anterior and above the pulmonary valve Corrected transposition of the great arteries (atrioventricular discordance) Parallel great arteries Double outlet right ventricle Transposition of the great arteries Corrected transpositio

3、n of the great arteries (atrioventricular discordance) 位置异常正常胎儿心脏：肺动脉位于主动脉的左前侧，比主动脉起源靠近头侧 大血管位置异常主动脉瓣在肺动脉瓣之上，位于肺动脉瓣右前方， 右室双出口 大动脉转位主动脉瓣在肺动脉瓣之上，位于肺动脉瓣左前方 矫正型大动脉转位(房室不一致) 平行大动脉 右室双出口 大动脉转位 矫正型大动脉转位(房室不一致)Abnormalities of sizeIn the normal heart: the pulmonary artery is slightly larger than the aorta,

4、both on visual inspection and by measurementAbnormalities in size of great arteriesPulmonary artery larger than normal Absent pulmonary valve syndromePulmonary artery smaller than the aorta and small for gestation Pulmonary stenosis or atresia (includes Tetralogy of Fallot) Reduced flow through the

5、tricuspid valve (stenosis, atresia, Ebsteins malformation)Aorta much smaller than the pulmonary artery and small for gestation Aortic stenosis or atresia Coarctation of the aorta Interruption of the aorta大小异常正常胎儿心脏: 无论是视觉上还是测量上，肺动脉都比主动脉稍宽大血管大小异常肺动脉内径大于正常 肺动脉瓣缺如综合症肺动脉内径小于主动脉并小于孕周 肺动脉狭窄或闭锁（包括法洛氏四联征） 通

6、过三尖瓣的血流量减少（三尖瓣狭窄，闭锁，三尖瓣下移畸形）主动脉远小于肺动脉并小于孕周 主动脉狭窄或闭锁 主动脉缩窄 主动脉弓离断Abnormalities of structure and functionIn the normal heart: (a) the arterial valves open freely (b) there is forward flow through both great artery valves at a velocity of less than 100 cm/sec, and (c) there is no regurgitationAbnormal

7、structure and function Restricted pulmonary valve opening with increased flow velocity Pulmonary valve stenosisRestricted aortic valve opening with increased flow velocity Aortic stenosisPulmonary artery regurgitation Absent pulmonary valve syndromeAortic regurgitation Aorta-Left ventricle tunnel (r

8、are)结构和功能异常正常胎儿心脏: (a) 动脉瓣开放完全 (b) 均有前向血流通过两个大动脉瓣并且流速低于100厘米/秒, 和 (c) 没有反流结构和功能异常肺动脉瓣开放受限，流速增快 肺动脉瓣狭窄主动脉瓣开放受限，流速增快 主动脉瓣狭窄肺动脉反流 肺动脉瓣缺如综合症主动脉反流 主动脉-左室通道（少见）Left ventricular outflow tract viewIn the normal heart: (a) the aorta arises wholly from the left ventricle and initially sweeps out towards the r

9、ight shoulder, (b) the anterior wall of the aorta is continuous with the ventricular septum, (c) there are no visible branches of the aorta seen close to the valve (d) the posterior wall of the aorta is continuous with the anterior leaflet of the mitral valve, (e) the aortic valve opens freely durin

10、g systole, and (f) on color flow mapping there is laminar (non-turbulent) forward flow across the aortic valve and no regurgitation Aortic override：The aorta arises from both ventricles astride a ventricular septal defect. Note that the anterior wall of the aorta is not continuous with the ventricul

11、ar septum. Aortic override occurs in, for example, tetralogy of Fallot and common arterial trunk左室流出道切面正常胎儿心脏: (a) 主动脉完全起源于左室，并马上转向右侧，(b) 主动脉前壁与室间隔连续，(c) 主动脉在瓣膜附近没有分支，(d) 主动脉后壁与二尖瓣前叶连续，(e) 主动脉瓣在收缩期完全开放，(f) 彩色血流显像可见跨主动脉瓣的层流（非湍流）且没有反流主动脉骑跨：主动脉骑跨于室间隔上起源于双室. 注意主动脉前壁与室间隔失去连续性. 主动脉骑跨可发生于法四或共同动脉干。Aortic or

12、igin viewIn the normal heart: (a) the aorta arises wholly from the left ventricle and initially sweeps out towards the right shoulder, (b) the anterior wall of the aorta is continuous with the ventricular septum, (c) the posterior wall of the aorta is continuous with the anterior leaflet of the mitr

13、al valve, (d) the aortic valve opens freely during systole, and (e) on color flow mapping there is laminar (non-turbulent, unaliased) forward flow across the aortic valve and no regurgitation Aortic stenosis:The aorta was visibly smaller than normal in relation to the size of the pulmonary artery (t

14、his is not appreciable here as the pulmonary artery is not seen). The suspicion of a small aorta was confirmed by measurement and comparison with growth charts for gestational age. The aortic valve did not open freely during systole (the valve cusps were visible throughout systole). The velocity of

15、flow across the aortic valve was increased, resulting in aliased turbulent flow on color flow mapping. 主动脉起源切面正常胎儿心脏: (a) 主动脉完全起源于左室，并马上转向右侧，(b) 主动脉前壁与室间隔连续，(c) 主动脉后壁与二尖瓣前叶连续，(d) 主动脉瓣在收缩期完全开放，(e) 彩色血流显像可见跨主动脉瓣的层流（非湍流）且没有反流主动脉瓣狭窄:与肺动脉相比，主动脉内径明显小于正常（此切面未显示肺动脉）。与孕周相比，主动脉测值明显低于正常，肯定了主动脉发育细小的怀疑。收缩期主动脉瓣开放

16、不完全（整个收缩期都可见主动脉瓣尖）。主动脉瓣跨瓣流速增加，彩色血流显像可见彩色血流紊乱。 The 3-vessel viewIn the normal heart: (a) the pulmonary artery is slightly bigger than the aorta, (b) the pulmonary valve is anterior and cranial to the aortic valve, (c) the pulmonary valve opens freely with laminar flow across it, (d) the pulmonary art

17、ery continues as the arterial duct and connects to the descending aorta and (e) there is forward flow in the arterial ductPulmonary atresia：The pulmonary artery is slightly smaller than normal. There is reverse flow in the arterial duct (red flow). The flow from the duct hits the closed pulmonary va

18、lve and then turns forward to feed the branches of the pulmonary artery (blue flow) 三血管切面正常胎儿心脏: (a) 肺动脉比主动脉稍宽, (b) 肺动脉瓣在主动脉瓣前侧及头侧, (c) 肺动脉瓣于收缩期完全开放，并可见层流血流通过, (d) 肺动脉通过动脉导管与降主动脉连接(e) 动脉导管内为前向血流肺动脉闭锁：肺动脉内径稍小于正常. 动脉导管内可见反向血流 (红色血流). 来自于动脉导管内的血流撞击到关闭着的肺动脉瓣，然后翻转向前进入肺动脉分之内(蓝色血流)。The 3-vessel viewIn the

19、normal heart: (a) the pulmonary artery is slightly bigger than the aorta, (b) the pulmonary valve is anterior and cranial to the aortic valve, (c) the pulmonary valve opens freely with laminar flow across it, (d) the pulmonary artery continues as the arterial duct and connects to the descending aort

20、a and (e) there is forward flow in the arterial ductAbsent pulmonary valve syndrome This is a form of tetralogy of Fallot. The pulmonary valve is thickened and does not open freely. The main pulmonary artery is dilated. There is no visible arterial duct. There is moderately severe pulmonary regurgit

21、ation on colour 三血管平面正常胎儿心脏: (a) 肺动脉比主动脉稍宽, (b) 肺动脉瓣在主动脉瓣前侧及头侧, (c) 肺动脉瓣于收缩期完全开放，并可见层流血流通过, (d) 肺动脉通过动脉导管与降主动脉连接(e) 动脉导管内为前向血流肺动脉瓣缺如综合：是法四的一种表现形式. 肺动脉瓣增厚，完全不开放。肺动脉主干扩张。未见动脉导管。彩色多普勒可见重度肺动脉反流。 Transverse arch viewIn the normal heart the transverse aortic arch: (a) is seen just above the 3-vessel view

22、(b) it lies above the arterial duct, (c) it arises in the middle of the chest and crosses the midline of the thorax from right to left in front of the trachea, (d) it is of even caliber along its length, and (e) color Doppler demonstrates forward flow Transposition of the great arteries：The aorta ar

23、ises much more anteriorly than normal, because it is arising from the anterior right ventricle. This occurs in transposition of the great arteries or double outlet right ventricle 主动脉弓横断面正常胎儿心脏主动脉弓横断面: (a) 在3血管平面之上，(b) 在动脉导管之上，(c) 在气管前方从右向左跨过胸腔中线，(d) 全程管腔内径相等，(e) 彩色多普勒显示为前向血流大动脉转位：由于主动脉起源于右室，所以主动脉起源

24、远比正常靠前，这种情况可见于大动脉转位或右室双出口。 Long axis view of the left ventricleIn the normal heart: (a) a long portion of aorta can be seen arising from the left ventricle, (b) no major branches are seen arising from the aorta soon after its origin, and (c) there is laminar flow across the whole length of the left

25、ventricular outflow tractTransposition of the great arteries ：The vessel arising from the left ventricle branches laterally indicating this is the pulmonary artery左室长轴切面正常胎儿心脏: (a) 可观察到较长一段从左室发出的主动脉，(b) 主动脉起源之后短距离内没有主要分支，(c) 彩色血流显像整个左室流出道均为层流大动脉转位：起源于左室的血管很快向两侧分叉提示此血管为肺动脉Short axis view of the left

26、ventricleIn the normal heart: (a) the right ventricle is “banana-shaped” and lies anterior to the left ventricle. (b) the pulmonary valve is seen at the cranial end of the right ventricle, (c) the left ventricle appears as a circle, contracting briskly and concentrically with the “fish-mouth” appear

27、ance of the mitral valve within it (d) the septum is intact, and (e) there is forward flow from the right ventricle to the pulmonary arterySevere aortic stenosis：The right ventricle is contracting normally but the left is “stiff” and immobile. This is due to high pressure within the left ventricle b

28、ecause of a severely obstructed aortic valve左室短轴切面正常胎儿心脏: (a) 右室呈“香蕉形状”位于左室前方，(b) 右室末端可见肺动脉瓣，(c) 左室显示为圆形，收缩有力，二尖瓣呈“鱼口型”位于中央，(d) 室间隔连续完整，(e) 右室至肺动脉内可见前向血流重度主动脉瓣狭窄：右室收缩正常但左室“僵硬”不运动。这是由于重度主动脉瓣梗阻引起的左室内高压造成的Arch and ductWhen the ultrasound beam is angled on the transverse arch, the arch and duct can be i

29、maged simultaneously. The duct and transverse arch are of similar size. The direction of flow is the same in the arch and ductAortic atresia ：The transverse arch is hypoplastic with flow in the opposite direction to the flow in the duct (retrograde flow)主动脉弓和动脉导管平面当超声束与主动脉弓横断面成一定角度时，可同时显示主动脉弓和动脉导管。动

30、脉导管与主动脉弓横断面大小相似。主动脉弓及动脉导管内的血流方向相同主动脉瓣闭锁：主动脉弓横断面显示主动脉弓发育不良，其内血流（反向血流）和动脉导管内血流方向相反主动脉弓和动脉导管平面当超声束与主动脉弓横断面成一定角度时，可同时显示主动脉弓和动脉导管。动脉导管与主动脉弓横断面大小相似。主动脉弓及动脉导管内的血流方向相同右位主动脉弓：主动脉弓没有穿过中线，在左侧形成降主动脉。而是位于右侧，在气管附近与动脉导管共同组成一个圆形。Arch and ductWhen the ultrasound beam is angled on the transverse arch, the arch and du

31、ct can be imaged simultaneously. The duct and transverse arch are of similar size. The direction of flow is the same in the arch and duct Double outlet right ventricle：There is dextrocardia. The aorta arises anterior to the pulmonary artery (identified by its lateral branching pattern). There is rev

32、erse flow in the arterial duct indicating pulmonary atresia. This is clearly different from the normal 3-vessel view seen in the left hand panel in the same orientation. 主动脉弓和动脉导管平面当超声束与主动脉弓横断面成一定角度时，可同时显示主动脉弓和动脉导管。动脉导管与主动脉弓横断面大小相似。主动脉弓及动脉导管内的血流方向相同 右室双出口：右位心。主动脉起源于肺动脉（有分支）前方。动脉导管内可见反向血流提示肺动脉闭锁。这与左侧所显示的正常三血管平面完全不同。 Arch and ductWhen the ultrasound beam is angled on the transverse arch, the