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）。     

超声多普勒测定二尖瓣返流的有效返流口面积

为探讨返流口面积大小对评价二尖瓣返流（ＭＲ）严重性的价值，对３５例ＭＲ患者进行了多普勒超声有效返流口面积（ＲＯＡ）测定及心导管检查。发现彩色多普勒血流会聚法（ＦＣＭ）及多普勒血流量法测得的ＲＯＡ与心导管左室造影返流程度，每搏返流量及返流分数均密切相关（相关系数分别为０．８６，０．８４；０．８９，０．８７；０．８０，０．７８；Ｐ＜０．００１）。两种超声方法的ＲＯＡ测值总体上无显著差异（Ｐ＞０．０５），但ＦＣＭ的结果优于多普勒血流量法，且ＦＣＭ计算ＲＯＡ更为方便。本文亦提出以ＲＯＡ估计ＭＲ程度的定量标准。     

以立体角代替平面角彩色多普勒血流会聚法评估三尖瓣返流程度

目的　探讨彩色多普勒血流会聚法在评估三尖瓣返流程度中的应用价值。方法　应用不同的血流会聚方程对３２例三尖瓣返流患者的返流程度进行测量, 并与传统法所测指标进行比较。结果　应用立体角会聚方程计算的返流率（Ｆ２）与传统方法测得的返流束指标ＳＲ／ＳＲＡ、ＶＰ 以及二维多普勒方法计算的每搏返流量Ｑ之间的相关关系（ｒ分别为０．４８, ０．４６, ０．９８）优于应用平面角会聚方程计算的返流率（Ｆ１）, 与上述指标之间的相关关系（ｒ分别为０．４６, ０．４４, ０．９２）。而且ＳＶ１明显低估返流程度,ＳＶ２更接近于实际值。结论　应用立体角会聚方程代替平面角会聚方程能更为准确地评估三尖瓣返流程度     

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     

彩色多普勒血流会聚法在生理性二尖瓣返流诊断中的价值

采用常规彩色多普勒技术（常规法）和彩色多普勒血流会聚法（会聚法）对５２例生理性二尖瓣返流和８７例病理性二尖瓣返流患者进行了对比研究。结果发现：３３／５２（６３％）例生理性二尖瓣返流和８７／８７（１００％）例病理性二尖瓣返流可于二尖瓣左室面显示血流会聚区；与常规法定量测值（返流束长度和面积）相比，会聚法定量测值（返流率和每搏返流量）在生理性与病理性二尖瓣返流之间的重叠程度较小。表明会聚法在生理性二尖瓣返流的诊断及鉴别诊断中优于常规法。     

彩色多普勒血流会聚的研究进展

彩色多普勒血流会聚的研究进展柯琴梅综述李治安审校血流会聚区（ｆｌｏｗｃｏｎｖｅｒｇｅｎｃｅｒｅｇｉｏｎ；ＦＣＲ）又称近端等速度表面面积法（ｐｒｏｘｉｍａｌｉｓｏｖｅｌｏｃｉｔｙｓｕｒｆａｃｅａｒｅａ；ＰＩＳＡ），是目前较理想的定量评估瓣膜返流及心内分...     

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     

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     

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。     

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     

Usefulness of the mitral/aortic flow velocity integral ratio as a screening method to identify patients with hemodynamically significant mitral regurgitation.

OBJECTIVE: We sought to test the value of a simple Doppler index, the mitral/aortic flow velocity integral ratio (MAVIR), as a screening method to identify patients with hemodynamically significant mitral regurgitation (MR). METHODS: Included in the study were 91 patients (mean age 61 +/- 14 years; 54% men) with echocardiographically diagnosed MR. The cause was organic in 23 patients and ischemic/functional in 68. MR degree was assessed by 2 quantitative echocardiographic measures: the regurgitant fraction and the regurgitant orifice area. RESULTS: A good correlation was found between MAVIR and both regurgitant fraction (r = 0.75) and orifice (r = 0.60). When we divided patients into 3 groups on the basis of the regurgitant fraction, used as reference standard, MAVIR significantly increased in proportion to MR severity (0.7 +/- 0.1 for mild MR vs 1.1 +/- 0.2 for moderate and 1.4 +/- 0.3 for severe regurgitation; P <.0001). A ratio > 1 identified 28 of 30 patients with severe MR (regurgitant fraction > 60%), whereas all patients with mild MR (regurgitant fraction < 40%) had a ratio < 1. Using a regurgitant orifice >or= 40 mm(2) as threshold for severe MR, a significant difference in MAVIR was also present among patients who had severe MR compared with those having mild and moderate regurgitation (P <.0001). CONCLUSIONS: These findings suggest that MAVIR is a sensitive index, potentially widely applicable in clinical practice as a screening parameter for identifying patients with hemodynamically significant MR.     

磁共振相位编码速度标识技术在儿童二尖瓣反流定量分析中应用

目的利用磁共振相位编码速度标识技术对儿童二尖瓣反流作定量分析。方法本组二尖瓣反流组共19例,男11例,女8例。正常对照组10例,男5例,女5例。19例二尖瓣反流病人先行心脏超声检查,利用半定量方法,诊断19例二尖瓣反流,轻度反流5例,中度反流10例,重度反流4例。利用磁共振的相位编码速度标识技术分别对正常对照组、二尖瓣轻、中、重度反流的病例进行左心室流入量和主动脉流量测定,随后对所测的结果进行统计学分析。结果在正常对照组中,左心室流入量与主动脉流量之间的相关性良好。正常组与轻度二尖瓣反流反流量与反流指数无显著性差异,正常组分别与中度、重度二尖瓣反流组反流量与反流指数有显著性差异,轻、中、重度二尖瓣反流组间有显著性差异,二尖瓣反流指数与超声的二尖瓣反流程度的估计相关性良好。结论磁共振相位编码速度标识技术为非创伤检查中对儿童二尖瓣反流定量分析的较好方法,并为以后的外科手术以及术后随访提供更为精确的信息。     

Value of pulmonary venous flow characteristics in the assessment of severity of native mitral valve regurgitation: an angiographic correlated study.

To evaluate the relation between left ventricular angiography and pulmonary venous flow velocity in native mitral valve regurgitation, 28 patients with sinus rhythm and valvular and/or coronary artery disease underwent transesophageal echocardiography within 24 hours after cardiac catheterization. Group I consisted of 17 patients, seven patients without (grade 0) and 10 patients with angiographically mild to moderate mitral regurgitation (grades 1 and 2). Group II consisted of 11 patients with angiographically severe mitral regurgitation (grades 3 and 4). Mitral regurgitation by transesophageal echocardiography was evaluated by measuring the regurgitant jet sizes and color-guided pulsed Doppler pulmonary venous flow velocities. Multivariate analysis revealed that the most powerful predictor (p less than 0.001) of angiographically severe (grades 3 and 4) mitral regurgitation was reversed systolic flow into the left upper pulmonary vein (sensitivity 82%, specificity 100%, positive predictive value 100%). If this variable was excluded from analysis, jet area and jet length (p less than 0.001) were the next best predictors for angiographically severe mitral regurgitation. Mean values of systolic peak pulmonary venous flow velocities were significantly lower in patients from group II, 13.0 +/- 11.1 cm/s versus 43.4 +/- 20.6 cm/s (group I) with p less than 0.005. This finding was also true for systolic time velocity integral, 1.3 +/- 1.3 cm (group II) versus 7.8 +/- 5.3 cm (group I) with p less than 0.005.(ABSTRACT TRUNCATED AT 250 WORDS)     

Right-to-left shunt through a patent foramen ovale caused by severe tricuspid regurgitation detected with color Doppler echocardiography.

We describe a 65-year-old patient with moderate combined mitral disease and severe tricuspid regurgitation, in whom the tricuspid regurgitant jet was oriented toward the interatrial septum. Color flow and pulsed Doppler demonstrated a late-systolic to mid-diastolic, right-to-left shunting of the tricuspid regurgitant jet through the foramen ovale. This finding was subsequently confirmed with transesophageal echocardiography.     

Left atrial systolic antegrade flow in patients with mitral regurgitation: a pulsed Doppler sign displayed by color flow imaging

Twenty-two patients with severe mitral regurgitation were observed to have turbulent systolic antegrade flow on pulsed Doppler mapping of the left atrium. All were studied by color flow imaging to delineate the mechanism of this peculiar flow. Pulsed Doppler findings of an eccentric regurgitant flow in one side, an antegrade systolic flow with slightly delayed onset in the other side, and a low velocity flow near the posterior wall, were consistant with the theory of a large eccentric regurgitant jet swirling in the left atrium. Color flow imaging confirmed this mechanism in all patients. Nineteen patients had flail mitral valve with a positive predictive value of 86%. The other three patients had deformed rheumatic mitral valve. The severity of mitral regurgitation was confirmed in all 16 patients studied by left ventricular cineangiography. We have shown that the antegrade systolic left atrial flow is the result of the swirling of a large regurgitant eccentric jet, is commonly observed with flail mitral valve, can occur in patients with deformed rheumatic mitral valve without flail leaflet, and most significantly indicates the presence of severe mitral regurgitation.     

二尖瓣返流病人收缩期左房内前向性血流的研究

本研究应用彩色多普勒超声心动图检测了31例收缩期左房内前向性血流。将脉冲多普勒取样容积置于二尖瓣口左房侧,在与负向性返流相并行的一侧出现收缩期正向性血流频谱时,定为前向性血流,彩色多普勒血流显示为红色血流。全部病人均经心血管造影及/或手术证实。结果表明,收缩期左房内前向性血流是由于大量、高速、偏心的血流在左房内折返形成漩涡而产生,此血流常发生于连枷样二尖瓣病人,阳性率为93.5％,也可以发生于非FMV严重的二尖瓣返流病人。     

Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography.

BACKGROUND: Cardiovascular magnetic resonance (CMR) is widely recognized as a non-invasive gold standard for quantification of ventricular volumes. In addition, it is an emerging diagnostic modality for clinical evaluation of mitral regurgitation (MR) and aortic regurgitation (AR). CMR facilitates accurate quantitation of regurgitation volumes and regurgitant fraction, but referring physicians are often more comfortable with qualitative measures, and few data exist for correlation of qualitative CMR regurgitation severity with that obtained by more conventional qualitative Doppler echocardiography. Because patients with AR and MR may commonly be assessed by both echocardiography and CMR modalities, consistency between qualitative gradient of regurgitation severity is important for follow-up. Therefore, we sought to define the CMR regurgitant fractions that best correlate with qualitative mild, moderate, and severe regurgitation by color Doppler echocardiography. METHODS AND RESULTS: Data from 141 consecutive patients (age 53 +/- 15 yr; 43% female) with contemporary (median, 31 days) CMR and echocardiographic data, including 107 regurgitant valves and 70 normal valves, were compared. Thresholds were developed on an initial cohort of patients with 55 regurgitant valves, and subsequently tested on a later cohort of patients with 52 regurgitant valves. Regurgitation fraction (RF) limits that optimized concordance of CMR and echo severity grades were similar for MR and AR and were: mild < or = 15%, moderate 16-25%, moderate-severe 26-48%, severe > 48%. CONCLUSIONS: The current study provides simple qualititative threshold grades for MR and AR severity that allows for standardized reporting of regurgitation severity by CMR and excellent correlation with clinical echocardiography.