成人心脏瓣膜病病因分析

目的：探寻成人心脏瓣膜病的主要病因。方法：回顾2004年3月～2004年11月在我院行心脏瓣膜手术并留取组织活检标本的成人心脏瓣膜病326例,结合病史、术中瓣膜状态及病理检查结果,确定引起瓣膜损害的主要原因。结果：最常见受累瓣膜为二尖瓣,无论二尖瓣和（或）主动脉瓣病变,瓣膜狭窄和（或）关闭不全,风湿病均为最常见的病因。结论：成人心脏瓣膜病病因以风湿性心脏瓣膜病居多。     

心脏瓣膜置换23例报告

我院自1986年10月至1988年4月施行心脏瓣膜置换手术23例,近期疗效满意。本文就重症心脏瓣膜病手术时机选择和术后并发人工瓣膜急性阻塞处理的体会作下述报道。 临床资料 本组男性8例,女性15例,年龄18～45岁,病程2～20年。风湿性心脏瓣膜病22例,先天性心脏瓣膜病1例。其中二尖瓣混合病变18例,二尖瓣关闭不全1例,二尖瓣狭窄、关闭不全伴主动脉瓣关闭不全2例,主动脉瓣关闭不全     

少见危重心脏瓣膜病手术及围术期处理

目的总结危重心脏瓣膜病手术救治休会。方法从1993年10月至1998年5月，对7例少见危重心脏瓣膜病进行了休外循环心内直视手术。其中．创伤性二尖瓣前叶撕裂合并慢性缩窄性心包炎1例．行心包剥脱及二尖瓣成形术；二尖瓣置换术后感染性心内膜炎严重瓣周漏1例，行再次二尖瓣置换水；二尖擗置换术后机械瓣膜故障1例；二尖瓣重度狭窄并心脏骤停1例；二尖瓣脂肪瘤1例(术前诊断为左房粘液瘤)，行二尖瓣置换术；联合瓣膜病行二尖瓣置换术重虚低心排出量综合征，再次手术行主动脉瓣置换1例；法乐四联症合并主动脉瓣关闭不全，行心内矫治及主动脉瓣置换术1例。结果 本组无手术及术后远期死亡。术后低心排出量综合征5例．急性心包填塞2例．严重肝、肾砷能损害2例，反复室颤1例，难以纠正的低血钾、低血钠各l例．术后经积极救治，惠均垂愈出院。结论 危重心脏擗膜病内科治疗无效的患，庄及时手术解除严重毁损的瓣膜及相关病变．纠正循环血液动力学障碍；该类病例围术期并发症较为蹙出．是临束救治的难点；及时合理地实施手术、麻醉力求平穗、良好的心肌保护措施以及强有力的术后处理是抢救成功的关键。     

超声监测经皮二尖瓣球囊成型术16例报告

经皮二尖瓣球囊成型术（ＰＢＭＶ）,因其创伤小,深受欢迎。但用经胸超声心动图与Ｘ线相结合监测进行心内引导治疗二尖瓣狭窄（ＭＳ）,报道较少［１］。我院自１９９４年８月以来,对１６例二尖瓣狭窄病人进行了超声监测下ＰＢＭＶ治疗,现总结报告如下。材料与方法本文１６例,男５例,女１１例,年龄２０～５１岁,平均３３．５岁,单纯二尖瓣狭窄６例,二尖瓣狭窄伴轻度关闭不全３例,二尖瓣狭窄伴轻度二尖瓣关闭不全及主动脉瓣关闭不全３例,二失瓣狭窄伴主动脉瓣轻度关闭不全及三尖瓣轻度关闭不全２例,二尖瓣狭窄伴主动脉瓣轻度关闭…     

老年钙化性心瓣膜病病变程度及类型与冠心病的关系

目的比较不同程度、不同类型的老年钙化性心瓣膜病（CVHD）患者冠心病发病率及易患因素的差异。方法574例经超声心动图诊断为CVHD的患者,根据血流动力学改变程度分为轻、重度病变组,比较冠心病发病率、易患因素等的差异。结果重度病变组97例,分为主动脉瓣狭窄组（AS组）、主动脉瓣关闭不全组（AI组）和二尖瓣病变组（MV组）,其余为轻度病变组;各组间血压、血脂、空腹血糖、年龄及冠心病、高血压病、高脂血症、糖尿病的发病率等无显著性差异。结论轻、重度CVHD对冠心病具有相似的预测价值,轻度CVHD亦应受到重视。     

老年退行性心瓣膜病的超声诊断分析

目的分析老年退行性心脏心瓣膜病的超声诊断方法和结果,总结超声诊断在老年退行性心脏瓣膜病中的临床诊断价值。方法选自本院2009年1月~2010年10月98例超声诊断为老年退行性心瓣膜病60岁以上的患者,观察其心瓣膜的形态和回声以及活动度,同时常规测量其心脏大小和功能,观察其瓣膜的形态以及运动情况,有无反流等。对这些诊断结果进行回顾性分析。结果被确诊为老年退行性心瓣膜病98例,心脏超声检查发现有主动脉瓣钙化的29例,有主动脉瓣环钙化的41例,有钙化性主动脉瓣狭窄的11例,有钙化性主动脉瓣关闭不全的11例,有二尖瓣钙化的6例;在主动脉瓣发生狭窄11例中,主动脉瓣口的平均压差为3.15~3.23kPa;其中没有冠瓣受累的51例,有右冠瓣受累的32例,有左冠瓣受累的15例;主动脉瓣发生退行性钙化返流的69例,比较轻的为细条状的钙化返流,严重的达到Ⅱ到Ⅳ度的钙化返流并且致心左室的内径发生增大。结论超声检查可以发现老年退行性心瓣病主要以主动脉瓣病变多见,心脏形态以及功能的改变是由于左心房的扩大以及左室的舒张功能减低。     

双瓣置换术患者围手术期的护理体会

风湿性心脏病 (简称风心病 )是一种严重的心脏疾病 ,常引起心脏瓣膜的改变 ,其后期治疗主要靠瓣膜置换术〔1〕。我院自 2 0 0 0 - 0 8～ 2 0 0 1 - 0 5对 6例风湿性心脏病联合瓣膜病患者行主动脉瓣、二尖瓣置换术 ,手术顺利 ,术后成功渡过危险期。现将围手术期护理体会报告如下 :1　临床资料　　本组 6例 ,男 2例 ,女 4例 ;年龄 2 2岁～ 51岁 ,平均 38岁。6例患者均为风湿性心脏病 ,主动脉瓣重度狭窄伴中度关闭不全、二尖瓣中度狭窄伴关闭不全。心功能Ⅳ级 5例 ,Ⅲ级 1例 ,均有心房纤颤。 4例肺功能正常 ,2例肺功能轻度下降。所有患者均有多…     

合并主动脉瓣返流的二尖瓣狭窄球囊成形术

合并主动脉瓣返流的二尖瓣狭窄球囊成形术２２１００４徐州解放军第９７医院项军屈健梅健张新建徐卫东刘牧关键词经皮球囊二尖瓣成形术；二尖瓣狭窄；主动脉瓣关闭不全中国图书资料分类号Ｒ５４随着经皮球囊二尖瓣成形术（ＰＢＭＶ）的广泛开展，经验不断积累，适应证亦有...     

MR多技术扫描检测活性心肌及其和心肌声学造影对比的临床研究

目的 评价MR多技术扫描和心肌声学造影（MCE）在检测心肌灌注、判断心肌存活中的作用。资料与方法 应用MR多技术扫描对36例冠心病患者进行检查,并将结果与冠状动脉造影、MCE结果对照。结果 共有81支冠状动脉狭窄≥70％,狭窄的冠状动脉供血区域为334个（57．99％）节段。MR心肌灌注扫描见268个（46．53％）节段呈缺血改变,MR心肌活性扫描见83个（14．4l％）节段心肌梗死。以冠状动脉造影结果为标准,MR心肌灌注扫描的敏感性为80．2％,特异性为100％,总符合率为88．5％,Kappa值为0．773。定性MCE检查共有202个（35．07％）节段呈缺血改变。以冠状动脉造影结果为标准,定性MCE的敏感性为60．5％,特异性为100％,总符合率为77．1％,Kappa值为0．563。MR心肌灌注扫描所发现的缺血节段比狭窄冠状动脉的供血节段少但无统计学意义（P=0．468）,MCE所发现的缺血节段比狭窄冠状动脉的供血节段少（P=0．000）;MR心肌灌注扫描检出缺血节段比MCE检出的多（P=0．000）。结论 MR多技术扫描可清晰显示心肌缺血或梗死的位置、程度,可重复性好,与冠状动脉造影结果的一致性较高。MCE为临床提供了元创、可重复地准确测定心肌缺血的新方法,但其评价方法具有一定主观性且低估心肌缺血的范围,检查者的经验和检查方法在一定程度上影响其准确性。     

心肌致密化不全的MRI与超声心动图对比研究

目的：探讨心肌致密化不全（NVM）的MRI和超声心动图征象，评价MRI对诊断心肌致密化不全的价值。方法：对常规超声心动图多切面诊断为NVM的14例患者进行MR检查。MR扫描序列包括黑血技术：双反转恢复快速自旋回波（DIRFSE）和三反转恢复快速自旋回波（TIRFSE）序列；亮血技术：快速稳态进动采集（FIESTA）序列。所有患者进行短轴面、四腔面和长轴面检查。结果：14例患者MRI和超声心动图显示13例左室受累，1例双室受累，以心尖部和中间部多见。MRI共显示54段，超声心动图显示53段，对各段的显示能力两者差异无统计学意义（P=1．000）。受累心肌分层，非致密化心肌和致密化心肌厚度比值（N／C）测量MRI与超声心动图分别为3．374-0．89、3．194-0．82。非致密化心肌层信号不均匀，可见异常粗大的肌小梁和其间深陷的隐窝，隐窝内血流与心腔内相通。合并室壁瘤形成1例，冠状动脉造影显示正常。1例因进行性心力衰竭而行心脏移植，受累心脏病理解剖显示心腔内异常粗大、增多的肌小梁和深陷的隐窝，与MRI有较好的一致性。结论：NVM的MRI表现具有一定特征，多序列、多平面的MRI对于诊断NVM有重要的临床价值。与超声相比，MRI具有较高的软组织分辨率和空间分辨率，对于心肌分层的显示优于超声。     

Magnetic resonance imaging of aortic and mitral valve insufficiency. Comparison with Doppler echocardiography and angiocardiography

Fourty-five subjects--10 normal volunteers and 35 patients with valvular insufficiency were examined with MRI and [20 of them with mitral (MI) and 15 with aortic (AI) insufficiency] were evaluated with MR imaging and with Doppler echocardiography (echo-Doppler); 22 of these patients were also studied with angiocardiography. The extent of regurgitation jet was classified as follows: minimal (1+), mild (2+), moderate (3+), and severe (4+), according to the max distance of regurgitant jet signal from valvular leaflets. In our series, MR imaging with FFE sequences always showed the regurgitant jet. High agreement was found between MR and echo-Doppler results (80% for MI, and 86% for AI). In 22 patients who underwent angiocardiography, we observed 73% agreement. Cine-MR imaging proved to be an accurate and sensitive technique to recognize and to evaluate severity of regurgitant valvular flow in patients with AI and MI. This technique may be useful in those patients in whom Doppler echocardiography is inadequate or impossible to perform.     

Cine MR imaging of heart valve dysfunction with segmented true fast imaging with steady state free precession

PURPOSE: To evaluate the value of cine true fast imaging with steady-state free precession (SSFP) for semiquantitative assessment of valvular dysfunction in the heart and to compare the results to that obtained with a standard breath-hold segmented gradient-recalled echo-planar imaging sequence (GE-EPI). MATERIALS AND METHODS: Twenty-three patients with known valvular dysfunction (main component: 16 with aortic valve stenosis, nine with aortic valve insufficiency, three with mitral stenosis, two with mitral regurgitation, two with tricuspidal regurgitation, and one with pulmonary stenosis) and 23 control subjects with normal valvular function underwent MR imaging on a 1.5-T system (ACS-NT, Philips, Best, The Netherlands). Cine SSFP and GE-EPI images were acquired in identical long-axis views. Images were evaluated for the presence and extent of the signal void arising from the valves and for image quality consensus by two experienced radiologists. Results were compared to those obtained by cardiac catheterization (in 16 patients) or color Doppler (in the remaining seven patients). RESULTS: On SSPF images, the complex flow pattern in valvular regurgitant or stenotic lesions caused signal void within the bright blood pool of the atria or ventricles, similar to GE-EPI, in all patients. Valvular dysfunction was delineated using SSFP with the same high sensitivity (100%) as using the GE-EPI sequence. Results correlated to those obtained by cardiac catheterization or color Doppler ultrasonography (P < 0.001, r = 0.97). However, the jet phenomenon was slightly more pronounced in five patients on GE-EPI. There was no significant signal void in the 23 control subjects with both sequences. In all 46 subjects, the image quality of SSFP images was rated higher (P < 0.05; 2.6 +/- 0.1; using a scale ranging from 0-3) compared to GE-EPI (1.7 +/- 0.1). CONCLUSION: The results of this study suggest that valvular dysfunction can be semiquantitatively assessed using SSFP cine MR imaging.     

Correlation of cine MR imaging with two-dimensional pulsed Doppler echocardiography in valvular insufficiency

Eight adults with known valvular insufficiency were studied with cine magnetic resonance (MR) imaging. Our cine MR uses cardiac synchronization of a rapid small flip angle pulse sequence on a 1.5 T MR system. Eleven regurgitant lesions (including aortic, mitral, and tricuspid valves) were imaged with both cine MR and two-dimensional pulsed Doppler echocardiography (2-DPDE). In each case of significant regurgitation the jet of valvular insufficiency was easily seen as a discrete area of low signal with cine MR. Not only was the regurgitant jet identified but also its relative severity agreed well with the 2-DPDE results. In two patients the regurgitant lesions were identified on cine MR prior to 2-DPDE. In addition to the regurgitant jet, chamber enlargement and wall thickening were also well demonstrated. Cine MR is a promising modality for both the detection and semiquantification of valvular insufficiency.     

Aortic stenosis: evaluation with multidetector CT angiography and MR imaging

Aortic valvular stenosis (AS) is the most common valve disease which results in the need for a valve replacement. Although a Doppler echocardiography is the current reference imaging method, the multidetector computerized tomograpghy (MDCT) and magnetic resonance imaging (MRI) have recently emerged as a promising method for noninvasive valve imaging. In this study, we briefly describe the usefulness and comparative merits of the MDCT and MRI for the evaluation of AS in terms of valvular morphology (as the causes of AS), quantification of aortic valve area, pressure gradient of flow (for assessment severity of AS), and the evaluation of the ascending aorta and cardiac function (as the secondary effects of AS). The familiarity with the MDCT and MRI features of AS is considered to be helpful for the accurate diagnosis and proper management of patients with a poor acoustic window.     

Cine MR imaging in aortic stenosis

The potential of cine magnetic resonance (MR) imaging for the assessment of aortic stenosis (AS) was investigated in 17 patients. The severity of AS was graded by continuous wave Doppler ultrasound as severe in 10 of 17 patients and as moderate in the remaining 7 patients. Cine MR demonstrated a flow disturbance proximal and/or distal to the aortic valve plane in all 17 patients. This flow disturbance was seen as a signal void with four typical features: (a) a high-velocity jet phenomenon distal to the valve plane during systole, closely related to the stenotic orifice (8 of 17); (b) a turbulent systolic signal void in continuity with the jet, which propagated for a variable extent into the aorta (17 of 17); (c) a signal void just proximal to the valve plane during systolic ejection, reflecting prestenotic acceleration of blood flow (5 of 17); and (d) a void at the valve plane due to valvular calcifications (14 of 17). The following features or a combination thereof appeared to correlate with more severe grades of AS as visualized on cine MR display: (a) identification of narrow high-velocity jet phenomenon; (b) extensive propagation of the turbulent signal void into the aorta; and (c) presence of a prestenotic acceleration effect. Assessment of the severity of AS with cine MR is still limited. However, cine MR can identify the presence of AS and several flow phenomena that correlate with more severe degrees of stenosis.     

慢性肾功能衰竭维持性血液透析患者心脏瓣膜钙化相关因素

 目的探讨慢性肾功能衰竭维持性血液透析患者心脏瓣膜病变的性质、病因及对心脏结构和功能的影响.方法通过彩色多谱勒心动超声检查观察82例慢性肾功能衰竭维持性血液透析患者心脏瓣膜钙化的程度、瓣膜面积、狭窄或关闭不全及血生化指标.结果82例中发现二尖瓣钙化14例,二尖瓣反流8例,二尖瓣面积减少致狭窄2例,主动脉瓣钙化17例,主动脉瓣反流9例,二尖瓣并发主动脉瓣钙化11例.且钙化程度与钙磷沉积、继发性甲状旁腺功能亢进和血液透析年限密切相关.结论慢性肾功能衰竭维持性血液透析患者心脏瓣膜钙化相当常见,尤以二尖瓣、主动脉瓣易发.     

主动脉瓣病变的影像学研究进展

随着人口老龄化程度的加剧,主动脉瓣退行性病变导致的狭窄及关闭不全成为老年人主动脉瓣换瓣治疗的主要病因。因此,准确评估主动脉瓣病变患者的瓣环直径、瓣膜和瓣周毗邻病变情况以及冠状动脉和心功能对于该类疾病的临床决策及预后判断具有十分重要的意义。本文拟就目前临床应用最为广泛的超声心动图、计算机断层扫描以及磁共振在主动脉瓣膜置换术前影像学评估中的优缺点以及研究进展作一综述,旨在为换瓣患者的术前评价提供更为丰富和客观的临床资料。     

Comparison of cine MR imaging with Doppler echocardiography for the evaluation of aortic regurgitation

Regurgitant blood flow is associated with localized signal loss of the blood pool within the recipient chamber on cine MR images, which may be useful for assessing regurgitant valvular disease. To evaluate the potential of this technique for determining the severity of aortic regurgitation, multilevel cine MR imaging was performed in 10 normal volunteers and in 25 patients with aortic regurgitation documented and graded for severity by Doppler echocardiography. Cine MR images were analyzed to obtain cardiac chamber volumes and to measure the extent of the signal loss associated with regurgitation. All regurgitant lesions were visualized on cine MR images as areas of diastolic signal loss extending from the aortic valve into the left ventricle. The extent of signal loss and the regurgitant volume determined from analysis of MR images correlated with the echocardiographic severity of the lesion. The total area of diastolic left ventricular signal loss was 0 cm2 in 10 normal volunteers, 24 +/- 13 (+/- SD) cm2 in eight patients with mild aortic regurgitation, 49 +/- 11 cm2 in nine patients with moderate aortic regurgitation, and 62 +/- 20 cm2 in eight patients with severe aortic regurgitation (p less than .05 for moderate and severe vs mild). Left ventricular volumes calculated from MR images correlated well with echocardiographic volumes (r = .92, SEE = 30 ml, p less than .0001). Regurgitant fraction calculated from analysis of cine MR images was 4 +/- 7% in normal volunteers and 31 +/- 8% in mild, 45 +/- 11% in moderate, and 56 +/- 9% in severe aortic regurgitation (p less than .05 for moderate and severe vs mild and normal). Thus, cine MR imaging can provide useful qualitative and quantitative data regarding cardiac dimensions and regurgitant valvular flow in patients with aortic regurgitation.     

Quantification of aortic valve stenosis in MRI—comparison of steady-state free precession and fast low-angle shot sequences

We compared two different magnetic resonance (MR) sequences [steady-state free precession (SSFP) and gradient echo fast low-angle shot (FLASH)] for the assessment of aortic valve areas in aortic stenosis using transesophageal echocardiography (TEE) as the standard of reference. Thirty-two patients with known aortic stenosis underwent MR (1.5 T) using a cine SSFP sequence and a cine FLASH sequence. Planimetry was performed in cross-sectional images and compared to the results of the TEE. In seven patients the grade of stenosis was additionally assessed by invasive cardiac catheterization (ICC). The mean aortic valve area measured by TEE was 0.97±0.19 mm², 1.00±0.25 mm² for SSFP and 1.25±0.23 mm² based on FLASH images. The mean difference between the valve areas assessed based on SSFP and TEE images was 0.15±0.13 cm² (FLASH vs TEE: 0.29±0.17 cm²). Bland-Altman analysis demonstrated that measurements using FLASH images overestimated the aortic valve area compared to TEE. Comparing ICC with MRI and TEE, only a weak to moderate correlation was found (ICC vs TEE: R=0.52, p=0.22; ICC vs SSFP: R=0.20, p=0.65; ICC vs FLASH: R=0.16, p=0.70). Measurements of the aortic valve area based on SSFP images correlate better with TEE compared to FLASH images.