Cardiovascular angiography see double ball sign

Introduction Cardiovascular angiography is one of the important means of diagnosing cardiovascular disease. It is a relatively complicated special inspection method, which has certain risks and needs to be strictly controlled. Cardiovascular angiography shows that the double-ball sign is a manifestation of the stenosis of Ebstein syndrome and requires surgery. The position of the right atrioventricular ring is normal (often enlarged). The anterior lobes of the tricuspid valve are normally attached to the annulus fibrosus, while the attachment points of the temporal and posterior lobes are obviously moved down and down the endocardium of the right ventricular wall. The extent of the movement and the manner of attachment vary from person to person, even if the attachment point of the valvular valve is adjacent to the annulus fibrosus, but because the leaflets are too long, they can often adhere to the right ventricular wall at different distal ends of the annulus.

Cause

The leaflets may be attached to the ventricular septum by means of a deformed chordae and the right ventricular apex. The posterior mitral tricuspid flap is often underdeveloped or completely absent may cause tricuspid regurgitation. In a small number of patients, the tricuspid valve merges into a aponeurosis in the ventricular lumen, with a hole in the middle or lateral margin, and the right atrial blood flow must be injected into the ventricle through this pore, thus impeding the evacuation of the atria. As the tricuspid valve moves down, the right atrium captures part of the right ventricle. The ventricular wall of this captured area becomes thinner and the room is enlarged, and the right atrium cavity is obviously enlarged. The right ventricle of the room belongs to the right atrium in function, but retains the characteristics of the right ventricular muscle in terms of electrical activity. The larger the right ventricle part of the room, the smaller the functional right ventricular cavity. The right ventricle of the room can not be inserted into the right ventricle. On the contrary, it is like a ventricular wall tumor. When the ventricle contracts, it expands contradictively, thus disturbing the right ventricular ejection.

Ebstein syndrome often has heart chamber traffic (as seen in 80% of cases). This heart chamber traffic can be an open orbital defect or a septal defect.

In the first two cases, there is often no cyanosis in the clinic. In the third case, there are a few patients with cyanosis. Even if there is no obvious right-to-left shunt, the difference in arteriovenous oxygen is increased due to low cardiac output, and there may be mild cyanosis in the clinic. In addition, in the functional right ventricle, systolic blood pressure is normal, and diastolic blood pressure is often increased, similar to constrictive pericarditis. Both atrial systolic and diastolic blood pressures were elevated. There may be systolic pressure difference on both sides of the pulmonary valve. There may be diastolic pressure difference on both sides of the tricuspid valve. The former may be too long due to a tricuspid leaflet and partially block the right ventricular outflow tract. The latter is due to tricuspid malformation and tricuspid valve. The mouth is narrow.

an examination

1. The symptoms of bruising in the neonatal period are obviously reduced or completely disappeared, and the cyanosis reappears after the elderly.

2. Cyanosis symptoms combined with tachyarrhythmia should first consider the disease.

3. Right-to-left shunt congenital heart disease, less pulmonary blood and no right ventricular hypertrophy.

4. The heart is enlarged, but the pulsation in the anterior region is very weak. There is a "multi-temporal" heart sound during auscultation.

5. Pulmonary blood is less and the heart is enlarged. The aorta and pulmonary artery are small, and the heart is like a balloon.

6.P-port high, but no right ventricular hypertrophy.

7. The right heart lead shows a complete right bundle branch block and a small multi-phase wide QRS wave.

8. There are blue-purple with B-type pre-excitation syndrome, and the pulmonary blood is less.

9. There are QR wave and T wave inversion on the V1~4 lead.

10. Echocardiography shows the tricuspid attachment point moving down.

Other auxiliary inspections:

1. ECG; 2. X-ray examination; 3. Echocardiography; 4. Right heart catheterization; 5. Selective right heart system angiography.

Differential diagnosis

Ebstein syndrome can be divided into 3 types according to clinical manifestations, auxiliary examination and hemodynamic changes during diagnosis: 1 light type: no or mild cyanosis, cardiac function I ~ II grade heart light to moderate increase, heart The internal shunt is mainly from left to right. There is no pressure difference between the right atrium and the functional right ventricle. There is no double spheroidal sign, no need for surgery or only closed intracardiac defect, and the prognosis is good. 2 stenosis type: cyanosis is obvious, heart function is above grade II, heart is mild to moderately increased, pulmonary circulation blood flow is reduced, there is pressure difference between enlarged right atrium and functional right ventricle, intracardiac shunt is right to left, cardiovascular The angiography sees the double ball sign and requires surgery. 3 insufficiency type: no or mild cyanosis, heart function level II or above, heart severity increased, no pressure difference between right atrium and functional right ventricle, intracardiac shunt can be left to right or right to left, angiography visible The right atrium is extremely large, with a double ball sign and requires surgery.

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