多普勒超声心动图对同种主动脉瓣功能的评价

本文报道了应用多普勒超声心动图技术评价１１例同种主动脉瓣移植术后的近期疗效及同种瓣的血液动力学特征。研究发现，同种主动脉瓣的最大血流速度及最大跨瓣压差显著低于主动脉瓣位机械瓣，与正常自体主动脉瓣比较无显著差别。术后左室舒张末期内径明显缩小，左室射血分数显著增加。     

多普勒超声技术定量测定二尖瓣位人工瓣跨瓣压差及瓣口面积的准确性研究

为观察多普勒超声测定二尖瓣位人工瓣跨瓣压差和瓣口面积（ＭＶＡ）的准确性，利用多普勒超声技术对２１例Ｓｏｒｉｎ型侧倾碟瓣的跨瓣压差及ＭＶＡ进行测定，并与心导管检查进行比较。相关分析结果表明，由多普勒测定的人工瓣跨瓣压差及ＭＶＡ与心导管测量值有密切的相关关系。研究结果进一步证明，由多普勒超声测量的跨瓣压差、ＭＶＡ均具有高度的准确性和可靠性。     

接受手术的二瓣化和三瓣化主动脉瓣患者的临床差异

目的研究需要接受主动脉瓣膜或者升主动脉手术的二瓣化或者三瓣化主动脉瓣膜患者的临床差异.方法将1996-2001年的2 570例主动脉瓣膜病变患者,根据主动脉瓣膜形态分为二组,2 015例(78.4%)是三瓣化瓣膜,555例(21.6%)是二瓣化主动脉瓣膜,具体研究统计各项相关数据.结果男性患者在二组中均明显多于女性,在二瓣化组中尤其明显.在二组中早期导致手术的瓣膜病变均是瓣膜狭窄.二瓣化瓣膜的患者接受主动脉瓣膜或者升主动脉手术的年龄平均比三瓣化瓣膜的患者年轻10岁.在二瓣化患者中的升主动脉扩张的发生率明显高于三瓣化的患者.但是在A型主动脉夹层动脉瘤的患者中,三瓣化瓣膜明显比二瓣化瓣膜多.三瓣化主动脉瓣膜的患者同时接受冠状动脉搭桥手术的概率明显高于二瓣化的患者.结论经临床资料对比显示,主动脉瓣先天性二瓣化畸形会加速瓣膜自身的纤维化、钙化导致瓣膜狭窄和关闭不全的早期出现,并且增加升主动脉扩张的危险性.     

多普勒超声技术对心脏移植患者急性排斥反应时左室舒张功能指标的观察──与心内膜心肌活检对照研究

为进一步探讨多普勒超声技术早期检出急性心脏排斥反应的可能性和可靠性，对３１例首次心脏移植患者进行了系列多普勒超声检查和２４小时内相应的心内膜心肌活检对照研究。结果表明，急性心脏排斥反应时左室质量（ＬＶｍａｓｓ）明显高于排斥反应前（Ｐ＜０．０１）；左室等容舒张期（ＩＶＲＴ）及舒张期二尖瓣口压差减半时间（ＰＨＴ）均明显缩短（Ｐ＜０．０００１）；舒张早期二尖瓣前向峰值血流速度较排斥反应前明显增高（Ｐ＜０．０１）。经成功应用免疫抑制剂治疗后，上述４项指标均恢复至对照前水平，研究结果表明，利用多普勒趔声技术测定的左室舒张功能指标是早期检出并监测急性心脏排斥反应的可靠、简便方法。     

二维多普勒超声评价法乐氏四联症手术前后血流动力学改变

用多普勒超声无创评价20例法乐氏四联症手术前后血流动力学改变。与正常组对照发现,法乐氏四联症右室舒张功能异常系心肌顺应性降低所致,而左心舒张功能异常多系前负荷受损,并非心肌异常,还获得了右室收缩时间间期的新参数。     

30例主动脉窦瘤破裂临床分析

本文系统分析30例主动脉窦瘤破裂的临床资料。总结出以下诊断要点:(1)本病多见于男性,好发年龄20～40岁;(2)多数起病急,进展快;(3)成年患者在心前区突然出现连续性杂音或原有收缩期杂音上又出现新的连续性杂音;(4)心电图不具备特异性,但若V_1导联呈rSr'形高度提示主动脉窦瘤破入右房;(5)X线胸片特点是心脏普遍增大,多数呈主动脉型心脏,而肺血增多不严重;(6)最后诊断依赖二维超声或主动脉造影。     

细小主动脉根部换瓣时扩大瓣环的方法

本院自1979年7月至1991年4月,对10例细小主动脉根部患者,做了扩大瓣环主动脉瓣替换术,采用了3种术式:Nicks氏手术3例(2例死亡),Konno氏手术1例(死亡),Manouguian氏手术6例(无死亡)。本文讨论了手术适应证并对3种术式进行了比较。     

BRUCELLOSIS COMPLICATED BY AORTIC VALVE ENDOCARDITIS

A 30 year old veterinary surgeon developed a febrile illness with serological evidence of Brucellosis. He was known to have aortic valve disease and during the course of the illness, the clinical features of endocarditis became evident, with a vegetation visible echocardiographically on the aortic valve. Because of persisting fever despite appropriate antibiotic therapy, aortic valve replacement with a viable cryopreserved allograft aortic valve was undertaken. Organisms consistent with Brucella species were demonstrated in the excised vegetation. The patient received a six week course of antibiotics and his post-operative course was uneventful.     

脉冲多普勒超声心动图对冠心病舒张功能的研究

本研究应用脉冲多普勒超声心动图(PDE)技术,记录20例正常人和37例慢性冠心病伴充血性心力衰竭(CHF)患者的二尖瓣血流频谱。测值分析发现,冠心病伴CHF患者左室舒张早期充盈流速显著降低,晚期充盈流速补偿性升高,提示左室舒张功能障碍普遍存在。     

Right ventricular apical view—A new window for doppler echocardiography of aortic valve stenosis

We studied a new Doppler echocardiographic approach in 56 patients with valvular aortic stenosis from the right ventricular apex (AS-RV) and compared the transvalvular gradients with the results of the standard view from the left ventricular apex (AS-LV). AS-RV resulted in good or acceptable velocity curves in 59% of patients. The correlation between the two apical views for the peak/mean gradients were close (r = 0.95/0.96). Using all typical positions for Doppler investigation of aortic stenosis, highest peak gradients were best recorded in five cases by AS-RV. In one woman with a narrow left ventricular cavum and severe aortic stenosis, only AS-RV yielded a technically good spectral curve. Thus, in selected patients—probably those with a small left ventricular cavity or an enlarged right ventricle—AS-RV may be the best window or even the only possibility in Doppler investigation of aortic valve stenosis.     

Accuracy of aortic stenosis severity assessment by Doppler echocardiography: importance of image quality

The aim of the present study was to investigate which factors could influence the accuracy of aortic stenosis severity assessment by Doppler echocardiography in an unselected population. Doppler echocardiographic determination of mean transvalvular pressure gradient and aortic valve area by continuity equation was performed in 101 patients before catheterization. According to the catheterization data, aortic stenosis was classified into 2 categories: mild to moderate (orifice area [Gorlin formula] > 0.75 cm², mean transvalvular gradient < 50 mmHg) and severe (orifice area < 0.75 cm², mean transvalvular gradient 50 mmHg). The influence of eight factors on the absolute difference in aortic valve area and mean transvalvular pressure gradient and on the concordant classification in the same category by both methods was investigated.Results. By multivariate analysis, the absolute difference in aortic valve area by both methods was significantly associated with poor image quality, absolute difference between mean catheterization and Doppler transvalvular gradient and inversely related to body mass index. Absolute difference in mean transvalvular gradients by both methods was significantly associated only with image quality. Poor image quality emerged as the only significant factor influencing the concordant classification between invasive and noninvasive studies according to orifice area (but not according to transvalvular pressure gradient).Conclusion. Echographic image quality significantly influences the accuracy of Doppler echocardiographic determination of aortic valve area and, to a lesser extent, of transvalvular pressure gradient. Therefore, the mere noninvasive approach is not suitable to every consecutive patient with aortic stenosis. Qualifications concerning overall image quality should identify patients most likely to benefit from catheterization.     

Diagnostic Accuracy of Handheld Echocardiography for Evaluation of Aortic Stenosis

Background: Symptomatic severe aortic stenosis is associated with increased mortality and morbidity. Early identification of these patients by echocardiography is crucial. We conducted this study to evaluate a handheld ultrasound device (HCU) in patients with suspected severe aortic stenosis (AS) in comparison to a standard echocardiography device (SE). Methods: A HCU (Vivid I; GE Healthcare) and a SE device (Philips iE 33) were used to evaluate 50 consecutive patients with suspected severe AS. Two consecutive echocardiographic studies were performed by two experienced and blinded examiners using HCU and SE device. AS was graded by mean transaortic pressure, aortic valve area (AVA), and indexed AVA (AVA adjusted for body surface area). Results: Mean difference for mean transaortic gradient, AVA and indexed AVA for the SE and HCU device were 1.28 mmHg (?0.70 to 3.26 mmHg), ?0.02 cm² (?0.06 to 0.01 cm²), and ?0.01 cm²/m² (?0.03 to 0.01 cm²/m²), respectively. Discrepancies between both devices were not associated with misinterpretation of the degree of AS. Conclusion: Our study demonstrates that HCU can be used to evaluate patients with suspected AS. (ECHOCARDIOGRAPHY 2010;27:481‐486)     

Postextrasystolic Potentiation in Low‐Gradient,Severe Aortic Stenosis: A Poor Man's Stress Echo?

An elderly man with dyspnea and syncope was found to have severe aortic stenosis (AS) by the continuity equation, despite a transaortic gradient that was only moderately elevated, in the setting of severe left ventricular dysfunction. The transaortic gradient increased during postextrasystolic beats, suggesting that his that his AS was truly severe; this was confirmed by dobutamine echocardiography. He underwent transcatheter aortic‐valve replacement (TAVR), with subsequent improvement in left ventricular systolic function. The diagnostic and prognostic significance of postextrasystolic potentiation, with associated increase in aortic stenosis gradient, deserves renewed attention in the TAVR era.     

多普勒超声估测置人碟瓣的血液动力学

作者对25例二尖瓣和15例主动脉瓣置换机械斜碟瓣进行脉冲、连续波多普勒超声研究。主动脉瓣人工瓣最大流速总平均2.35±0.29m/s,二尖瓣人工瓣最大流速总平均1.61±0.32m/s,不同大小瓣膜最大流速之间均无显著性差异,但不同大小二尖瓣机械瓣压力减半时间有显著性差异(P<0.001),较大规格机械瓣(29号)瓣口面积接近生理特点。     

负荷多普勒超声评价法乐氏四联症根治术后肺动脉反流的血液动力学反应

本文通过应用负荷多普勒超声无创方法评价法乐氏法乐氏四联症术后患者的运动耐量和肺动脉反流(PR)对血液动力学反应的影响。31例与按年龄、性别和体表面积的大小相匹配的20例正常志愿者作对照研究。在次极量仰卧运动中测量最大心率、心率血压双乘积、最大运动耐量指数。用多普勒超声测量静息和次极量仰卧运动时主动脉血流平均加速度、心脏指数、左室短轴缩短率及其它静息时的超声指标。结果显示:术后患者右室增大,与PR程度呈正相关,最大心率反应、氧消耗量和最大运动耐量指数较正常对照组均有降低(P<0.001)。按PR程度,将本组病例分成无、轻度、中度和重度PR组,无PR和轻度PR组的血液动力学反应接近正常,重度PR组有显著低心输出量反应,无PR组的最大运动耐量指数也低于正常对照组。法乐氏四联症术后患者运动耐量降低和血液动力学反应异常与PR相关,PR的产生与右室流出道重建方式有关。     

48例主动脉瓣下狭窄的外科治疗

本文报告４８例（分散性）主动脉瓣下狭窄（ＤＳＡＳ）。其中隔膜型狭窄８例（１６．７％），肌纤维型狭窄３９例（８１．８％），隧道型狭窄１例（２％）。单纯ＤＳＡＳ组（１５例）术后无死亡，合并其它心内畸形组（３３例）术后早期死亡２例。作者认为，ＤＳＡＳ手术早期效果良好，并就影响远期疗效的因素进行了讨论。     

经皮球囊二尖瓣成形术前后三种计算二尖瓣口面积方法的比较

对３３例以二尖瓣狭窄为主的风湿性心脏病患者进行研究，比较了经皮球囊二尖瓣成形术（ＰＢＭＶ）前后３种计算二尖瓣瓣口面积的方法。统计表明，ＰＢＭＶ前Ｇｏｒｌｉｎ公式，多普勒超声心动图压差减半时间及二维超声心动图测量的二尖瓣口面积间有显著相关，但ＰＢＭＶ后仅二维超声心动图测量二尖瓣口面积（ＭＶＡＥ）与连续波多普勒超声心动图测量二尖瓣口面积（ＭＶＡＤ）维持ＰＢＭＶ前相似的相关性；３种方法计算的瓣口面积在ＰＢＭＶ前后的变化率亦不相关。ＰＢＭＶ后血液动力学改变对Ｇｏｒｌｉｎ公式及压差减半时间计算的二尖瓣口面积有明显影响，３种计算二尖瓣口面积的方法不能混用，ＰＢＭＶ术后测量二尖瓣口面积应以二维超声心动图方法为准。     

Assessing the true severity of low-gradient aortic stenosis using resting echocardiography

BackgroundDobutamine stress echocardiography (DSE) is required to determine whether low-gradient aortic stenosis (AS) with a small aortic valve area (AVA) is truly severe. The purpose of the present study was to evaluate the usefulness of ejection dynamics parameters at resting echocardiography for predicting the result of DSE performed in patients with low-gradient AS.MethodsThe results of resting echocardiography and DSE performed on 51 AS patients with low mean-gradient (<40 mmHg) and small indexed AVA (<0.60 cm²/m²) were retrospectively reviewed. Acceleration time (AT) and the ratio of AT to ejection time (ET) were measured on the recorded images. True-severe AS was defined as that with indexed projected AVA < 0.60 cm²/m².ResultsTwenty-six (51%) patients had true-severe AS, while 22 (43%) patients had preserved left ventricular ejection fraction (≥50%). Baseline indexed AVA and AT/ET were independently associated with indexed projected AVA at DSE. AT/ET was the only independent determinant of valve compliance. Indexed AVA ≤ 0.493 cm²/m² and AT/ET > 0.334 at baseline had sensitivities of 69% and 65% and specificities of 84% and 84%, respectively, for predicting true-severe AS. The presence of either indexed AVA ≤ 0.493 cm²/m² or AT/ET > 0.334 had a higher sensitivity (88%), and their co-occurrence had a higher specificity (100%).ConclusionsIndexed projected AVA at DSE was predicted by AT/ET, which represented valve compliance, along with indexed AVA. The true severity of low-gradient AS can be screened using a combination of resting indexed AVA and AT/ET without performing DSE.     

应用多普勒超声冷加压试验检测糖尿病患者心功能

本文应用脉冲多普勒超声心动图和冷加压试验检测43例无临床心脏病表现的糖尿病患者,发现部分患者存在潜在性左心室收缩功能减退,其原因可能是临床前期的糖尿病性心肌病和糖代谢障碍。