单纯性二尖瓣前叶裂的常规经胸超声心动图诊断分析

目的 使用常规经胸超声心动图诊断分析单纯性二尖瓣前叶裂,评估其诊断单纯性二尖瓣前叶裂的临床价值。 方法 2015年3月—2020年5月于华中科技大学同济医学院附属同济医院和中国科学技术大学附属第一医院门诊或住院的经胸超声心动图检查发现单纯性二尖瓣前叶裂患者108例,选取胸骨旁左心长轴切面、二尖瓣水平左室短轴切面、心尖四腔心切面、心尖两腔心切面及心尖三腔心切面等,二维超声心动图重点观察二尖瓣形态、回声、瓣裂位置、长度及宽度,彩色多普勒观察反流束的起源及反流程度;常规测量左房、左室内径及左室射血分数等指标。根据美国超声心动图协会(ASE)推荐,使用Carpentier等提出的二尖瓣命名法对二尖瓣前叶裂进行分区定位。并与术中所见进行对照分析。 结果 二维超声心动图显示二尖瓣前叶回声中断,呈“裂隙”状,彩色多普勒显示反流束起源于裂口处,是二尖瓣前叶裂的特征性表现;108例单纯性二尖瓣前叶裂,其中A3区87例,A2区6例,A1区9例,两区以上共同瓣裂6例;合并二尖瓣重度反流12例,中-重度反流9例,中度反流12例,轻-中度反流60例,轻度反流15例;合并二尖瓣脱垂27例。以往曾接受超声心动图检查的75例患者中,仅有极少数被怀疑为二尖瓣前叶裂。24例接受了手术治疗,其中22例行瓣膜修补术或成形术,2例因术中监测仍存在较重的反流改为瓣膜置换术。24例接受手术治疗的患者,17例为完全性瓣裂,7例为部分性瓣裂。所有接受手术治疗的24例患者超声均作出了准确的诊断。 结论 单纯性二尖瓣前叶裂发生率较高,经胸超声心动图可以准确诊断单纯性二尖瓣前叶裂及其并发症,对选择治疗方案或随访具有重要的临床价值。 

Diagnostic analysis of the isolated anterior mitral cleft by routine transthoracic echocardiography

Objective To diagnose and analyze the isolated anterior mitral cleft by routine transthoracic echocardiography, and to evaluate the clinical value of routine transthoracic echocardiography in the diagnosis of the isolated anterior mitral cleft. Methods Total 108 patients with isolated anterior mitral cleft were found by transthoracic echocardiography in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology and the First Hospital Affiliated to China University of Science and Technology from March 2015 to May 2020. Through parasternal left long axis section, mitral valve horizontal left ventricular short axis section, apical four-chamber section, apical two-chamber section and apical three-chamber section, the morphological characteristics, echo and location, length, width of the mitral by 2 D echocardiography, and the origin of the reflux beam and the degree of reflux by color Doppler flow imaging. The diameter of left atrium, left ventricular and left ventricular ejection fraction were measured. According to the recommendation of American Society of Echocardiography, the anterior mitral cleft were located by the mitral valve nomography proposed by Carpentier et al, and compared with the intraoperative findings. Results The echo of the mitral valve anterior lobe was interrupted and showed a "fissure" shape by 2 D echocardiography, and the reflux beam was originated from the cleft by color Doppler, which was the characteristic manifestation of the anterior mitral cleft. Of the 108 patients with the isolated anterior mitral cleft, 87 were in zone A3, 6 in zone A2, 9 in zone A1 and 6 in two or more zones; 12 with severe mitral regurgitation(MR), 9 with moderate-severe MR, 12 with moderate MR, 60 with mild-moderate MR, 15 with mild MR; 27 with mitral valve prolapse. Of the 75 patients who had previously undergone echocardiography, only a very small number were suspected the isolated anterior mitral cleft. Of the 24 patients who underwent surgery, 22 underwent valvular repair or valvuloplasty, and 2 underwent valve replacement due to serious reflux. Among the 24 patients, 17 had complete valvular fissure and 7 had partial valvular fissure. All the 24 patients who had undergone surgery were diagnosed accurately. Conclusion The incidence of the isolated anterior mitral cleft is higher, and transthoracic echocardiography can accurately diagnose the isolated anterior mitral cleft and its complications, which has important clinical value in selecting treatment plan or follow-up.