[學習]二維超聲心動圖常用切面及選擇

1、1.胸骨旁左室長軸切面,(1)正常解剖結(jié)構(gòu)的超聲表現(xiàn)：心底部自前向后分別為右室流出道、主動脈根部及左心房，正常三者內(nèi)徑基本相同。中部由前向后依次為右室前壁、右室流出道、室間隔、左室流出道、左室流入道(二尖瓣前、后葉及腱索)。心尖部自前向后依次為室間隔、左室腔及左室后壁。(2)選用范圍:1)右主流出道：評價右窒流出道有無狹窄、擴大等。2)主動脈根部；評價主動脈根都病變，包括有無管壁增厚、夾層，管腔擴大、狹窄;竇部擴大、瘤樣膨出或破

2、口;瓣葉(右及無冠瓣)增厚、纖維化或鈣化、贅生物、脫垂、梿枷樣運動、開放受限或關團不全等，并可分別測量瓣環(huán)、竇部、嵴部及開主動脈徑，3)左心房；觀察并測量左心房大小、左房內(nèi)有無血栓、腫瘤、隔膜、左房下后方冠狀靜脈竇有無擴大，后方異常管道結(jié)構(gòu)(肺總靜脈)。4)右室前壁；評價右室前壁有無液區(qū)(心包積液)，心室壁有無增厚、右室腔大小。5)室間隔：測量室間隔厚度(肥厚或變薄)及運動幅度(減弱或不運動)、回聲;室間隔中都連續(xù)中斷(肌部間隔缺

3、損)，上部與主動脈前壁連續(xù)中斷(膜周或嵴下型室間隔缺損)，主動脈騎跨于室間隔上(法洛四聯(lián)癥或永存動脈干)，心尖部室間隔連續(xù)中斷(室壁穿孔)等。6)左室腔及左室后壁：測心腔大小、后壁厚度及運動幅度、觀察心腔形態(tài)，有無心尖圓鈍(擴大)、室壁膨出(室壁瘤)及附壁血栓等。7)二尖瓣及瓣器；觀察二尖瓣葉的厚度、回聲強度彈性、開閉活動、有無增厚、鈣化、贅生物等異常，鍵索有無增厚、粘附著于室間隔等，二尖瓣前葉根部與主脈后壁的纖維連續(xù)是否正常，有無

4、肌性連續(xù)（右室雙出口、大血管轉(zhuǎn)位）。,胸骨旁左室長軸切面,(3)正常值：①主動脈內(nèi)徑：胸旁左室長軸切面，收縮末期徑，環(huán)部前后徑為1.6-2.6cm ，竇部為2.4-3.9cm，主動脈竇上（嵴部）為2.1-3.4cm ，升主動脈為2.2-3.4cm，主動脈弓徑為2.2-2.7cm。②左房內(nèi)徑：前后徑（收縮末期徑、主動脈竇后方垂直距離）為2.4-3.3cm 。,③右室內(nèi)徑: 前后徑（舒張末期徑，腱索水平測）為2.0cm 以下。④左室內(nèi)

5、徑：前后徑（腱索水平）：舒張末期為3.7-5.2cm；收縮末期為2.3-3.6cm。⑤室間隔厚度（舒張末期，腱索水平測）：( 9.4士0.9 ) mm。⑥左室后壁厚度（舒張末期，腱索水平測）：( 9.4士0 . 8 ) mm 。,胸骨旁左室長軸切面Schematic diagram of the parasternal long-axis view in diastole,showing the aortic root (Ao),

6、 sinotubular junction (STJ), closed right coronary and noncoronary cusps of the aortic valve (RCC and NCC), the open anterior and posterior mitral valve leaflets (AMVL and PMVL), and the left ventricular septum and pos

7、terior wall. The medial papillary muscle has been shown for reference, although slight medial angulation is needed to visualize this tructure in the long-axis view. The right ventricular outflow tract (RVOT) is anterio

8、r, while the coronary sinus (CS) in the atrioventricular groove and the descending aorta (DA) are seen posteriorly. The right pulmonary artery (RPA) lies posterior to the ascending aorta. The position of the pericardiu

9、m is indicated by the thin line. Normal parasternal long-axis 2D echo images at end-diastole (above) and end-systole (below).,2.右室流出道切面,解剖圖,3.右室流入道切面,showing the right ventricle (RV) and atrium (RA),tricuspid valve (T

10、V), and ostia of the coronary sinus (CS) and inferior vena cava (IVC).,Schematic and 2D echo images in a right ventricular inflow view,,4.胸骨旁主動脈根部短軸切面,(1)正常結(jié)構(gòu)的超聲表現(xiàn)：圖像左側(cè)，從前向后依次為右室流出道、肺動脈瓣、肺動脈主干及左右肺動脈。中部為右室流出道、主動脈根部、左房

11、。右側(cè)為右室流入道、三尖瓣、右心房,(２)此切面選用范圍：1)測量主肺動脈及左右肺動脈徑，評價肺動脈有無狹窄或擴大。2)測量肺動脈瓣環(huán)徑，觀察肺動脈瓣開、閉運動，評價有無狹窄（法洛三聯(lián)癥、四聯(lián)癥等）、閉鎖（肺動脈閉鎖、假性共干等）。3)觀察主、肺動脈的空間位置關系。4)測量右心室流出道內(nèi)徑及前壁厚度，評價有無狹窄擴大及增厚，有無異常結(jié)構(gòu)（隔膜、下移的三尖瓣或

12、 腫瘤）。 5)觀察主動脈瓣葉數(shù)目（二瓣或多瓣畸 形）， 厚度及三個瓣葉的關系及交界處 有無粘連，瓣葉有無狹窄及關閉不全。 6)觀察主動脈竇病變（主動脈竇瘤或竇瘤

13、 破裂）。 7)觀察左右冠狀動脈開口及主干有無病變 （冠狀動脈開口異常、擴大、狹窄或閉塞）。 8)觀察右房大小及三尖瓣有無病變（狹 窄、關閉不全、Ebstein 畸形、三尖瓣閉鎖）。,胸骨旁主動脈根部短軸切面,(3) 正常測值：1)右室流出道徑（自室上嵴至流出道前壁垂直距離）；舒張末期為1.9-2.5cm。2

14、)主肺動脈徑（胸旁主動脈根部短軸切面，瓣上1cm 處）：舒張末期為1.5-2.5cm。3)肺動脈瓣環(huán)徑為1.1-2.2cm ，右肺動脈徑0.8-1.6cm ，左肺動脈徑l.0-1.4cm。,胸骨旁主動脈根部短軸切面Schematic diagram of a parasternal short-axis view at the aortic valve level,showing the relationship betwee

15、n the three cusps of the aortic valve--right coronary cusp (RCC), noncoronary cusp (NCC), left coronary cusp (LCC)--and the left atrium (LA), right atrium (RA), right ventricular outflow tract (RVOT), and the pulmon

16、ary artery (PA) with right (RPA) and left (LPA) branches. The positions of the right coronary artery (RCA), left main coronary artery (LMCA), pulmonic valve, and tricuspid valve are shown.Two-dimensional echocardio

17、graphic images at the aortic valve level in systole (above) and diastole (below). Note the three open leaflets of the aortic valve in systole and the normal perpendicular relationship of aortic and pulmonic valves,,

18、5．胸骨旁腱索水平短軸切面,1)正常結(jié)構(gòu)的超聲心動圖表現(xiàn)：圖右側(cè)依次顯示左室前壁、側(cè)壁、后壁，中部為室間隔。右前方為右室前壁、右室腔及右室后壁。,2)此切面選用范圍：①測量左室腔徑（前后及左右徑），評價左室大小，觀察左室壁厚度及室腔形態(tài)（正常左室腔呈圓形），腔內(nèi)顯示乳頭肌上緣或鍵索。②右室腔大小、位置及形態(tài)，有無擴大、轉(zhuǎn)位。3)正常測值：左室橫徑舒張末期為3.3-5.3cm ，收縮末期為2.4-4.2cm。,Re

19、lationship between the short-axis plane with left ventricular wall segments indicated, and the apical four-chamber, two-chamber, and long-axis image planes (perpendicular to the short-axis plane).,６.心尖四腔切面,(１)正常解剖結(jié)構(gòu)的超聲心動

20、圖表現(xiàn): 圖像右側(cè)自上向下依次為左心室、二尖瓣、左房，左側(cè)為右心室、三尖瓣、右房，中央為室間隔、房間隔。,(２)此切面選用范圍:1)觀察與測量心室及心房大小及形態(tài)；2)觀察房、室間隔連續(xù)情況；3)觀察室壁厚度及運動、有無局部運動異常（心肌缺血、梗死）或膨出（室壁瘤）；4)觀察二尖瓣與三尖瓣數(shù)目、形態(tài)及開閉情況，測量兩隔葉根部附著位置間距離（Ebstein ) ；5)觀察心腔內(nèi)有無腫物（附壁血栓或心內(nèi)腫

21、瘤）及其附著位置、大小、活動情況；6)觀察三條（左上、左下、右上）肺靜脈是否均回入左房（肺靜脈異位引流）；7)左心房內(nèi)有無隔膜（三房心）；8)評價心功能。,心尖四腔切面,(3)正常測值①左室長徑：舒張末期為7.0～8.4cm，收縮末期為5.0～6.4cm 。②左房內(nèi)徑：上下徑為3.1～5.3cm （收縮末期，二尖瓣環(huán)聯(lián)線中點至左房頂部），橫徑為3.0～5.3cm。（收縮末期，心房中部）。③右室內(nèi)徑：橫徑為2.5～4.

22、2cm（舒張末期徑），長徑為5.8～7.8cm（舒張末期徑）。④右房內(nèi)徑為3.4～4,9cm , 橫徑為2.9～4,5cm （心尖四腔切面，收縮末期上下徑）。,心尖四腔切面Schematic diagram of the apical four-chamber view,showing the relationships of the left and right ventricles (LV and RV) and atria

23、(LA and RA). In the left ventricle, the papillary muscle, chordae, and anterior and posterior mitral leaflets (AMVL, PMVL) are seen. The descending aorta (DA) is seen in partial cross section lateral to the left atriu

24、m, while the right superior pulmonary vein(RSPV) drains into the left atrium adjacent to the interatrial septum. In the right ventricle, the moderator band (M and the anterior and septal tricuspid valve leaflets (AT

25、VL and STVL) are seen. Note the ventriculoatrial septum (VAS) separating the left ventricle from the right atrium in association with the normal, slightly more apical position of the tricuspid compared with the mitra

26、l valve annulus.Two-dimensional echo images in an apical four-chamber view at end-diastole (above) and end-systole (below).,心尖四腔切面,心尖四腔切面Subcostal view showing all four cardiac chambers,,,7.心尖兩腔切面,8.主動脈弓長軸切面,Schema

27、tic and 2D echo images of the aorta in a long-axis view from the suprasternal notch window. The ascending aortic (Ao) arch and descending thoracic aorta are seen with the origins of the left carotid and subclavian ar

28、teries. The right pulmonary artery (RPA) lies immediately inferior to the arch.,附：心超常見縮寫表 1,Abbreviation Definition2-D Two dimensional imaging3-D Three dimensional imagingA-Mode Amplitude modeA Atrial diastolic

29、 velocity peakA Area (seen in mathematical formulas)APEX 2C Apical two chamber viewAPEX 3C Apical three chamber view (also known as Apical Long axis)APEX 4C Apical four chamber viewAPEX 5C Apical five cha

30、mber viewAcT Acceleration timeAF Atrial fibrillationAMVL Anterior mitral valve leafletAnt Anterior,Ao AortaAI Aortic insufficiencyAS Aortic stenosisAsc AscendingASD Atrial septal defectASH Asymmetrical

31、septal hypertrophyATVL Anterior tricuspid valve leafletAV Aortic valveAVA Aortic valve areaAVR Aortic valve replacementBAV Balloon aortic valvuloplastyBP Blood pressureBSA Body surface areac propagation s

32、peed of sound in tissue,附：心超常見縮寫表2,dB DecibeldP/dt Rate of change in pressure over timeE EnergyECG ElectrocardiogramED End-diastoleEDD End-diastolic dimensionEDV End-diastolic volumeEF Ejection fractionep

33、i epicardiumEPSS E-point of septal separationES End-systoleESD End-systolic dimensionESPVR End-systolic pressure-volume relationshipESV End-systolic volume,CAD Coronary artery diseasecath Cardiac catheterizat

34、ionCBV Catheter balloon valvuloplastyCh ChordaeCm Centimetercm/s Centimeter per secondCO Cardiac outputCont eq Continuity equationcos CosineCS Coronary sinusCSA Cross sectional areaCx circumflex coro

35、nary arteryD DiameterDA Descending aorta,附：心超常見縮寫表3,ETT Exercise treadmill testΔ? Frequency shift? FrequencyFL False lumenFn near zoneFo resonance frequency (operating frequency)Fs scattered frequencyFS

36、V forward stroke volumeFt transmitted frequencyFx functionHCM hypertrophic cardiomyopathyHPRF High pulse repetition frequencyHR Heart rateHV Hepatic veinI IntensityIAS Interatrial septum,inf inferiorIV

37、intravenousIVC Inferior vena cavaIVCT Isovolumic contraction timeIVRT Isovolumic relaxation timekHz KilohertzL LengthLA Left atriumLAA Left atrial appendageLAD Left anterior descending coronary arteryLA

38、E Left atrial enlargementLAO Left anterior obliquelat LateralLAXX Parasternal long axisLCC Left coronary cuspLLD Left lateral decubitus,附：心超常見縮寫表4,MS Mitral stenosisMV Mitral valve MVA Mitral valve areaMV

39、I Mitral valve insufficiencyMyx myxomaNCC Noncoronary cuspΔP change in pressureP PressurePA Pulmonary arterypAn PseudoaneurysmPAP Pulmonary artery pressurePD Pulsed DopplerPDA Patent ductus arteriosis

40、PE Pericardial effusionPEP Pre-ejection periodPISA Proximal isovelocity surface area,LMCA Left main coronary arteryLPA Left pulmonary arteryLSPV left superior pulmonary veinLV Left ventricleLVEDD Left ventric

41、ular end diastolic dimensionLV-EDP Left ventricular end diastolic pressureLVESD Left ventricular end systolic dimensionLVH Left ventricular hypertrophyLVI Left ventricular inflowLVO Left ventricular outflowLV

42、OT Left ventricular outflow tractM-mode Motion modeMAC Mitral annular calcificationMB Moderator bandMI Myocardial infarction,附：心超常見縮寫表5,PM papillary musclePMVL Posterior mitral valve leafletpost posteriorPI

43、 Pulmonary insufficiencyPRF Pulse repetition frequencyPRFR Peak rapid filling timePS Pulmonary stenosisPV Pulmonic valvePTCA Percutaneous transluminal coronary angioplastyPV Pulmonary veinPVC Premature vent

44、ricular contractionPWT Posterior wall thicknessQ Volume flow rateQp Pulmonic volume flow rateQs Systemic volume flow rateRA Right atrium,RAE Right atrial enlargementRAO Right anterior obliqueRAP Right atria

45、l pressureRCA Right coronary arteryRCC Right coronary cuspRF Regurgitant fractionRJ Regurgitant jetROA Regurgitant orifice areaRPA Right pulmonary arteryRSPV Right superior pulmonary veinRSV Regurgitant s

46、troke volumeRV Right ventricleRVE Right ventricular enlargementRVH Right ventricular hypertrophyRVI Right ventricular inflowRVO Right ventricular outflow,附：心超常見縮寫表6,TGA Transposition of the great arteriesTGC

47、Time gain compensationTI Tricuspid valve insufficiencyTL True lumenTOF Tetralogy of FallotTPV Time to peak velocityTS Tricuspid stenosisTSV Total stroke volumeTTE Transthoracic echocardiographyTV Tricuspi

48、d valveV VelocityV VolumeVeg Vegetation,RVOT Right ventricular outflow tractSAM Systolic anterior motionSAXX Parasternal short axisSC SubcostalSSN Suprasternal notchST Septal thicknessSTJ Sinotubular ju