四叶式主动脉瓣畸形的诊断及外科治疗

目的 总结四叶式主动脉瓣畸形的超声心动图诊断并探讨外科治疗.方法 回顾分析上海市心血管病研究所2004年1月至2007年5月超声心动图资料,总结四叶式主动脉瓣膜病例的超声诊断特点.观察23例四叶式主动脉瓣四叶分布形态、回声、启闭及血流动力学情况.并总结分析手术治疗的9例病人的资料.结果 在92656例心脏超声检查中,共检出四叶式主动脉瓣膜畸形23例,检出率为0.248‰.年龄19～83岁,平均(50.3±18.8)岁;男11例,女12例.23例中22例合并不同程度主动脉瓣膜反流,仅1例主动脉瓣膜功能正常.其中9例行主动脉瓣膜置换手术,术中发现A型8例,F型1例.结论 四叶式主动脉瓣膜畸形是非常少见的先天性心脏畸形,多数由超声心动图检查发现,实时三维超声心动图对可疑病例可明确诊断.四叶式主动脉瓣膜畸形主要并发主动脉瓣膜反流,严重者应手术治疗.

Quadricuspid aortic valves: incidence, diagnosis and treatment

Objective To study the incidence andassociated lesions of quadricuspid aortic valves (QAV) and to explore the echocardiographic diagnostic value and outcomes of surgicaltreatment. Methods Over a 3-year period, 92 656 patients were studied by TTE. Congenital quadricuspid aortic valve deformity wasdiagnosed by TTE and real time three-dimensional echocardiography. The morphologic changes, echoes, opening and closing of QAVand blood flow dynamics were observed by Philips SONOS-7500 color ultrasound system. Results Diagnosis of QAV was made in 23patients (0.248‰). Their ages were 19～83 years, including 11 male, and 12 female. One patient showed normal QAV function, 5had grade Ⅱ aortic regurgitation, 1 had grade Ⅱ～Ⅲ aortic regurgitation,2 patient Ⅲ, 10 patients Ⅲ～Ⅳ,4 patients Ⅳ. 9 QAVpatients underwent aortic valve replacement with surgical confirmation of the valve morphology. No stenosis was found. Associated le-sions were mitral valve prolapse and tricuspid insufficiency. Conclusion QAV is rare, most of them may present with pure aortic re-gurgitation without stenosis. Severe aortic insufficiency requires surgical treatment.