如何解读超声心动图报告-主动脉夹层——手把手教你学心超系列(12)

AD的二维超声表现
AD的二维超声表现
AD的食管超声探查
AD的食管超声表现
Schematic overview of modified transesophageal echocardiography. 1. Esophagus with TEE probe; 2. Trachea and left main bronchus
A normal flow pattern during extracorporeal circulation; artefact in the long-axis view, which does not indicate a persistent dissection.
ቤተ መጻሕፍቲ ባይዱ
1 A
UCG不推荐作为血流动力学稳定，血压正 常而怀疑（非高风险）PE诊断的初始。
2
B
不允许即刻行CT肺动脉造影时TTE可以提供 RVD 的证据，并据此先行溶栓挽救生命。
3
C
血压正常时，TTE不推荐作为诊断工具， 但可以用于危险分层。
AD的并发症
A型夹层破入心包腔手术过程
小结
肺栓塞是临床危重症，但肺栓塞不等于肺血栓栓塞症 超声心动图是PE的重要评估手段，表现各异 肺栓塞患者的超声报告多种多样，应区别对待
AD的食管超声表现
Modified TEE video of a patient with Stanford type A aortic dissection with progression into the innominate artery, visualized in a 2D long-axis and short-axis view.
AD的食管超声表现
Modified TEE aortic arch short axis view. Panel (a) Plain 2D image showing a dissection starting in the proximal aortic arch, which continued distally into the descending aorta. The intimal tear did not progress into the innominate artery. Panel (b) Similar image with color-Doppler showing flow through the true aortic lumen, and a normal perfusion of the innominate artery. 1 = Trachea with inflated endotracheal balloon; 2 = Innominate artery; 3 = True lumen; 4 = False lumen; red lines delineate the intimal tear
主动脉夹层的症状、体征、并发症
DeBakey分型
Stanford分型
常见的破口位置
主动脉夹层的破口位置以发生于升主动脉者 居多
其次为左锁骨下动脉远端胸主动脉和主动脉 弓；发生于腹主动脉者最少
正确判断夹层破口位置，对于选择治疗方案 有重要参考意义
诊断血管 CT MRI TEE
效果 造影
AD的食管超声表现
Propagation of an intimal tear into the innominate artery with almost complete obstruction of the vessel with limited perfusion of the true lumen
AD的食管超声表现
Modified TEE showing the innominate artery with three different modalities. Panel (a) 2D-image showing an intimal tear and differential flow. Panel (b) 3D-image in a different patient without dissection. Panel (c) MMode image of the same patient without dissection. 1 = Trachea with inflated endotracheal balloon; 2 = Innominate artery; 3 = Intimal tear
血管造影 ++ +++ ++ +++ +++ --+++ ++
CT ++ +++ + ++ --++ + +
MRI +++ +++ +++ +++
+ +++ ++
+
TEE +++ ++/+++ ++
+ +++ +++
+ ++
目录
主动脉夹层概述 主动脉夹层的超声表现 如何解读主动脉夹层的超声报告
AD的M型超声表现
AD的食管超声表现
Modified TEE long- and short axis (X-plane) images of the innominate artery. Panel (a) Image before surgery, showing propagation of an intimal tear into the innominate artery with almost complete obstruction of the vessel with limited perfusion of the true lumen. Panel (b) Image after surgery showing a normal flow pattern during extracorporeal circulation; artefact in the long-axis view, which does not indicate a persistent dissection. 1 = Trachea with inflated endotracheal balloon; 2 = Innominate artery
如何解读主动脉夹层的超声心动图报告
——手把手教你学心超系列（12）
目录
主动脉夹层概述 主动脉夹层的超声表现 如何解读主动脉夹层的超声报告
基本概念
主动脉夹层（aortic dissection）是指血液通过内膜的破口进入主动脉壁囊样 变性的中层而形成夹层血肿，并随血流压力的驱动逐渐扩展，导致主动脉中层的 解离过程。 本病并非主动脉壁的扩张，故有别于主动脉瘤。 多急剧发病，突发剧烈疼痛、 休克和血肿压迫相应的主动脉分支血管时出现的脏器缺血症状。 65%～75%病人在急性期(2周内)死于心包压塞、心律失常等心脏 并发症。年 龄高峰为50～70岁，男性发病率较女性为高。
敏感 ++ ++ +++ +++
性
特异 +++ +++ +++ ++/+
性
++
撕裂 ++ + +++ ++
部位
是否 +++ ++ +++ +
有血
栓
主动 +++ --- + +++
脉瓣
反流
心包 --- ++ +++ +++
压塞
分支 +++ + ++ +
受累
冠脉 ++ + + ++
受累
诊断效果 敏感性 特异性 撕裂部位 是否有血栓 主动脉瓣反流 心包压塞 分支受累 冠脉受累
AD的食管超声表现
Modified TEE aortic arch short-axis view in a patient with a normal aortic arch and flow pattern. 1 = Trachea with inflated endotracheal balloon; 2 = Innominate artery; 3 = Aortic arch; 4 = Left carotid artery
AD的食管超声表现
Panel (a) Modified TEE long- and short axis (X-plane) view of the distal ascending aorta (DAA), showing an intimal tear. Panel (b) Same image with color-Doppler showing differential flow in the true- and false lumen. 1 = Trachea with inflated endotracheal balloon; 2 = True lumen; 3 = False lumen; 4 = Intimal tear