二尖瓣脱垂抑正常

二尖瓣脱垂抑正常陈海泉，王小涛，孙耀昌，沈学东，王敏生，施纯敏为了探讨二尖瓣脱垂超声心动图的诊断标准，结合正常人，我们总结了经手术及病理检查确诊为二尖瓣脱垂者的超声心动图的表现。资料与方法１．研究对象：超声心动图诊断为二尖瓣脱垂，手术证实，并经病理检...     

二尖瓣脱垂综合征

二尖瓣脱垂系由于各种原因致使二尖瓣在心脏收缩时向左房漂浮而产生的一种综合征。常在胸部心前区闻及收缩中期喀喇音及全收缩期杂音,并伴胸痛、心悸、晕厥等症状。发病率约为4～17％,以中老年及女性为多,男女比例为1:2。大多数病例为原发性,偶为继发性。笔者复习文献,综述如下。 1 病因 1.1 原发性(特发性):二尖瓣脱垂的发病原因很多,分为继发性与原发性两大类,以原发性居多,约占70％以上,原发性又分为家族性和非家族性。     

二尖瓣脱垂的临床评价

1913年Ｃａｌｌａｖａｒｄｉｎ描述收缩期喀喇音的二尖瓣脱垂(ＭＶＰ)病人在尸解时发现有心包粘连以后 ,一直认为收缩期喀喇音是心外的额外音。直到 196 1年Ｒｅｉｄ认为这与二尖瓣腱索绷紧有关 ,提出收缩期喀喇音和晚期杂音来源于二尖瓣的假说 ,后又被临床所重视并得到了证实。 196 3年Ｂａｒｌｏｗ等首先应用心血管造影证实收缩期喀喇音和收缩晚期杂音的患者有ＭＶＰ ,证明这种听诊所见由于左心室收缩晚期二尖瓣 (后叶 )脱垂伴有二尖瓣返流所致[1] 。ＭＶＰ不仅指瓣叶在收缩期向心房脱垂 ,同时二尖瓣 (或三尖瓣 )在形态上许多改变。本文报…     

二尖瓣环的非平面特性对二尖瓣脱垂诊断的重要性

二尖瓣环的非平面特性对二尖瓣脱垂诊断的重要性上海医科大学中山医院上海市心血管病研究所周国宝综述林佑善沈学东校二尖瓣脱垂最初认为是不常见的疾病［１］，随着超声心动图的问世，现已逐渐成为一个广泛的临床问题［２］．二维超声心动图是二尖瓣脱垂诊断的首选方法［...     

二尖瓣脱垂115例临床分析

二尖瓣脱垂１１５例临床分析刘茂松宋明华＊华西医科大学附属第一院心内科二尖瓣脱垂（ＭｉｔｒａｌＶａｌｖｅＰｒｏｌａｐｓｅ，ＭＶＰ）系常见的瓣膜病之一，其发病率逐年增高，国外已占单纯二尖瓣返流的第一位，但由于其病因不十分明确，临床症状无特异性，易被误诊或...     

二尖瓣脱垂综合征诊断标准的新指导：附46例临床分析

本文选择从超声心动图(UCG)和心音图(PCG)诊断二尖瓣脱垂(MVP)的46例患者,分析超声心动图的MVP征与临床体征的相应关系(符合率),认为二尖瓣收缩期向上移位不一定就是病理性异常。为了辨别正常与异常MVP之间的界限,就病理性MVP临床诊断标准提出了见解,同时指出超声波医师对MVP患者检查应注意的问题。     

1例妊娠合并胸廓畸形的护理

妊娠是女性特殊的生理时期，临床上妊娠并发症也较常见。但是妊娠合并胸廓畸形临床上并不多见。据文献报道：妊娠合并胸廓畸形的发作1953～1979年、1980～1985年、1985～1994年分别为0．42％、0．131％及0．79％。2003年1月，我院收治1例妊娠合并胸廓畸形、慢性支气管炎急性发作、慢性阻塞肺气肿患者，现将护理体会报道如下。     

慢性肺心病合并胸廓畸形35例临床分析

慢性肺心病在临床上很常见，但此病合并胸廓畸形的诊治尚少系统报道，针对本院1999年10月至2002年10月3年间收治的此类患者与单纯肺心病患者临床资料进行比较分析，现报告如下。     

二维及彩色多普勒对房室瓣脱垂的分级及临床意义

目的 二维超声及彩色多普勒对房室室瓣脱垂的分级,并评价其临床意义。方法 利用二维及彩色多普勒技术８８０例有心脏杂音患者的二、三尖瓣的形态、大小、活动及血流动力学变化。结果 二、三尖瓣脱垂颁为三组。Ｉ组级脱垂,不需临床治疗,Ⅱ级为中度脱垂,可考虑做或替换术;Ⅲ级为重度脱垂,必须施行瓣膜替换术。结论 二维及ＣＤＦＩ对房室瓣脱垂的判断准确,为临床修复、瓣膜替换术提供可靠依据。     

不同原因所致二尖瓣脱垂超声,手术及病理对比分析

本文回顾性分析１６例不同原因所致二尖瓣脱垂超声心动图表现，结合手术及病理改变，评价超声诊断价值。除二尖瓣不同程度脱垂外，９例粘液样变性的瓣叶冗长、活动幅度增强，青少年与老年瓣膜厚度及瓣口面积有所不同。５例瓣膜感染性炎性病变中４例瓣叶不厚或瓣尖轻度增厚，见赘生物；另１例瓣膜增厚、严重变形、穿孔。以上１４例均有不同程度腱索延长、断裂。２例风湿性瓣膜病变的瓣叶增厚，部分钙化，１例无交界粘连，腱索延长     

Mitral Valve Prolapse and Pre-Excitation

Two out of 118 patients with mitral valve prolapse were found to have pre-excitaiton. The presence of mitral valve prolapse in one patient with Lown-Ganong-Levine syndrome and the persistence of prolapse in (he presence and absence of pre-excitation in another patient with intermittent type B Wolff-Parkinson-White syndrome suggest that mitral valve prolapse in pre-excitation syndrome may not be secondary to the abnormal activation pattern of the left ventricle, which has been suggested as a possible mechanism by some investigators. (PACE, Vol. 5, September-October, 1982)     

体元模型三维重建超声显像定量二尖瓣脱垂部位节段和范围

本研究旨在采用动态三维重建技术定量二尖瓣脱垂的部位和范围，为二尖瓣关闭不全手术方式的选择提供形态学依据。研究对象为２１例经手术证实的二尖瓣脱垂患者。结果：２１例二尖瓣脱垂均能立体显示病变瓣膜的形态特征，从左房往左室方向观察，在心脏收缩期。脱垂部位象“伞面”状飘向左心房，与正常瓣膜间有鲜明的边界。三维重建可以明确反映脱垂所累及的部位、瓣叶节段和范围，并定量其横径和纵径。本组中脱垂范围最大者为１２．６ｍｍ×９．７ｍｍ，最小者为２．３ｍｍ×３．８ｍｍ。１４例因脱垂累及范围较大或瓣膜质地较坚硬，而行瓣膜置换术；７例因脱垂累及的范围较小而行瓣膜修复术。结论：三维重建超声显像能够正确定量二尖瓣脱垂的部位和范围，是诊断二尖瓣脱垂最有效的新方法     

Malignant Ventricular Arrhythmias in Patients with Mitral Valve Prolapse and Mild Mitral Regurgitation

Mitral valve prolapse (MVP) is a common disorder that, in general, has a good prognosis. Rare occasions of sudden death have been reported in patients with MVP and it is presumed that the basis of sudden death is arrhythmic. We report seven patients with moderate to severe MVP and malignant ventricular arrhythmias. All patients had trivial to mild mitral regurgitation and normal left ventricular function. Three patients presented with syncope, two with out-of-hospital cardiac arrest, and three with recurrent palpitations and presyncope. In a mean follow-up period of 2.5 years (range 6 months to 5 years), two patients died suddenly despite successful control of their nonsustained ventricular tachycardia (VT) with sotalol as shown by ambulatory monitoring. Two patients, who had sustained VT despite antiarrhythmic drug therapy, had mitral valve surgery, however, monomorphic VT could be induced in both even after surgery. The arrhythmias in the remaining three patients are controlled on antiarrhythmic drugs. We conclude that a selected subset of patients with MVP, malignant ventricular arrhythmias, and miid mitral regurgitation are at risk of sudden death. Syncope, inferolateral repolarization changes, complex ventricular ectopy, and a markedly myxomatous valve may be pointers to higher risk of sudden death and mitral valve surgery may not provide control of ventricular arrhythmias.     

Monomorphic Right Ventricular Tachycardia in a Patient with Mitral Valve Prolapse

A patient with mitral valve prolapse and symptomatic ventricular ectopy underwent an electrophysiological study during which a sustained monomorphic ventricular tachycardia with a left bundle branch block/right axis deviation morphology was induced. This morphology was replicated by pace mapping at the right ventricular outflow tract. To the best of our knowledge, this finding has not been previously described and suggests that the association between ventricular arrhythmias and mitral valve prolapse may not necessarily be causal.     

AV Node Dysfunction in the Mitral Valve Prolapse Syndrome

The mitral valve prolapse syndrome is associated with a variety of atrial and ventricular arrhythmias. A portion of these patients manifest bradyarrhythmias, which in turn, may be the cause of lightheadedness and syncope. Thie study details the clinical and electrophysiologic characteristics of seven patients with symptomatic mitral valve prolapse and AV node dysfunction. The electrophysiology study demonstrated either a prolonged AH interval or abnormal response to atrial pacing in six of seven patients. A significant proportion of these patients had abnormalities of sinus node function and distal His-Purkinje conduction in addition to AV node dysfunction. AV node dysfunction in symptomatic patients with mitral valve prolapse may be secondary to autonomic dysfunction of diffuse conduction system disease.     

经胸和经食管超声心动图诊断非风湿性二尖瓣脱垂伴部分腱索断裂的价值

目的 :比较多平面经食管超声心动图 ( MTEE)及经胸超声心动图 ( TTE)对诊断非风湿性二尖瓣脱垂伴部分腱索断裂的价值。方法 :应用 MTEE和 TTE检查二尖瓣脱垂伴部分腱索断裂 12例 ,9例患者与手术资料对照。结果 :MTEE显示该病变以特发性腱索断裂最常见 ,其次为感染性心内膜炎 ,MTEE可清楚显示二尖瓣细小腱索断裂、瓣膜局部脱垂 ,还可显示瓣膜穿孔、赘生物和钙化 ,准确判断瓣膜关闭不全的程度 ;而 TTE仅能部分显示。结论 :MTEE是诊断非风湿性二尖瓣脱垂伴部分腱索断裂可靠的技术 ,可为选择治疗方案及评价预后提供重要依据。     

Anterior Mitral Valve Length is Associated with Ventricular Tachycardia in Patients with Classical Mitral Valve Prolapse

Background: The aim of this study was to investigate the electrocardiographic and echocardiographic predictors of ventricular tachycardia (VT) in patients with classical mitral valve prolapse (MVP). Methods: Thirty patients (nine men and 21 women; mean age, 41.5 ± 15 years) in sinus rhythm with mitral valve prolapse who had VT in 24‐hour Holter analysis and 30 patients with MVP without VT (eight men and 22 women; mean age, 43 ± 16 years) were included in this study. Transthoracic echocardiography, QT analyses from 12‐lead electrocardiography, and 24‐hour Holter electrocardiogram recordings were performed. Results: Mitral posterior leaflet thickness (0.48 ± 0.03 cm vs 0.43 ± 0,08 cm, P = 0.025), mitral anterior leaflet length (3.2 ± 0.24 cm vs 2.9 ± 0.36, P < 0.001), mitral posterior leaflet length (2.2 ± 0.3 cm vs 1.9 ± 0.35 cm, P = 0.01), left atrium anteroposterior diameter (4.2 ± 0.8 cm vs 3.5 ± 0.5 cm, P = 0.001), and mitral annulus circumference (15.7 ± 1.3 cm vs 14.6 ± 1.6 cm, P = 0.004) were increased significantly in MVP cases with VT. No significant difference was found between the cases with and without VT in terms of frequency‐ and time‐domain analysis. QT dispersion (72 ± 18 ms vs 55 ± 15 ms, P = 0.0002) and corrected QT dispersion (QTcD) (76 ± 18 ms vs 55 ± 15 ms, P = 0.0002) were significantly increased in cases with VT compared with those without VT. Based on logistic regression analysis for MVP cases, in the case of VT, an enhancement in QTcD (P = 0.01) and the mitral anterior leaflet length (P = 0.003) were the independent predictors of VT. Conclusion: Mitral anterior leaflet length and enhanced QTcD are closely related with VT in patients with classical MVP. (PACE 2010; 33:1224–1230)