Come P C
Charles A. Dana Research Institute, Thorndike Laboratory, Department of Medicine, Beth Israel Hospital, Boston, Massachusetts 02215.
Am J Med. 1988 Mar;84(3 Pt 1):384-94. doi: 10.1016/0002-9343(88)90257-4.
Echocardiography provided the initial diagnosis of significant pulmonary hypertension, unrelated to left heart pathologic conditions, in 10 patients: four with acute pulmonary embolism; five with chronic pulmonary hypertension, primary in three patients and secondary to tumor emboli in the other two patients; and one with Eisenmenger's syndrome due to previously unsuspected atrial septal defects. Referral diagnoses were pericardial disease in five patients (including three with suspected tamponade), and right ventricular infarction versus pericarditis, atrial septal defect, dyspnea, inferoposterior infarction (by electrocardiography), and Ebstein's malformation in one patient each. The echocardiographic diagnoses were confirmed by lung scan (ventilation/perfusion mismatches were interpreted as high probability for pulmonary emboli in all four patients considered to have acute pulmonary emboli by echocardiographic study), pulmonary angiography (one patient), cardiac catheterization (four patients), and autopsy (three patients). No patient had evident aortic or mitral valvular, myocardial, or other left heart pathologic condition. In acute pulmonary embolism, mean right ventricular diameter was increased at 4.2 cm (range 3.2 to 6 cm) and right ventricular wall thickness was normal (mean 4.5 mm, range 3 to 5 mm). Moderate or marked right ventricular hypokinesis was noted in two patients each. Doppler examination, performed in three patients, revealed tricuspid regurgitation in all, with an increased flow velocity suggestive of mild to moderate systolic pulmonary hypertension (right ventricular minus right atrial pressures of 28 to 36 mm Hg). Patients with chronic pulmonary hypertension also had right ventricular dilatation (mean 4.4 cm diameter, range 3 to 5.4 cm) and hypokinesis (marked in four and moderate in one patient), but wall thickness was increased in all (mean of 9 mm, range 6 to 14 mm) and the flow velocities in the tricuspid regurgitant jets, detected by Doppler in all patients, suggested higher right ventricular minus right atrial pressures of 44 to 104 mm Hg (mean 64 mm Hg). The single patient with Eisenmenger's syndrome had right ventricular dilatation (3.2 cm), hypertrophy (10 mm), and hypokinesis (mild). Only the patient with Eisenmenger's syndrome had Doppler or contrast echocardiographic evidence for an intracardiac or extracardiac shunt. In the absence of left heart pathologic conditions, right ventricular dilatation and hypokinesis strongly suggest pulmonary arterial or primary right ventricular disease.(ABSTRACT TRUNCATED AT 400 WORDS)
超声心动图对10例与左心病理状况无关的严重肺动脉高压患者做出了初步诊断：4例为急性肺栓塞；5例为慢性肺动脉高压，其中3例为原发性，另外2例继发于肿瘤栓塞；1例因先前未被怀疑的房间隔缺损导致艾森曼格综合征。转诊诊断中，5例为心包疾病（包括3例疑似心包填塞），其余1例分别诊断为右心室梗死与心包炎、房间隔缺损、呼吸困难、下后壁梗死（通过心电图诊断）以及埃布斯坦畸形。超声心动图诊断经肺扫描（在超声心动图检查诊断为急性肺栓塞的所有4例患者中，通气/灌注不匹配被判定为肺栓塞的高概率表现）、肺动脉造影（1例患者）、心导管检查（4例患者）及尸检（3例患者）得以证实。所有患者均无明显的主动脉或二尖瓣瓣膜、心肌或其他左心病理状况。在急性肺栓塞患者中，右心室平均直径增至4.2厘米（范围为3.2至6厘米），右心室壁厚度正常（平均4.5毫米，范围为3至5毫米）。各有2例患者出现中度或重度右心室运动减弱。3例患者接受了多普勒检查，结果均显示三尖瓣反流，流速增加提示轻度至中度收缩期肺动脉高压（右心室与右心房压差为28至36毫米汞柱）。慢性肺动脉高压患者也存在右心室扩张（平均直径4.4厘米，范围为3至5.4厘米）及运动减弱（4例重度，1例中度），但所有患者的右心室壁厚度均增加（平均9毫米，范围为6至14毫米），所有患者经多普勒检测的三尖瓣反流束流速提示更高的右心室与右心房压差，为44至104毫米汞柱（平均64毫米汞柱）。唯一1例艾森曼格综合征患者存在右心室扩张（3.2厘米）、肥厚（10毫米）及运动减弱（轻度）。仅艾森曼格综合征患者有心脏内或心脏外分流的多普勒或对比超声心动图证据。在无左心病理状况的情况下，右心室扩张及运动减弱强烈提示肺动脉或原发性右心室疾病。（摘要截选至400词）
