彩色多普勒血流会聚法定量评估二尖瓣返流严重程度的研究

彩色多普勒血流会聚区（ＦＣＲ）法是近几年发展起来的一定量二尖瓣返流的新方法。本文应用该方法，对５５例显示血流会聚区的二尖瓣返流患者行ＦＣＲ法与返流束面积法（ＳＲ）、返流束面积与左房面积之比法（ＳＲ／ＳＬＡ）相比较，相关系数分别为０．８２２及０．７３２（Ｐ值均小于０．０１），并应用ＦＣＲ法定量测定二尖瓣返流率。按不同的返流率将二尖瓣返流分为轻、中、重三度。本文认为血流会聚法为定量评估二尖瓣返流（特别是中至重度返流）一较为理想的无创性方法，具有广泛的理论研究及临床应用前景。     

彩色多普勒血流会聚法对室间隔缺损分流程度的评估研究

本文应用彩色多普勒血流会聚法对２３例单纯室间隔缺损患者的分流程度进行评估，结果表明血流会聚法所测分而率Ｆ与频谱多普勒法所测的每搏分流量Ｑｐ－Ｑｓ及肺体循环血流量之比Ｑｐ／Ｑｓ之间均有极好的相关性（ｒ分别为０．９９和０．８７，Ｐ＜０．００１）。血流会聚区的简化指标ＮＬ×Ｒ及ＮＬ×Ｓ与Ｑｐ－Ｑｓ（ｒ＝０，９０～０．７３，Ｐ＜０．００１）及Ｑｐ／Ｑｓ（ｒ＝０．９３～０．８８，Ｐ＜０．００１）之间的相关性均很好。彩色多普勒血流会聚法能够快速、准确、无创地评估室间隔缺损的分流程度，其简化指标可以简便地对室间隔缺损的分流程度进行评估。     

彩色多普勒定量评价瓣膜返流的一种简便方法--"返流狭径"预测二尖瓣返流程度的实验研究

目的：评价返流狭径预测二尖瓣返流（ＭＲ）程度的准确性。方法：实验动物选用绵羊６只,预先手术（在４个月前）造成腱索损害引起ＭＲ。采用药理学方法获得２２种不同的血流动力学状态,使用Ｖｉｎｇｍｅｄ７７５彩色超声仪,探头匹配频率５ＭＨｚ,检测ＭＲ和返流狭径（ＶＣ,Ｖｅｎａｃｏｎｔｒａｃｔａ）,图像资料直接以数字化形式输入微机待后分析。结果：最大返流量（ＲＦＲ）１．８～９．８Ｌ／ｍｉｎ（５．２±２．５Ｌ／ｍｉｎ）;平均ＲＦＲ０．７～４．１Ｌ／ｍｉｎ（２．４±１．２Ｌ／ｍｉｎ）;每搏返流量（ＲＳＶ）７．０～４７．５ｍｌ／ｂｅａｔ（２４．６±１１．９ｍｌ／ｂｅａｔ）;返流分数（ＲＦ）２３％～７８％（５３±１７％）。返流狭径与最大ＲＦＲ相关良好（ｒ＝０．９４,ＳＥＥ＝０．０５ｃｍ）,与ＲＳＶ和ＲＦ相关较好（ｒ＝０．８５,ＳＥＥ＝０．０８ｃｍ和ｒ＝０．８９,ＳＥＥ＝０．０７ｃｍ）。结论：使用高分辨力的超声仪器测定返流狭径是评价ＭＲ程度的实用、简便和准确的无创检测技术,并为今后的临床和实验研究提供了一种可比的测量方法     

彩色多普勒血流会聚法定量二尖瓣返流的临床探讨

为探讨临床应用彩色多普勒血流会聚法定量评价二尖瓣返流，本文采用心脏造影－热稀释方法作对照，研究２２例二尖瓣返流患者，发现会聚法测得的每搏返流量、返流分数与心导管法浊值总体相关良好（ｒ分别为０．９３－０．９４，０．８１－０．８７）。会聚方法（１）计算的每搏返流量值与心导管法测值无显著差异，而会聚方法（２）的每搏返流量测值出现低估。会聚方法（１）能直接较准确计算每搏返流量，但不能直接提供返流分烽，该方     

多普勒超声估测小儿先心病肺动脉压

经多普勒超声检测２０例先天性心脏病（ＣＨＤ）患儿三尖瓣最大返流速度来估测肺动脉收缩压（ＰＡＳＰ）,旨在探讨该法的准确性及临床意义。２０例ＣＨＤ患儿均伴肺动脉高压（ＰＨ）和三尖瓣返流（ＴＲ）,男女各１０例,年龄３～１４岁,平均（６．８±３．５）岁。其中室间隔缺损（ＶＳＤ）１２例,ＶＳＤ并房间隔缺损４例,ＶＳＤ并动脉导管未闭４例。应用ＡＣＵＳＯＮ－１２８型彩色多普勒超声仪,探头频率２．７～７．０ＭＨｚ。用连续多普勒仔细探测三尖瓣最大返流速度,按简化泊努利方程计算收缩期三尖瓣最大跨瓣压,加上右心房压即…     

彩色多普勒血流会聚与众射流参数在二尖瓣返流定量中的价值

用血流会聚新方法及射流参数对二尖瓣返流定量的价值进行了研究。结果表明血流会聚法计算返流量与二尖瓣返流容积及返流分数相关性最佳。彩色多普勒射流参数与二尖瓣返流容积和二尖瓣返流分数的相关性不一，其中返流起始宽度与两者相关性分别为ｒ＝０．８７－０．９３，Ｐ＜０．０００１）．彩色多普勒射流参数与二尖瓣返流容积和二尖瓣返流分数的相关性不一，其中返流起始宽度与两者相关性分别为ｒ＝０．８８和０．８１（Ｐ＜０．０     

双平面经食管彩色多普勒评价二尖瓣返流对肺静脉血流的影响

本文应用双平面经食管多普勒测定了２０例正常人和３８例二尖瓣返流（ＭＲ）患者的肺静脉血流频谱，旨在评价不同程度ＭＲ对肺静脉（ＰＶ）回流的影响。结果表明：①与正常组相比，明显ＭＲ组ＰＶ收缩期峰值流速及流速积分显著降低（Ｐ＜０．０２），而舒张期峰值流速及流速积分显著升高（Ｐ＜０．０５及０．０２），且随着ＭＲ程度的加重，上述改变更趋明显；②３８例ＭＲ患者中，２４例记录到ＰＶ收缩期负向波，其中轻度ＭＲ４例（３３．３％），中度ＭＲ７例（７０％），重度ＭＲ１３例（８１．２％），房颤及窦性心律的ＭＲ患者出现ＰＶ负向波的例数无明显差异（１２／１９对１０／１９，Ｐ＝０．３７）；③ＭＲ时，ＰＶ收缩期负向波流速与ＭＲ返流束面积和长度正相关（ｒ分别为０．５１及０．４１，Ｐ＝０．００１和０．０１４），而与ＭＲ最大返流速度及返流压差不相关（Ｐ＞０．０５）。结论：ＭＲ对肺静脉血流具有重要影响，主要是使肺静脉在收缩期的回流减慢甚至出现倒流，后者尤常见于重度ＭＲ者，因此测定肺静脉血流频谱有助于对ＭＲ严重性的估价     

六种超声参数估测主动脉瓣返流程度的对照研究

本文应用二维及彩色多普勒超声心动图对４０例主动脉瓣关闭不全患者的返流程度用六种超声参数进行综合评估。这六种超声参数为：（１）主动脉瓣返流面积（ＡＲＡ）；（２）左室面积（ＬＶＡ）；（３）返流面积与左室面积比值（ＡＲＡ／ＬＶＡ）；（４）返流束长度（ＡＲＬ）；（５）返流速度（ＡＲＶ）；（６）左室内径（ＬＶＤ）。结果表明：ＡＲＡ与ＬＶＡ相关最好，ｒ＝０．８３９，其次为ＬＶＤ与ＡＲＡ，ＬＶＤ与ＡＲＡ／ＬＶＡ，ＡＲＡ／ＬＶＤ与ＡＲＬ，相关系数分别为０．７７５，０．７５５，０．７１３，而ＡＲＶ除与ＡＲＬ相关（ｒ＝０．６３１）外，与其他参数均不相关。提示我们用ＡＲＡ，ＬＶＡ，ＡＲＡ／ＬＶＡ，ＡＲＬ和ＬＶＤ综合分析，才能更合理估测主动脉瓣返流程度。     

超声脉冲多普勒三维数字频谱图在房室瓣返流的应用研究

本文报告了使用超声多普勒三维数字频谱图仪对５０例房室瓣返流（２８例二尖瓣返流、２２例三尖瓣返流）的应用研究，观察到不同程度房室瓣返流组的多普勒散射光点数（Ｎ）、散射强度（Ｓ）及其比值（Ｓ／Ｔ、Ｓ／Ｎ等）有着显著性差异（Ｐ＜０．０５－０．００１），散射强度等测值与彩色多普勒超声所测返流分数相关良好（ｒ值０．６３－０．９６）。提示超声多普勒三维数字频谱图提供了一种定量研究房室瓣返流的途径。     

测量有效返流口面积在二尖瓣关闭不全定量诊断中的价值

用彩色多普勒血流会聚方法测量了二尖瓣有效返流口面积，并探讨了该指标在二尖瓣关闭不全定量诊断中的价值。结果表明，这一指标与二尖瓣返流容积、返流分数，彩色多普勒返流起始宽度、返流面积具有良好的相关性（分别为ｒ＝０．８９、０．８４、０．８２及０．６７，Ｐ＜０．００１～０．０００１）。有效返流口面积≥３０ｍｍ２区别轻、中度与重度返流的准确度为９５．７％。有效返流口面积是一种较好的反映二尖瓣关闭不全的指标。     

Pulsed Doppler echocardiography in the assessment of tricuspid regurgitation

Pulsed Doppler echocardiography is a noninvasive method with high sensitivity and specificity for the assessment of tricuspid regurgitation. In patients with tricuspid regurgitation, pansystolic unusual Doppler signals are detected in the right atrial cavity, which are interpreted as tricuspid regurgitant flow signals. They distributed in a spindle-shaped area from the tricuspid orifice toward the right atrial posterior wall in parallel with the interatrial septum. The orientation of the range where the regurgitant Doppler signals are detected in the right atrial cavity shows the direction of the regurgitant jet. However, such a result is determined mainly in patients with functional tricuspid regurgitation. In regard to patients with organic tricuspid lesion, different considerations may be necessary. Semiquantitative grading of the severity of regurgitation is possible, based on the distance covered by the regurgitant signals from the tricuspid orifice. Tricuspid regurgitation is demonstrated also by contrast echocardiography. The severity is graded based on the distance reached by regurgitant curvilinear contrast echoes from the tricuspid valve in the M-mode echocardiography. If the ultrasound beam is adequately directed through the tricuspid orifice, the grade estimated by the contrast echoes are well correlated with that by the Doppler. However, if the M-mode is performed without the guide by the two-dimensional image, it may miss the most adequate beam direction for the observation, resulting in underestimating severity. The influences of tricuspid regurgitation are generally seen in the flow pattern of the major veins. However, they are more sharply reflected by the flow condition in the right atrial cavity than by the flows patterns in the major veins.     

彩色多普勒血流会聚法评估偏心性二尖瓣返流的临床价值

观察３０列显示血流会聚区的偏心性二尖瓣返流患者的返流束形态，发现均为附壁细长束。返流束面积、返流束面积／左房面积与频谱多普勒法及血流会聚法测定的参数比较左相关性均较差，相关系数分别为０．５９、０．５６及０．５５、０．５７，耐血流会聚法所测返流率与频谱多普勒法所测返流量则高度相关，相关系数为０．９６（Ｐ＜０．０１）。     

近场射流宽度在评价三尖瓣返流中的应用探讨

本文观察了39例三尖瓣返流患者的彩色返流束，根据返流束是否偏心分为中心返流组（A组）和偏心返流组（B组），并把两组返流束大小参数同多普勒法计算的每搏返流流率进行相关分析。结果发现，近场射流宽度与三尖瓣返流流率间在A、B两组均呈良好相关（r＝0.75，和0.71，P＜0.05），返流束长度及面积在A组与运流流率间呈中度相关（r＝0.58，和0.54，P＜0.05），而在B组则无明显相关（P＞0.05）。结论：（1）近场射流宽度可以较准确地评价三尖瓣返流程度;（2）在偏心三尖瓣返流时彩色返流束长度和面积低估返流程度。     

Quantitative assessment of valvular regurgitations using the pulsed Doppler technique. Approach to the regurgitant lesion

It is now possible with pulsed Doppler to grade the severity of aortic, mitral and tricuspid regurgitations on a quantitative basis. “Indices” were devised, using the measurement of the spatial extent of abnormal Doppler signals.For aortic regurgitation: (1) at the aortic valvular orifice area, by measurement of the regurgitant aortic valvular area and calculation of the valvular regurgitant “index”. (2) In the left ventricle outflow tract, by calculation of an “index” combining information from two echographic (short and long axis) planes.For mitral regurgitation: by calculation of the total regurgitant “index” combining information from examination of the annulus in short axis, and of the left atrium in long axis view.For tricuspid regurgitation: at the tricuspid annulus, by averaging the depth of the reversal wave on two samples recorded using various echographic approaches.A group of patients with aortic (42), mitral (55) and tricuspid (57) regurgitation proven by invasive procedures, was investigated with this procedure using a 3 MHz two dimensional pulsed Doppler echo device. Correlative coefficients between the Doppler grading and that provided by independently performed invasive procedures on a three point scale, ranged between 0.66 and 0.88, with significant differentiation of mean values of indices (P < 0.01 to P < 0.001) for each grade of severity.Success in the Doppler grading of severity of the regurgitations requires (1) a sampling as close as possible to the lesion, and optimally at the very site of the lesion, (2) the largest explorable area at the site of the lesion, (3) the relevancy of the selected Doppler parameter in order to take into account, as much as possible, the three dimensional configuration of the regurgitant jet. Moreover, this mapping procedure provides a pathophysiological insight of the regurgitant lesion for left-sided regurgitations.     

实时三维彩色多普勒血流显像与磁共振定量心脏瓣膜反流束容积的对照研究

目的探讨实时三维彩色多普勒血流显像（RT-3DCDFI）技术诊断和定量评估心脏瓣膜反流的临床应用价值。方法17例主动脉瓣反流患者和11例二尖瓣反流患者,应用RT-3DCDFI采集瓣膜反流束三维彩色多普勒血流信号数据库,导入TomTec三维图像工作站脱机测量反流束容积,并与磁共振（MRI）测值对照。结果28例瓣膜反流RT-3DCDFI检查均取得满意效果,包括中心型反流19例（主动脉瓣反流12例,二尖瓣反流7例）,偏心型反流9例（主动脉瓣反流5例,二尖瓣反流4例）。RT-3DCDFI与MRI对反流束容积的测值相关性良好。全部病例组RT-3DCDFI与MRI测值相关性r=0.93,Y=0.89X＋3.39,P〈0.0001,二者间的均数差为1.7ml,标准差为8.3ml;中心型反流组RT-3DCDFI与MRI测值相关性r=0.94;偏心型反流组RT-3DCDFI与MRI测值相关性r=0.91。结论RT-3DCDFI可准确测量瓣膜反流束容积,有望为临床定量评估心脏瓣膜反流提供一种简便、准确、可靠的新方法。     

血流会聚区大小与返流束大小评估二尖瓣返流程度的对比研究

为了探讨彩色多普勒对二尖瓣返流程度更为准确，快捷的评估方法，我们对３０例二尖瓣关闭不全患者进行了血流会聚区大小及反流束大小判断二尖瓣返流的对比研究，结果显示，血流会聚高，宽，面积及返流束长，面积，瞬间返流容积等与频谱多普勒法测量的二尖瓣返流分数的相关性分别为０．９２，０．８２，０．９１，０．５９，０．７２和０．６７。上述六种参数预报重度二尖瓣返流的准确度分别为９０．０％，８６．７％，９０．０％，７     

Three-dimensional color Doppler: a new approach for quantitative assessment of mitral regurgitant jets.

Color Doppler echocardiography does not provide adequate information about the severity of mitral regurgitation in patients with eccentric mitral regurgitation. We have developed a new procedure for 3-dimensional (3D) color Doppler reconstruction and for segmentation of regurgitant jets. The volume of regurgitant jets was compared with jet area in 63 patients with mitral regurgitation. Mitral regurgitation was assessed by angiography, regurgitant fraction and volume by pulsed Doppler, JA by planimetry, and JV by 3-dimensional Doppler. Twenty-eight patients with central jets were compared with 35 patients with eccentric jets. In the patients with eccentric jets, JV showed significant correlations with regurgitant volume (r = 0.90; P <.01) and regurgitant fraction (r = 0.76; P < .01) and was able to separate groups with different degrees of mitral regurgitation (P <.01). Three-dimensional Doppler revealed origin, direction, and spatial spreading of complex jet geometry. JV, a new parameter of mitral regurgitation, was also capable of quantifying asymmetrical jets.     

Flow Convergence Flow Rates from 3-Dimensional Reconstruction of Color Doppler Flow Maps for Computing Transvalvular Regurgitant Flows Without Geometric Assumptions: An In Vitro Quantitative Flow Study

OBJECTIVE: This study was designed to develop and test a 3-dimensional method for direct measurement of flow convergence (FC) region surface area and for quantitating regurgitant flows with an in vitro flow system. BACKGROUND: Quantitative methods for characterizing regurgitant flow events such as flow convergence with 2-dimensional color flow Doppler imaging systems have yielded variable results and may not be accurate enough to characterize those more complex spatial events. METHOD: Four differently shaped regurgitant orifices were studied: 3 flat orifices (circular, rectangular, triangular) and a nonflat one mimicking mitral valve prolapse (all 4 orifice areas = 0.24 cm(2)) in a pulsatile flow model at 8 to 9 different regurgitant flow rates (10 to 50 mL/beat). An ultrasonic flow probe and meter were connected to the flow model to provide reference flow data. Video composite data from the color Doppler flow images of the FC were reconstructed after computer-controlled 180 degrees rotational acquisition was performed. FC surface area (S cm(2)) was calculated directly without any geometric assumptions by measuring parallel sliced flow convergence arc lengths through the FC volume and multiplying each by the slice thickness (2.5 to 3.2 mm) over 5 to 8 slices and then adding them together. Peak regurgitant flow rate (milliliters per second) was calculated as the product of 3-dimensional determined S (cm(2)) multiplied by the aliasing velocity (centimeters per second) used for color Doppler imaging. RESULTS: For all of the 4 shaped orifices, there was an excellent relationship between actual peak flow rates and 3-dimensional FC-calculated flow rates with the direct measurement of the surface area of FC (r = 0.99, mean difference = -7.2 to -0.81 mL/s, % difference = -5% to 0%), whereas a hemielliptic method implemented with 3 axial measurements of the flow convergence zone from 2-dimensional planes underestimated actual flow rate by mean difference = -39.8 to -18.2 mL/s, % difference = -32% to -17% for any given orifice. CONCLUSIONS: Three-dimensional reconstruction of flow based on 2-dimensional color Doppler may add quantitative spatial information, especially for complex flow events. Direct measurement of 3-dimensional flow convergence surface areas may improve accuracy for estimation of the severity of valvular regurgitation.     

Color flow Doppler mapping studies of "physiologic" pulmonary and tricuspid regurgitation: evidence for true regurgitation as opposed to a valve closing volume.

Color flow Doppler mapping using either an Aloka 880 or a Toshiba SSH65A system was performed in 39 normal subjects (aged 13 to 45 years) and 43 patients (aged 13 to 82 years) with pathologic tricuspid or pulmonary regurgitation to evaluate the incidence of "physiologic" regurgitation of right heart valves and to determine the differentiating characteristics in the spatial distribution and velocity encoding of "normal" and "pathologic" regurgitant jets. In the normal subjects, tricuspid and pulmonary regurgitation were documented in 32 (83%) and 36 (93%), respectively, and were unrelated to the system being used. Flow acceleration and aliasing were imaged on the right ventricular side of the tricuspid regurgitant orifice and on the pulmonary artery side of the pulmonary valve (in both normal subjects and patients), and indicated flow convergence for true regurgitation through an orifice as opposed to blood being driven retrogradely by the closing valve. Such proximal acceleration was documented in all patients with pathologic tricuspid regurgitation, in 31/32 of the normal subjects with tricuspid regurgitation, and was also observed in 12/15 (80%) of the patients and 4/12 (33%) of normal subjects with pulmonary regurgitation who were examined with the Toshiba system. The dimensions (mean +/- SD) of tricuspid regurgitant jets (length [JL] and area [JA]) were consistently larger in the patients than in the normal subjects [JL: 3.4 +/- 0.9 vs 1.2 +/- 0.5 cm, p less than 0.001; and JA: 5.7 +/- 2.0 vs 1.4 +/- 0.7 cm2, p less than 0.001) as were the pulmonary regurgitation jet dimensions (JL: 1.8 +/- 0.4 vs 0.9 +/- 0.08 cm, p less than 0.001; JA: 1.8 +/- 0.7 vs 0.3 +/- 0.08 cm2, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)