经食道三维超声在房颤二尖瓣结构变化对其 返流程度影响中的应用

目的 经食道三维超声心动图研究房颤患者二尖瓣结构变化对其返流程度影响。方法 选取电生理检查、射频消融手术患者66例。根据术前心电图分为阵发性房颤、持续性房颤、非房颤对照三组,分别行经胸二维超声检查,获得左房舒张末内径、左室舒张末内径、二尖瓣返流量,除外心脏瓣膜病、左心室扩大相关疾病、先心等病例。根据二尖瓣返流程度将其分为轻微返流、轻度返流、中度返流三组。行食道三维超声检查,应用MVQ软件进行二尖瓣量化分析,分别获得瓣环前后径、瓣环前外-后内径、瓣环高度、瓣叶非平面交角、前叶交角、后叶交角等二尖瓣参数。结果 对照组与持续性房颤组,对照组与阵发性房颤组之间DAIPm、H对比,差异有统计学意义（P＜0.05）;DAIPm、H在阵发性房颤组与持续性房颤组,差异无统计学意义（P＞0.05）;NAP、θANT、θPOST在持续性房颤、阵发性房颤、对照组,差异无统计学意义（P＞0.05）;DAP、DAIPm 在MR轻微组与中度组间比较,差异有统计学意义（P＜0.05）; H、θNAP、θANT在不同程度MR,差异无统计学意义（P＞0.05）;θPOST不同程度MR间对比,差异有统计学意义（P＜0.05）。结论 房颤患者二尖瓣后叶交角的增大常预示其功能性二尖瓣返流的增加,二尖瓣后叶交角对评估其反流程度有一定意义。     

基于多普勒超声成像二尖瓣返流评价方法的研究进展

二尖瓣返流是心脏疾病最主要的发病之一。随着现代医疗技术的发展,瓣膜修复和瓣膜置换手术的成功率显著提高,术前检查变得尤为重要,需要准确地对二尖瓣返流严重程度进行评价,以确定相应的治疗方案。本文回顾了近年来对于二尖瓣返流的测量方法,讨论了各种方法的适用范围和优缺点,和基于超声多普勒图像三维重建的二尖瓣返流定量评价方法的前景。     

心房功能性二尖瓣反流的研究进展

心房功能性二尖瓣反流（AF-MR）是功能性二尖瓣反流的一种特殊类型,其发病率高,临床预后差。AF-MR的发病机制与二尖瓣瓣环扩张、房源性瓣叶牵拉、二尖瓣后叶运动障碍、二尖瓣瓣环收缩障碍、二尖瓣瓣叶适应性增生不足或过度增生、左室舒张功能不全及左房压升高有关。AF-MR患者临床上常合并高血压、糖尿病、长程持续性房颤、非二尖...     

外科手术治疗小儿动脉导管未闭合并中、重度二尖瓣返流的疗效观察

目的：观察外科手术治疗小儿动脉导管未闭(patent ductus arteriosus,PDA)合并中、重度功能性二尖瓣返流(mitral regurgitation,MR)的疗效。方法：回顾性分析2006年1月至2009年12月期间行外科手术治疗PDA合并MR的患者12例。分别于动脉导管结扎术后1周、3个月和1年复查心脏超声,观察左室内径、左室收缩功能及二尖瓣返流面积与左房面积之比(MR/LA)的变化。结果：12例术前诊断PDA合并中、重度MR患者均行动脉导管结扎术,术后均无残余分流。术后3月后心脏彩色多普勒测定左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室短轴缩短率(FS)和MR/LA均较术前明显改善(P<0.05);LVEDD术后1年较术后3个月进一步降低(P<0.05)。结论：外科手术治疗中重度功能性MR的PDA安全、有效。     

左心疾病继发功能性三尖瓣返流的外科治疗现状

<正>健康人群中,约有80%~90%存有不同程度的三尖瓣返流[1]。功能性三尖瓣返流(functional tricuspid regurgitation,FTR)是指在无器质性三尖瓣病变及相关心肌损伤的情况下,由于三尖瓣及其相关结构的功能异常所导致的三尖瓣返流,常由左心系统瓣膜病变引起,是三尖瓣最常见的疾病。文献报道,至少1/3的二尖瓣病变患者存在中、重度三尖瓣返流[2],在实施二     

高血压合并阵发性房颤患者心脏超声临床特点

目的:观察分析高血压合并阵发性房颤患者的心脏超声特点,为临床准确诊断提供依据。方法:选取2019年08月至2020年08月我院收治的51例高血压合并阵发性房颤患者作为研究组,同时选取51例单纯高血压患者作为常规组,所有患者均接受心脏超声诊断确定有无二尖瓣返流;同时观察心脏收缩期右房上下径、左房前后径、室间隔厚度、舒张期左心室末期内径、左室射血分数、早期二尖瓣血流速度/心房收缩时二尖瓣充盈峰速(Early mitral valve velocity/Mitral valve filling peak velocity during atrial contraction,E/A)。结果:研究组与常规组血压、腰围、BMI指数、血脂、血糖以及血尿素氮无差异(p>0.05);研究组二尖瓣返流病例数多于常规组(P<0.05);研究组E/A、室间隔厚度、收缩期左房前后径均高于常规组(P<0.05),而收缩期右房上下径、舒张期左心室末期内径、左室射血分数无差异(P>0.05)。通过Logistic分析发现,二尖瓣反流、室间隔厚度、收缩期左房前后径与阵发性房颤相关(P<0.05)。结论:高血压合并阵发性房颤的心脏超声特点包括:室间隔厚度增加、左心房扩大、二尖瓣返流等,与单纯高血压差异显著。     

码丁啉治疗新生儿胃食道返流疗效观察

目的：观察吗丁啉治疗新生儿胃食道返流疗效。方法与结果：对６２例胃食道返流患者随机分为治疗组和对照组。对照组仅采用传统的体位疗法,治疗组在此基础上加用口服吗丁啉止吐进行观察疗效。治疗１天止吐为显效,治疗２天止吐为有效,治疗２天以上仍有呕吐为无效。结论：吗丁啉止吐总有效率明显高于对照组,Ｐ〈０．０１,且未发现副作用。因此吗丁啉可作为新生儿胃食道返流的首选药。     

多普勒超声对二尖瓣球囊成形术后二尖瓣返流的远期随访分析

应用多普勒超声心动图对74例二尖瓣球囊成形术(PBMV)病人术前、术后1天及4年的二尖瓣返流(MR)进行研究，将MR划分为Ⅳ级，术后1天与术前比较，MP程度不变59例(80％)、加重Ⅰ级12例(16％）、加重Ⅲ级1例(1％)、减轻Ⅰ级2例(3%)，术后4年与术后1天比较．MR程度不变55例(74％)，加重Ⅰ级11例(15％)、加重Ⅲ级1例(1％)、减轻Ⅰ级7例(10％)。表明轻度MR(≥2 )是PBMV木后常见并发症．仅极少数病人出现严重MR(≥3 )，且部分病人随访过程中MR程度减轻。     

吗丁啉治疗新生儿胃食道返流疗效观察

目的观察吗丁啉治疗新生儿胃食道返流疗效.方法与结果对62例胃食道返流患者随机分为治疗组和对照组.对照组仅采用传统的体位疗法,治疗组在此基础上加用口服吗丁啉止吐进行观察疗效.治疗1天止吐为显效,治疗2天止吐为有效,治疗2天以上仍有呕吐为无效.结论吗丁啉止吐总有效率明显高于对照组,P＜0.01,且未发现副作用.因此,吗丁啉可作为新生儿胃食道返流的首选药.     

双源螺旋CT对非缺血性二尖瓣反流机制的研究

目的运用双源螺旋CT（DSCT）探寻非缺血性二尖瓣反流的反流机制。方法超声诊断为二尖瓣反流并行CT俭查的46例患者．其中男性28例,女性18例;年龄37～81岁,平均年龄63．57岁。二尖瓣反流组依据多普勒超声检查分为轻度反流组（20例）、中度反流组（14例）、重度反流组（12例）。分别在cT图像上测量收缩中期幕状面积、幕状高度、二尖瓣瓣环前后径、联合间距离等二尖瓣装置形态参数。另随机选择无二尖瓣反流的体检者43例作为止常埘照组．．结果小同程度二尖瓣反流组在幕状面积、幕状高度、瓣环前后径、收缩中期和舒张末期瓣环面积较正常对照组差异有统计学意义（P〈O．05）。而瓣环联合间径差异无统计学意义（P〉0．05）。不同程度二尖瓣反流组在舒张期左心室短轴长度、球形度．收缩期左心室长径、舒张末期容积（EDV）、收缩末期容积（ESV）差异有统计学意义（P〈0．05）,、乳头肌间距变化度、左心事长径位移度组间差异均无统计学意义（P〉0．05）。结论DSCT功能检查对二尖瓣反流机制研究有重要价值,、非缺血性二尖瓣反流乃因心室-瓣膜环受过重前负荷而扩张．导致前外侧乳头肌腱索对前叶体部的过度牵拉．致使精确闭合的双侧瓣叶产毕前叶的云云h不对称导计对合而稠的减少,产生反流。     

人工瓣环置入和迷宫Ⅲ型手术治疗退行性二尖瓣环扩张伴发心房颤动

背景：对退行性二尖瓣关闭不全合并心房颤动患者,需要在行二尖瓣人工瓣环置入治疗时同期处理心房颤动问题,迷宫Ⅲ型手术虽是治疗心房颤动的金标准,但其安全性遭到质疑。 目的：评价人工瓣环置入和迷宫Ⅲ型手术治疗退行性二尖瓣环扩张伴发心房颤动的安全性。 方法：纳入退行性二尖瓣关闭不全合并心房颤动患者43例,按随机数字表法分两组治疗,试验组(n=21)施行二尖瓣成形和迷宫Ⅲ型手术,对照组(n=22)仅施行二尖瓣成形。 结果与结论：①术中安全性指标：试验组体外循环时间、主动脉阻断时间、血红蛋白尿发生率高于对照组(P < 0.001),两组尿量无差异。②术后安全性指标：试验组房性心律失常发生率、临时起搏器应用比例和住院时间高于对照组(P < 0.05),两组间二次开胸止血率、脑卒中发生率无差异。③术后疗效：试验组术后当天与出院时的窦性心律转复率均明显高于对照组(P < 0.001)。出院时,两组心功能均恢复为NYHA Ⅰ级或Ⅱ级,超声心动图显示二尖瓣反流均在微量或轻度以下,三尖瓣均关闭良好,两组间左心房内径、左心室内径、左心室容积和射血分数无差异,但试验组跨二尖瓣A峰和跨三尖瓣A峰比例明显高于对照组(P < 0.001)。结果说明人工瓣环置入和迷宫Ⅲ型手术治疗退行性二尖瓣瓣环扩张伴发心房颤动在围手术期安全有效。  中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Die Doppler-echokardiographische Quantifizierung des regurgitierenden Blutvolumens bei Patienten mit Mitralinsuffizienz

Summary The purpose of this study was to assess the accuracy and clinical utility of pulsed Doppler echocardiography in determining the regurgitant fraction in patients with pure mitral regurgitation. In 30 unselected consecutive patients with mitral regurgitation and in 20 patients without valvular heart disease pulsed Doppler echocardiography was performed to measure blood flow at the mitral and aortic valve. The regurgitant blood volume was calculated as the difference of the stroke volumes measured at the mitral and aortic valve. The regurgitant fraction was computed as regurgitant blood volume/mitral flow. By cardiac catheterization regurgitant blood volume and regurgitant fraction were obtained from the left ventricular angiographic stroke volume and the stroke volume measured by thermodilution. Five patients were excluded because of technically poor left ventricular angiograms. In 4 patients with mitral regurgitation measurement of the regurgitant blood volume and regurgitant fraction was impossible by Doppler because of poor ultrasound signal quality. In 21 patients with mitral regurgitation the correlations between the invasive and the Doppler measurements were significant (regurgitant blood volume:r=0.89, SEE=20.9 ml; regurgitant fraction:r=0.91, SEE=7.1%). However, the mean percent error of the regurgitant fraction measurement (12.0±11.6%) was smaller than of the regurgitant blood volume measurement (24.9±17.0%). In the control group the regurgitant blood volume ranged between –25.1 ml and 11.6 ml and the regurgitant fraction between –17.7% and 12.4%.Thus, pulsed Doppler echocardiography is clinically useful in determination of the regurgitant fraction in 84% of unselected adult patients with pure mitral regurgitation. The Doppler method is limited in the diagnosis and quantification of mild regurgitation. However, the method is more accurate in determining the regurgitant fraction than measuring the regurgitant blood volume.

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Abkürzungsverzeichnis MI Mitralinsuffizienz - RBV regurgitierendes Blutvolumen - RF Regurgitationsfraktion - SV_Angio angiographisch berechnetes Schlagvolumen - SV_Ao Doppler-echokardiographisch an der Aortenklappe gemessenes Schlagvolumen - SV_Mi Doppler-echokardiographisch an der Mitralklappe gemessenes Schlagvolumen - SV_Thermo mittels Thermodilution bestimmtes Schlagvolumen     

心脏瓣膜假体植入和外科消融迷宫手术治疗瓣膜病合并心房颤动

文题释义：人工瓣膜置换或瓣环植入：由于二尖瓣成形术具有保留完善左心室结构和功能、减少血栓形成等优点,许多指南都推荐瓣膜成形作为二尖瓣病变的首选术式,而人工瓣环植入是瓣环成形的重要组成部分。但对于瓣叶及瓣下结构已存在严重病变的患者,瓣膜成形效果可能不佳,应行瓣膜置换。由于人工机械瓣的长期抗凝及血栓、出血等并发症,生物瓣存在耐久度问题;人工瓣膜选择是一个复杂的过程,必须平衡患者特征和材料的特定因素综合决定。 迷宫手术：通过切开和缝合形成一系列瘢痕来阻断心房颤动的信号传播。最初的手术方式常导致左心房功能障碍及起搏器植入高发生率,经过了两次换代,迷宫Ⅲ手术已成为心房颤动外科治疗的金标准。然而迷宫Ⅲ手术的复杂性和高技术难度阻止了其进一步推广。迷宫Ⅳ手术于2002年推出,射频消融与冷冻消融取代了原先的切开缝合,使得迷宫手术的受欢迎程度明显增加。背景：二尖瓣疾病患者二尖瓣置换与二尖瓣瓣环成形术后的心房颤动发生率较高,迷宫手术是心房颤动外科治疗的金标准,而人工瓣膜与瓣环对迷宫手术的影响不明确。 目的：评价瓣膜性房颤外科消融迷宫术后窦性心律-左心房收缩功能的变化规律,以及瓣膜置换或瓣环植入是否影响窦性心律-左心房收缩功能的恢复。 方法：纳入2013年10月至2017年10月中国人民解放军北部战区总医院收治的324例二尖瓣病变伴随持续性或长期持续性心房颤动患者,接受迷宫手术后均进行人工瓣膜置换或人工瓣环植入治疗。分别于出院时,术后1,3,6,12,24个月进行心电图和超声心动图随访。应用多因素Cox回归模型分析左心房收缩力恢复的预测因素。试验已通过中国人民解放军北部战区总医院(原沈阳军区总医院)伦理委员会批准。结果与结论：①2例患者(0.6%)在围术期死亡,其余322例患者均获得2年随访,随访期间无人工材料相关不良事件发生;②患者术后左心房收缩力恢复率逐步升高,至术后1年,左心房收缩力与窦性心律共存的一致性较好(Kappa系数≥0.75,P < 0.05),术后2年时窦性心律和左心房收缩力恢复率分别为86.6%和85.1%;③Cox多元回归分析显示,较长术前心房颤动时间、较大术前左心房内径、术后3个月左心房收缩力缺失和冷冻消融术式是迷宫术后中晚期(>3个月)窦性心律和左心房收缩力恢复的共同预测因素(P < 0.05),较长术前心房颤动持续时间、较大术前左心房内径、切开与缝合术式是左心房收缩力中晚期恢复的预测因素(P < 0.05),瓣膜置换或瓣环植入、材料类型及假体型号不是心房颤动和力中晚期恢复的影响因素(P > 0.05);④ROC曲线分析显示,术前心房颤动时间与术前左心房内径对左心房收缩力恢复的最佳预测临界值分别为36.5个月(敏感度90.5%,特异性93.7%)和60.5 mm(敏感度93.8%,特异性85.0%);⑤结果表明外科消融迷宫术后左心房收缩力恢复是一个动态提高的过程,早期左心房收缩力恢复有利于维持稳定的窦性心律,术前心房颤动持续时间延长、左心房内径增大及冷冻消融能量方式对外科消融迷迷宫手术存在不利影响,瓣环成形或瓣膜置换不会影响外科消融迷宫手术疗效。ORCID: 0000-0002-9632-7651(马超) 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Early clinical evaluation of the Cosgrove-Edwards prosthetic heart valve ring

 We discuss the usefulness of the Cosgrove-Edwards ring from our early clinical results from 25 rings in 24 patients who underwent mitral annuloplasty (MAP) or tricuspid annuloplasty (TAP) between June 1999 and December 2000. In the MAP group, the posterior mitral annulus between the anterior and posterior fibrous trigones was reinforced with the prosthetic ring. In the TAP group, the annuli of the anterior and posterior leaflets were splinted with the ring. The prosthetic ring was attached by pledgeted U-sutures. Cardiologists performed echocardiography pre- and postoperatively. Thirteen of the 14 in the MAP group showed mitral valve regurgitation of grade 0 or I. Six of the 11 in the TAP group showed tricuspid regurgitation of grade 0 or I, and 5 patients with regurgitation equal to or greater than grade II who remained in atrial fibrillation postoperatively recovered without further clinical symptoms. No patient has required reoperation during a follow-up period of up to 2 years. Cosgrove-Edwards ring-related complications, such as valve stenosis, ring detachment, and arrhythmia, have been not recognized in these patients. In conclusion, for mitral and tricuspid annuloplasty, the Cosgrove-Edwards prosthetic ring showed excellent early clinical results, particularly in patients maintained in sinus rhythm. Received: November 5, 2001 / Accepted: May 30, 2002 Correspondence to:Y. Misawa     

Analog simulation of aortic and of mitral regurgitation

By using an equivalent electronic circuit either mitral or aortic regurgitation was simulated. Simulation allowed not only a measurement of various pressures within the cardiovascular system and cardiac output, but also mitral and aortic flow.In normal conditions mitral and aortic flows were monophasic, anterograde. In valve regurgitation mitral and aortic flows were, as expected, biphasic.In mitral regurgitation, during systole and diastole the valve flow was retrograde and anterograde, respectively.In aortic regurgitation, during systole and diastole the valve flow was anterograde and retrograde, respectively.The magnitude of the regurgitant valve flow was measured by time-integration and compared to the net flow, i.e. cardiac output. Valve flow was determined not only by the magnitude of valve dysfunction, but also by the resistive/capacitive characteristics of the “falsely” attached regurgitant circuit. If the regurgitant valve flow was large enough, it in turn affected the function of the left ventricle.The present investigation suggests that many features observed in patients with mitral or aortic regurgitation can be qualitatively satisfactorily simulated. In some respects even quantitative simulation is possible. However, for simulation of chronic mitral or aortic regurgitation, in the analog electronic circuit additional adjustments—in capacitance of the left ventricle and pulmonary system—would be required.     

两种人工瓣环置入修复单纯二尖瓣环扩张引起的二尖瓣关闭不全的比较

背景：退行性二尖瓣关闭不全的病例有逐渐增加的趋势,而单纯二尖瓣环扩张引起的二尖瓣关闭不全是退行性二尖瓣关闭不全的一种类型,国内尚无关于此类二尖瓣关闭不全的外科治疗的临床研究报告。 目的：观察单纯瓣环置入修复单纯二尖瓣环扩张引起的二尖瓣关闭不全早中期生物相容性的反应。 方法：单纯二尖瓣瓣环扩张致二尖瓣关闭不全患者48例,均行二尖瓣人工瓣环置入修复,其中使用Carpentier-Edwards生理环23例、SJMTM刚性鞍形成形环25例。出院后随访,采用超声心动图观察心功能和二尖瓣反流程度等变化,并比较两种瓣环与宿主生物相容性有无差别。 结果与结论：围术期无死亡,均治愈出院。48例均获随访,随访率100%,随访时间3个月至4年,无死亡病例。NYHA心功能分级Ⅰ级32例,Ⅱ级16例。与术前比较,随访期超声心动图显示左心房内径、左心室舒张末期内径、左心室收缩末期内径、肺动脉收缩压和反流速面积/左房面积均明显减少(P < 0.01),左室射血分数明显增加(P < 0.01)。跨瓣压差均< 3 mm Hg。二尖瓣无明显返流36例,微量返流10例,轻度反流2例。未出现成形环断裂、成形环撕脱及溶血现象。Carpentier-Edwards生理环组和SJMTM刚性鞍形成形环组比较,上述各指标差异无显著性意义(P > 0.05)。结果提示对于因单纯二尖瓣环扩张引起的退行性二尖瓣关闭不全,通过正确的置入技巧、选择合适的人工瓣环,应用人工瓣环置入有与宿主生物较好的生物相容性反应,置入后的瓣膜替代功能良好。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

rh-BNP对扩张性心肌病伴重度二尖瓣反流患者行二尖瓣置换术血流动力学影响

目的：观察持续静脉应用重组人脑利钠肽(recombinant human brain natriuretic peptide,rh-BNP)对扩张性心肌病伴重度二尖瓣反流患者行二尖瓣置换术围术期血流动力学的影响。方法：在2012年1月至2016年06月期间,对扩张性心肌病伴重度二尖瓣反流行二尖瓣置换术的患者随机分组,其中对照组32例,rh-BNP组33例。对照组实施常规治疗,rh-BNP组在常规治疗基础上加用rh-BNP。观察比较两组患者围术期肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)、心脏排血指数(cardiac index,CI)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室短轴缩短率(left ventricular fractional shortening,LVFS)及左心室舒张末期内径(left ventricular end diastolic dimension,LVDd)。结果：与术前相比,两组术后均表现为PCWP降低,CI升高,比较有显著性差异(P<0.05),而LVEF、LVFS、LVDd无明显变化(P>0.05)。与对照组相比,rh-BNP组患者术后PCWP明显降低,CI明显升高,比较有显著性差异(P<0.05),而LVEF、LVFS、LVDd变化亦无显著性差异(P>0.05)。结论：在扩张性心肌病伴重度二尖瓣反流行二尖瓣置换术的患者中,rh-BNP能够降低PCWP,提高CI,从而改善围术期的血流动力学。     

Percutaneous and off-pump treatments for functional mitral regurgitation

A new era in the treatment of functional mitral regurgitation is emerging with new devices that can be placed percutaneously or minimally invasively without cardiopulmonary bypass. These devices are categorized into three groups: annuloplasty, edge-to-edge repair, and ventricular reshaping. Percutaneous annuloplasty devices, implanted via the coronary sinus, mimic surgical annuloplasty by reducing the mitral annular anterior-posterior (or septal-lateral) dimension. Several devices, such as the PTMA, CARILLON, Monarch, and PS3 systems, are in clinical trials. Percutaneous edge-to-edge repair devices mimic the surgical Alfieri edge-to-edge repair technique, creating a double-orifice mitral valve; of these, MitraClip is in clinical trials. Ventricular reshaping devices treat both mitral annular dilatation and papillary muscle displacement (and thus leaflet tethering). The surgical Coapsys device is currently in clinical trials, and its percutaneous “interventional” version, iCoapsys, is being prepared for a clinical trial. Numerous issues need to be addressed before these devices can become standard therapies for functional mitral regurgitation. Device safety and efficacy must be demonstrated in carefully designed clinical trials with the goal of achieving outcomes equal to or better than those of surgical repair.