超声心动图评价偏心性主动脉瓣反流所致室壁冲击伤

目的 观察经胸彩色多普勒超声心动图评价偏心性主动脉瓣反流（AR）所致室壁冲击伤的效果。方法 26例经胸彩色多普勒超声显示中量及以上偏心性AR患者反流束已明确冲击至室间隔或左心室游离壁某处并发生变形，分析其影像学资料，观察偏心性AR对室壁造成冲击伤的形态学特点。结果 偏心性AR高速射流冲击部位均位于室间隔或左心室游离壁基底段或中上段（26/26，100%）。其中4例（4/26，15.38%）下间隔和下壁均被冲击，5例（5/26，19.23%）仅下壁被冲击，13例（13/26，50.00%）下壁和下侧壁均被冲击，2例（2/26，7.69%）仅下侧壁被冲击，下间隔、下壁和下侧壁均被冲击者2例（2/26，7.69%）。被冲击室壁处均可见局部扩张（26/26，100%）；6例（6/26，23.08%）运动幅度明显减低或消失，10例（10/26，38.46%）轻度减低，10例（10/26，38.46%）正常。CMR图像上除可见局部室壁扩张和运动减低外，严重者延迟增强时可见相应受损部位心肌纤维化改变。核素心肌灌注检查中，冲击伤重者可见局部心肌血流灌注和代谢减低均减低，而轻者无局部心肌血流灌注和代谢减低。结论 彩色多普勒超声心动图可用于观察中量及以上偏心性AR直接冲击室壁所致损伤部位和程度。

Echocardiographic evaluation of myocardial impact injury caused by eccentric aortic regurgitation

Objective To explore the effect of transthoracic color Doppler echocardiography on evaluating myocardial impact injury caused by eccentric aortic regurgitation (AR). Methods Transthoracic color Doppler echocardiographic imaging data were collected in 26 cases with local deformation of some part of the ventricular septum or left ventricular free wall rammed by moderate and above eccentric AR, and the morphological characteristics of ventricular wall impact injury were analyzed. Results Myocardial impact injury caused by eccentric AR located at the basal-mid segment of ventricular septum or left ventricular wall (26/26, 100%). Both inferoseptal and inferior wall were impacted in 4 cases (4/26, 15.38%), only inferior wall were impacted in 5 cases (5/26,19.23%), both inferior and inferolateral wall in 13 cases (13/26, 50.00%), inferolateral wall in 2 cases (2/26, 7.69%), while inferoseptal, inferior and inferolateral wall all were impacted in 2 cases (2/26, 7.69%).No anterolateral, anterior nor anteroseptal wall was impacted. Local dilatation was observed at the impacted wall in all cases (26/26, 100%). Severe hypokinesia was detected in 6 cases(6/26, 23.08%), mild hypokinesia in 10 cases(10/26, 38.46%),while normal motion was observed in the rest 10 cases(10/26, 38.46%). In addition to local wall dilatation and hypokinesia, myocardial fibrosis could be observed from LGE images in one case. Local perfusion and metabolism decreased on radionuclide perfusion images in severe cases, but not in mild cases. Conclusion Moderate and above eccentric AR can cause damage to some part of the wall impacted directly by the eccentric aortic regurgitation, and the location and extent of damage can be evaluated using color Doppler echocardiography.