单纯主动脉瓣反流病因超声心动图与手术对照分析

目的探讨行手术治疗的单纯主动脉瓣反流病因分布。方法手术治疗的单纯主动脉瓣重度反流患者86例．通过超声心动图观察主动脉瓣反流、瓣膜形态及异常回声、升主动脉内径,综合超声心动图、手术所见、部分病理结果和临床资料确定最终病因。结果在手术治疗单纯主动脉瓣反流患者中,瓣膜松弛、感染性心内膜炎和升主动脉夹层分别排行前3位病因。风湿性心脏病、退行性变、白塞病排行并列第4位。其余病因为主动脉瓣二叶瓣和梅毒。结论本组行手术治疗的单纯主动脉瓣反流病人中,病因以瓣膜病为主．超声心动图在确定病因方面起重要作用。     

超声心动图评价经心尖经导管主动脉瓣置换术治疗主动脉瓣单纯关闭不全的近中期疗效

目的:探讨经心尖经导管主动脉瓣置换术(TAVR)治疗主动脉瓣单纯关闭不全的近中期临床症状改善情况、左心室结构及功能等变化特点.方法:选取2018年1月至2019年6月在空军军医大学西京医院行经心尖途径TAVR治疗主动脉瓣单纯关闭不全的患者53例,随访1年,观察术后左心室各径线、主动脉生物瓣内和瓣周反流、二尖瓣反流程度等...     

二维彩色多普勒超声心动图对188例主动脉瓣反流患者的观察

目的　探讨老年性退行性主动脉瓣反流的发病趋势及其机制。方法　采用二维多普勒超声心动图及彩色多普勒血流显像(CDFI)对 188例主动脉瓣反流者进行病因分类统计分析。结果　老年性退行性心瓣膜病 (DCVD)引起反流 99例 ,占总数 5 2 .66%。平均年龄为 63 .5岁。风湿性心脏病引起反流 46例 ,占总数 2 4.47%,平均年龄 42 .7岁。高血压、冠心病等引起反流 2 0例 ,占总数的 10 .64 %。无心血管系统临床症状和体重存在主动脉瓣膜反流者 2 3例 ,占总数的 12 .2 3 %。结论　 DCVD是老年人心血管系统在形态和功能上发生的一种衰老性改变 ,主要机制为主动脉瓣的机械磨损、钙化及纤维化。加强对老年性心脏病的研究 ,延缓和减少 DCVD的发生 ,超声早期诊断有其特殊的临床意义     

经皮主动脉瓣置换术中的二尖瓣反流

主动脉瓣狭窄（aortic stenosis,AS）已成为最为常见的心脏瓣膜病变之一。经皮主动脉瓣置换术（transcatheter aortic valve replacement,TAVR）为无法进行外科手术或外科手术高危的重度/中-重度AS患者提供了一种创伤更小的治疗方法,是近年来国内外发展的热点。由于TAVR手术自身特点,二尖瓣反流（mitral regurgitation,MR）的评价和改变对其尤为重要。目前针对TAVR手术的MR的研究主要集中于术后MR的变化及其影响,但TAVR术中可能出现明显的MR程度的变化,其变化趋势、影响因素及其对患者预后的影响应受到更多重视。超声心动图是评价和监测MR的重要手段,可以较为准确地反映MR变化趋势,对其对预后的影响进行判断,探讨术中MR变化的可能机制。随着超声心动图技术的发展,需要引进更为灵敏客观的指标预测及监测TAVR术中MR的变化趋势,进一步寻找术中MR可能的影响因素。     

主动脉瓣穿孔的超声心动图特征

目的探讨主动脉瓣穿孔的超声心动图特征及临床价值.方法应用彩超心动图诊断仪检测主动脉瓣膜形态结构及血流异常特点.结果主动脉瓣叶不能自然合拢,形成连枷瓣样改变及血液返流偏心束是主动脉瓣穿孔的重要特点.结论彩色超声心动图可以明确瓣膜穿孔部位、程度,也可以判断血液返流的方向、程度,为有效选择手术方案提供了其他检查无法比拟的临床资料.     

主动脉瓣成形术治疗主动脉瓣反流的现状及进展

主动脉瓣成形术（aortic valve repair, AVr）保留了自体瓣膜结构的完整,具有良好的血流动力学指标,无需长期抗凝治疗,免除了人工瓣膜昂贵的经济负担,以及术后较低的瓣膜相关并发症,使得这项技术被广泛接受。AVr适合任何年龄的患者,尤其有利于青少年、孕妇及老年患者。本文将AVr治疗AI（aortic insufficiency, AI）的现状及进展做一综述。     

主动脉瓣穿孔的超声心动图特征

目的:探讨主动脉瓣穿孔的超声心动图特征及临床价值。方法:应用彩色超声心动图诊断仪检测主动脉瓣膜形态结构及血流异常特点。结果:主动脉瓣叶不能自然合拢,形成连枷瓣样改变及血液返流偏心束是主动脉瓣穿孔的重要特点。结论:彩色超声心动图可以明确瓣膜穿孔部位、程度,也可以判断血液返流的方向、程度,为有效选择手术方案提供了其他检查无法比拟的临床资料。     

72例非风湿性主动脉瓣关闭不全临床与超声心动图分析

分析７２例非风湿性主动脉瓣关闭不全（涉及６类１４种病）临床与超声心动图表现。７２例中，老年退行性变居首位。因无舒张期杂音临床漏诊１５例，其中５例返流在中度以上，为先天性心脏病和退行性变；临床误诊１８例。在超声心动图上，各病因之主动脉瓣改变多有其特征，可使绝大多数诊断明确。但对老年退行性变、二叶瓣畸形、风湿性心脏病后期主动脉瓣严重钙化，需多切面寻找有无瓣叶粘连、其他部位病变等以相区别。结缔组织病多需借助免疫学、骨关节相作出诊断。     

经导管主动脉瓣置换术治疗单纯主动脉瓣反流的临床疗效分析及经验

目的 探讨使用自膨胀式瓣膜行经导管主动脉瓣置换术（TAVR）在单纯主动脉瓣反流（PAR）患者中的疗效,总结这一术式的初步经验。方法 纳入2022年4月至2023年5月武汉亚心总医院和武汉亚洲心脏病医院使用TaurusElite经导管主动脉瓣系统实施TAVR的PAR患者共20例,收集并分析患者的临床基线资料、超声心动图资料及术后住院期间和出院后30 d随访资料。结果 患者的平均年龄为（73.5±5.5）岁,平均美国胸外科医师协会（STS）评分（8.7±3.6）%,术前重度主动脉瓣反流16例（16/20）。经TAVR治疗后,手术成功20例（20/20）,单一瓣膜器械成功19例（19/20,瓣中瓣1例）。术后30 d随访结果显示,20例患者未出现死亡、致残性脑卒中、心肌梗死及转外科事件,术后主动脉瓣残余反流程度均为无或者微量,手术效果理想。结论 经过严格的病例筛选及规范的手术标准化操作,使用自膨胀式瓣膜行TAVR治疗PAR患者的可行性高,早期临床结果良好,可进一步推广应用;对于所归纳总结的术式经验,可做进一步临床验证。     

Acute aortic regurgitation following fibrous strand rupture of aortic valve successfully diagnosed by transesophageal echocardiography

Fibrous strand rupture is a rare cause of acute aortic regurgitation, but is a serious condition because of acute massive regurgitation. Therefore, prompt and accurate diagnosis is required. We saw a 53‐year‐old man who presented with acute dyspnea without evidence of infection. Transesophageal echocardiography revealed severe aortic regurgitation because of fibrous strand rupture. We performed surgery and found that the fibrous strand of the right coronary leaflet was ruptured. In cases of acute aortic regurgitation, the rupture of fibrous strand should be considered and transesophageal echocardiography would be very useful to diagnose it.     

Sensitivity and specificity of pulsed Doppler echocardiography in detection of aortic and mitral regurgitation

In order to assess the value of pulsed Doppler echocardiographyin detection of valvular regurgitation, 63 patients were evaluatedfor aortic and/or mitral regurgitation using pulsed Dopplerechocardiography and selective cineangiography. The Dopplerstudy was considered as positive when a turbulent flow was detectedbelow the aortic valve for aortic insufficiency and behind themitral valve for mitral insufficiency on a graphic display (timeinterval histogram) when technically adequate andor on an audiosignal.These results were compared with standard angiographic evaluationof the regurgitation: pulsed Doppler echocardiography had 94%sensitivity and the specificity rate was very high (87.5%) evenfor mild regurgitation. Thus, Doppler technique is highly specificand sensitive in detection of aortic and mitral regurgitationwhen both audiosignal and time interval histogram are simultaneouslyperformed.     

Assessment of aortic regurgitation by transesophageal echocardiography: correlation with angiographic determination

Transthoracic echocardiographic studies have shown that color Doppler mapping of the aortic regurgitation (AR) jet correlated well with the severity of regurgitation as assessed by contrast aortography. The present study was performed to assess whether these parameters could be similarly applied to measurements determined by transesophageal echocardiography (TEE). In order to determine and validate criteria for the assessment of AR severity, 39 clinically stable patients with a TEE color Doppler study and contrast aortography within a 2-week period were identified. The ratio of the jet area (JA) to left ventricular diastolic area (LVDA) had the best correlation to AR severity as determined by contrast aortography (r = 0.89). Jet length, JA, the ratio of jet width to the width of the left ventricular outflow tract and jet width had r values of 0.88, 0.88, 0.83, and 0.84, respectively. The best sensitivity and specificity for the assessment of AR by TEE were obtained as follows: JA/LVDA ratio of 0%-7% predicts 0-1 + AR; 8%-20% 2-3 + AR, and greater than 20% 4 + AR. Of the three patients miscategorized, none was misgraded by more than one angiographic grade of AR. Jets that measure more than 6 cm in length or have an area of greater than 10 cm 2 have a 100% sensitivity and specificity for diagnosing 4 + AR. In the present study the ratio of JA to LVDA area correlates best with AR severity as determined by angiography.     

Asymptomatic chronic traumatic aortic valve perforation with severe aortic regurgitation

Here, we present a young asymptomatic male patient incidentally diagnosed to have aortic regurgitation (AR). The patient had a history of a blunt trauma to the thorax two years back but did never have any symptoms. Transthoracic echocardiography showed a moderately dilated left ventricle with normal systolic function and severe AR with normal nondilated aortic root and tri-leaflet aortic valve. To diagnose the etiology of the AR, a transesophageal echocardiogram (TEE) was done, which revealed a perforation in the nonadjacent leaflet (NAL) and confirmed severe AR with two AR jets being clearly visualized, one through the point of incomplete coaptation and other one through the perforated area in the NAL. The patient was treated with aortic valve replacement and was doing well on follow-up.     

Echocardiographic and hemodynamic features of severe aortic regurgitation with diastolic opening of the aortic valve

Severe aortic regurgitation may be associated with premature aortic valve opening. Several possible etiologies for this diastolic opening have been suggested. We present a patient with hemodynamic data, M-mode and 2-D echocardiography in the setting of severe aortic regurgitation and diastolic aortic valve opening. Our data lead us to conclude that aortic valve opening in this situation is neither from passive flotation nor dependent on atrial systole. We believe that active ventricular recoil mechanisms can facilitate increases in diastolic ventricular pressure which then can transiently exceed aortic pressure in the setting of severe aortic regurgitation. This hemodynamic observation suggests that the valve opening is an active process.     

升主动脉瘤合并主动脉瓣关闭不全的外科治疗

目的：回顾性总结自１９９１年１２月至１９９９年５月期间,３３例升主动脉瘤伴主动脉瓣关闭不全外科治疗的经验。方法：３３例升主动脉瘤中,１例为真性动脉瘤。３２例为夹层动脉瘤。夹层动脉瘤按ＤｅＢａｋｅｙ分型法,Ｉ型８例,ＩＩ型２４例,均伴主动脉关闭不全,均行Ｂｅｎｔａｌｌ手术,１０例合并二、三尖瓣关闭不全,做二、三尖瓣整形手术。１例合并冠心病,做内乳动脉与前降支搭桥术,结果：手术死亡率为６．０％（２／３３）,２例分别死于感染性心内膜为和吻合不可控制性渗血,２例有严重脑部并发症,随访时间１～５５个月,远期死亡２例,均系错迷窒息死亡,其余２９例心功能明显改善,眩动脉瘤无复发。结论：（１）升主动脉瘤合并主动脉瓣关闭不全行Ｂｅｎｔａｌｌ手术,采用良好的心肌保护方法,注意吻合技术防止出血,可以取得良好的手术效果。（２）对Ｄ     

Prevalence and clinical associations of mitral and aortic regurgitation in patients with aortic stenosis

Background

Most guidelines directing clinicians to manage valve disease are directed at single valve lesions. Limited data exists to direct our understanding of how concomitant valve disease impacts the left ventricle (LV).

Methods

We identified 2817 patients with aortic stenosis (AS) from the echocardiography laboratory database between September 2012 and June 2018 who had a LV ejection fraction (EF) ≥50%. LV mass, LV mass index, LV systolic pressure (systolic blood pressure + peak aortic gradient). Covariates were collected from the electronic medical record. Multi-variate analysis of covariance was used to generate adjusted comparisons.

Results

Our population was 66% female, 17% African-American with a mean age of 65 years. Of note, 7.3% were noted to have significant (moderate/severe) aortic regurgitation (AR), and 11% had significant (moderate/severe) mitral regurgitation (MR). Adjusting for covariates at different levels, significant MR had a much stronger association with heart failure compared to those with significant AR (p < .001 vs. p = .313, respectively) at all levels of adjustment. Both significant mitral and AR exhibited an association with increasing left ventricular mass, even with adjustment for baseline demographics and clinical features (p < .001 vs. p = .007, respectively).

Conclusion

In patients with AS, 16% also experience at least moderate MR or AR. Further, significant MR has a stronger association with heart failure than significant AR, even though both increase left ventricular mass. Those with moderate AS and significant MR or AR experience similar or higher levels of heart failure compared to severe AS without regurgitation. Mixed valve disease merits further studies to direct longitudinal management.     

Retrograde atrial kick in acute aortic regurgitation. study of mitral and pulmonary venous flow velocities by transthoracic and transesophageal echocardiography

Background and hypothesis: The purpose of this study was the comprehensive evaluation of the changes in pulmonary venous and mitral flow velocities of patients with acute and chronic severe aortic regurgitation. Transmitral flow velocities obtained with pulsed-wave Doppler echocardiography have been used to provide information on left ventricular (LV) filling and diastolic function. Pulmonary venous flow tracings are an important adjunct to LV inflow pattern in assessing LV diastolic function. Methods: Fourteen patients with severe aortic regurgitation (8 chronic and 6 acute) and in sinus rhythm were examined by transthoracic and transesophageal pulsed Doppler echocardiography. Mitral and pulmonary flow velocities were recorded and compared. All patients had ejection fractions > 40%. Results: Early mitral flow peak velocity was higher in patients with acute regurgitation (p<0.001). The mitral A wave was absent in five patients with acute regurgitation. In contrast, a prominent reverse atrial pulmonary systolic wave AR was demonstrated in these patients. Peak diastolic velocity of the pulmonary venous flow was greater in patients with acute aortic regurgitation (0.76 ± 0.13) than in patients with chronic aortic regurgitation (0.40 ± 0.09) (p<0.001). Peak systolic velocity did not differ significantly between the two groups. The systolic fraction of pulmonary venous flow in patients with acute aortic regurgitation was lower (0.43 ± 0.05) than that of patients with chronic regurgitation (0.63 ± 0.1) (p<0.01). All patients with acute aortic regurgitation had an S/D ratio < 1, while those with chronic regurgitation had an S/D >1 (p< 0.001) and an E/A<1. Conclusion: Patients with severe acute aortic regurgitation showed a retrograde atrial kick (absence of transmitral A wave with prominent pulmonary AR wave). These patients had an S/D ratio < 1 (restrictive Doppler pattern). Patients with chronic aortic regurgitation exhibited a Doppler pattern of abnormal LV relaxation (E/A <1, S/D > 1).