中老年二尖瓣脱垂和腱索断裂患者的超声心动图分析

目的:比较中老年二尖瓣脱垂和二尖瓣腱索断裂患者的超声心动图像。方法:通过超声心动图检查对54例中老年二尖瓣脱垂和二尖瓣腱索断裂患者的心脏结构和功能进行分析。结果:二尖瓣脱垂组中性别无明显差异,前后叶无明显差异,二尖瓣返流以中度为主(73.1%);二尖瓣腱索断裂组中,男性(67.9%)多于女性(32.1%),腱索断裂后叶(60.7%)多于前叶(39.3%),二尖瓣返流以中重度为主(92.9%);心脏结构改变腱索断裂组重于脱垂组。结论:中老年患者二尖瓣脱垂和腱索断裂的超声心动图具有明显的特征性。     

二尖瓣脱垂的CT表现

目的了解二尖瓣脱垂的CT表现并探讨CT诊断二尖瓣脱垂的可行性。方法对25例经手术或心脏超声证实的二尖瓣脱垂患者的64层CT心脏图像进行分析。结果所有25例患者均可见收缩期二尖瓣叶突人左心房,并超过瓣环平面2mm。其他CT表现包括瓣叶增厚超过2mm（14例）和腱索断裂（3例）。结论二尖瓣脱垂具有特殊的CT表现,CT能够可靠地诊断二尖瓣脱垂。     

二尖瓣腱索断裂295例超声与手术结果的比较研究

目的通过观察大样本二尖瓣腱索断裂(MCTR)的超声心动图和手术特点,探讨MCTR疾病分布特点、经胸超声心动图(TTE)特征,并明确其在指导手术中的价值。资料与方法收集5年以来在北京阜外心血管病医院住院的295例MCTR患者病例资料,记录所有患者心电图、经胸超声心动图、手术结果,将结果进行比较分析。结果 295例MCTR患者中,前叶腱索断裂100例,后叶腱索断裂182例,前后叶腱索均断裂13例;腱索完全断裂26例,部分断裂269例;进行换瓣手术110例,修补手术132例。本组MCTR的主要超声特点为二尖瓣叶脱垂、出现连枷样或挥鞭样改变、二尖瓣中～重度反流、心脏扩大、轻中度肺动脉高压。根据手术结果判断,TTE对MCTR的诊断符合率为96.7;判断前后叶脱垂和腱索断裂的诊断符合率为92.5,准确判断为完全和部分腱索断裂的诊断符合率为89.3。TTE的主要误诊原因是在判断腱索摆动与断裂腱索、二级腱索断裂部位仍有缺陷和缺少经验。经过统计学分析,MCTR是进行换瓣还是修补手术,与附着瓣叶的部位有关(P<0.05),而腱索是否部分或完全断裂与手术方式的选择无关(P>0.05)。结论经胸超声心动图能够准确地诊断大部分MCTR,并且能够协助外科医生进行初步分型和选择手术方式。     

双孔二尖瓣成形术应用于先天性二尖瓣关闭不全的矫治

目的 探讨双孔二尖瓣成形术治疗先天性二尖瓣关闭不全的可行性和有效性。方法 将脱垂的前叶边缘与后叶相对应的边缘缝合到一起，形成双孔二尖瓣。结果 本组3例病人，1例为先天性二尖瓣关闭不全，2例为部分型心内膜垫缺损。术后恢复平稳，没有手术死亡，无二尖瓣关闭不全和二尖瓣狭窄发生。结论 双孔二尖瓣成形术是矫治先天性二尖瓣关闭不全的一种简便而有效的方法。     

二尖瓣病变合并三尖瓣轻度关闭不全患者二尖瓣置换术后三尖瓣返流加重的超声特点和临床意义

目的:探讨二尖瓣病变合并三尖瓣轻度关闭不全(TR)患者在二尖瓣置换术后三尖瓣关闭不全加重的超声特点,为临床手术方式的制订提供依据.方法:回顾性分析130例二尖瓣病变合并三尖瓣轻度关闭不全患者二尖瓣置换术前及术后的临床和超声资料,术后随访时间为1～6年,平均(3.51±1.82)年.超声检查测量每例患者术前的左心室射血分数(LEVF)、右心房、右心室、左心房和左心室内径、肺动脉收缩期压力、三尖瓣瓣环直径和三尖瓣返流面积、以及术后三尖瓣返流面积,并相应的分为正常组和异常组,采用卡方检验分析上述指标与术后三尖瓣返流的关系.结果:超声检查显示在二尖瓣置换术后130例患者的二尖瓣功能均良好,但33例患者的三尖辩返流量较术前明显增加,其中术前有左心功能下降者25例,右房增大27例,右室增大26例,左房增大15例,左室增大27例,肺动脉压增高27例,三尖瓣环扩大28例.卡方检验显示术前左心室内径与术后三尖辩返流加重无显著相关性(P＞0.05),而其它指标与术后三尖瓣返流加重的相关性均有统计学意义(P＜0.05).结论:术前左心功能下降、右心室、右心房和左心房增大、肺动脉收缩期压力升高、三尖瓣瓣环增大可能是二尖瓣病变合并三尖瓣轻度关闭不全患者在二尖瓣置换术后出现三尖瓣返流加重的危险因素,术中有必要积极处理.     

外科治疗缺血性二尖瓣关闭不全的早期疗效分析

目的 探讨缺血性二尖瓣关闭不全患者同期行冠状动脉搭桥(CABG)+二尖瓣置换或成形术的早期疗效.方法 回顾性分析2006年12月-2011年11月解放军总医院心血管外科收治的46例缺血性二尖瓣关闭不全患者的临床资料,其中男34例,女12例,年龄66.8±76.4岁,16例行CABG+二尖瓣置换术,30例行CABG+二尖瓣成形术,分别于术前及术后测定左室内径及左室射血分数.结果 1例二尖瓣成形+CABG患者术后早期死于心力衰竭,余45例均治愈出院.超声心动图检查显示,术后7d患者左室内径从51.8±10.4mm降至46.8±8.1mm(P＜0.01),左室射血分数(54.3％±10.1％)与术前(53.4％±11.6％)比较差异无统计学意义(P＞0.05).结论 对于缺血性二尖瓣关闭不全患者,同期处理二尖瓣后早期效果满意,但远期疗效有待进一步观察.     

飞行人员二尖瓣脱垂伴关闭不全术后放飞一例

一、临床资料 患者,男性,39岁,运7领航员,飞行总时间3000 h. 2007年12月因感冒后心悸、胸闷就诊于体系医院,行心脏超声检查发现"二尖瓣脱垂伴关闭不全,二尖瓣中量反流",经治疗后症状消失,结论飞行合格.此后正常参加飞行,每年大体检心脏超声均提示"二尖瓣脱垂伴关闭不全及少、中量反流".2010年12月在体系医院行心脏超声检查提示"二尖瓣脱垂伴关闭不全,可疑后瓣腱索断裂,大量反流",结论:暂时飞行不合格,转我院进一步治疗.查体:听诊闻及心尖部全收缩期吹风样杂音(3/6).超声结果提示"二尖瓣脱垂伴关闭不全,二尖瓣大量反流".于2012年2月22日转解放军总医院行全机器人二尖瓣成形术,手术过程顺利.术后转回我院康复治疗,1周后出院,结论:暂时飞行不合格.     

三尖瓣成形在瓣膜替换中的应用

目的:本文总结三尖瓣成形经验.方法:从1987年1月～1998年12月,35例二尖瓣或二尖瓣加主动脉瓣替换患者同时行三尖瓣瓣膜成形.术前心功能Ⅲ、Ⅳ级27级.超声提示:三尖瓣呈中-重度关闭不全23例,轻度或无关闭不全但瓣环扩张大于35mm12例.全组行DeVega成形31例,Kay成形4例.结果:手术死亡3例(8.6%),近3年无手术死亡.对后29例作了随访,平均随访4.6个病人年,4年生存率为86%.结论:三尖瓣成形能改善左心瓣膜替换患者近远期手术结果.因此,对超声提示三尖瓣明显关闭不全或三尖瓣环直径大于35mm应行三尖瓣成形.通常将扩大的瓣环缩小至30mm,多可使返流减少或消失.     

二尖瓣狭窄合并左心房血栓患者的经皮二尖瓣球囊成形术

目的　评价经皮二尖瓣球囊成形术 (PBMV)治疗风湿性二尖瓣狭窄合并左心房血栓的临床疗效和安全性。方法　 2 7例风湿性二尖瓣狭窄合并左心房血栓患者进行PBMV ,19例食管超声心动图 (TEE)有左心房内新鲜血栓者术前经华法令抗凝治疗 3～ 6个月。结果　 2 7例风湿性二尖瓣狭窄合并左心房血栓患者进行PBMV均成功。 19例TEE有左心房内新鲜血栓者 ,PBMV术前经华法令抗凝治疗后 ,TEE复查示 9例左心房血栓消失 ,10例左心房内血栓明显缩小 ,机化为高强回声团块的陈旧性血栓 ;5例经胸心脏超声发现左心房陈旧性血栓 ,未行TEE也未予华法令治疗者 ,术中 1例发生脑栓塞。其余患者均无并发症发生。结论　对风湿性二尖瓣狭窄伴有心房纤维颤动患者 ,PBMV前应常规行TEE检查 ;二尖瓣狭窄伴左心房血栓者经充分抗凝治疗后行PBMV是安全可行的。     

彩超诊断二尖瓣关闭不全的临床价值

心脏瓣膜病——二尖瓣关闭不全是各种心肌病变及心脏肿瘤所致二尖瓣装置(瓣叶、瓣环、腱索．乳头肌)和左心室的结构和功能的异常使二尖瓣前、后叶在心脏收缩时不能完全闭合，左心室的血液部分倒流至左心房而致的一系列血流动力学改变?彩色多普勒超声诊断二尖瓣关闭阳性率高．目前，已成为诊断二尖瓣关闭不全的首选方法．为临床提供     

Assessment of functional anatomy of the mitral valve in patients with mitral regurgitation with cine magnetic resonance imaging: comparison with transesophageal echocardiography and surgical results

The ability of magnetic resonance imaging (MRI) to accurately define the functional anatomy of mitral regurgitation was assessed. Transesophageal echocardiography (TEE) and cine MRI were performed on 43 patients with mitral regurgitation and were compared for the jet number, location, direction and presence of a prolapse (atrial displacement, malapposition or a flail). In 36 patients, diagnostic accuracy in reference to surgery was assessed. Comparing TEE and MRI the jet number and location were judged in concordance in 86% of patients. Jet location did not show a significant difference (Wilcoxon: P = 0.66) and both modalities correlated strongly (Spearman: r = 0.68, P<0.0001). Jet direction was judged with high concordance (kappa=0.63). Additionally, prolapse evaluation showed high concordance (kappa: valve, 0.63; anterior mitral leaflet, 0.70; posterior mitral leaflet, 0.73). Compared with surgery, the sensitivity for the detection of malapposition of any leaflet or one of both leaflets ranged between 75% and 93% for TEE and 71% and 89% for MRI. Specificities ranged between 88 and 96% for TEE and 88 and 100% for MRI. TEE detected torn chordae in all ten patients, six of which were missed by MRI. MRI is comparable with TEE in prolapse and jet evaluation. MRI is inferior to TEE in depicting anatomical details such as torn chordae.     

心脏瓣膜创伤的诊断和手术治疗

目的：总结心脏瓣膜创伤的诊断和手术治疗经验，方法：对4例心脏瓣膜创伤的临床资料进行回顾性分析。结果：二尖瓣前叶乳头肌断裂伴瓣叶穿孔行二尖瓣置换术1例。主动脉瓣穿孔伴关闭不全行主动脉瓣置换术1例，三尖瓣前叶撕裂1例，用自体心包做瓣叶修补术及三尖瓣环De Vega 成形术。三尖瓣隔瓣腱索断裂伴创伤性室缺1例，行三尖瓣修复成形术及室缺修补术，4例患者手术疗效满意。结论：心脏瓣膜创伤应尽早进行瓣膜置换术或瓣膜修复成形术，能取得优良效果。     

冠心病患者发生二尖瓣脱垂样改变超声心动图特点分析

目的 探讨冠心病患者发生二尖瓣脱垂样改变的超声心动图特点,并分析其对治疗策略的影响.方法 选取北部战区总医院收治的同时行冠状动脉旁路移植与二尖瓣手术的171例患者为研究对象.根据冠状动脉病变严重程度将其分为A组(病变支数≥3支,n=98)与B组(病变支数1～2支,n=73).另选取我院同期收治的二尖瓣脱垂无冠心病行二尖...     

Papillary muscle head rupture in a patient with normal coronarography findings

BACKGROUND: Rupture of papillary muscle generally happens during acute myocardial infarction and is the cause of acute mitral regurgitation, pulmonary oedema, so it should be promptly recognized and managed. CASE REPORT. A patient, 52 year-old, was admitted to the Thoracic Department with fever, general weakness, dyspnea and cough as a case of suspected pneumonia. Two days before the admission he was treated with antibiotics. At thoracic ward, his clinical status got serious and he transferred to Intensive Care Unit (ICU) as pulmonary oedema. At the time of admission to ICU the patient was seriously ill with tachycardia, tachydyspnea, orthopnea and cyanosis image. Auscultatory, he showed pulmonal stasis at both sides and a tachyarrhythmic action, with a systolic murmur 5/6 grade above the mitral valve. Echocardiography showed grave mitral regurgitation with prolapsus of posterior leaflet with suspected chordal rupture. At coronarography no significant lesions of coronary arteries were found. After hemodynamic stabilization the patient was operated. During the operation, Transesophageal echocardiography (TEE) examination showed a rupture of the head of the posteromedial papillary muscle. He was surgically treated with atypical quadrantectomy of posterior leaflet with homologous pericardial patch anuloplasty. CONCLUSION: The recognition of acute mitral regurgitation caused by the papillary muscle rupture and prompt surgical treatment is of vital interest for the survival of patients.     

Paravalvular leakage in transcatheter mitral valve replacement: Bringing simulation theory one step closer to reality

Transcatheter mitral valve replacement (TMVR) has emerged as a promising technique for the treatment of these patients with severe mitral valve disease and high or prohibitive surgical risk. Early experience with TMVR has shown a high rate of technical success and promising reductions in the severity of mitral regurgitation sustained out to 1 year post procedure. Despite this, procedural complications remain high, with the most common and significant of these being valve embolization, left ventricualr outflow tract (LVOT) obstruction and paravalvular leakage (PVL). It is this currently unanswered question that Morris et al. start to address in this issue of the Journal. They use the same annular segmentation and valve simulation as already proposed to predict LVOT obstruction, but use it to focus instead on examining the residual gap left between the base of the simulated transcatheter valve and the mitral leaflets or surgical prosthesis.     

慢性缺血性二尖瓣关闭不全的外科治疗

目的：探讨慢性缺血性二尖瓣关闭不全（IMR）的手术治疗方法和效果。方法：2004-04~2008-09,冠脉搭桥同期外科治疗IMR 21例,其中中度反流17例,重度反流4例。二尖瓣成形术6例,其中使用人工瓣环4例。瓣膜置换术15例,其中双叶机械瓣8例、生物瓣7例。结果：全组手术死亡1例。17例术后平均随访24个月,远期死亡1例,生存者远期心功能l~Ⅱ级者16例,Ⅲ级者1例。术后超声复查左心室内径较术前明显缩小,瓣膜功能良好。结论：中度和中度以上缺血性二尖瓣关闭不全在作冠脉搭桥术时应同时手术处理病变的瓣膜,术后效果满意。而手术矫治的方法应根据瓣膜的病理改变和手术者的经验决定。     

Late Gadolinium Enhancement of Left Ventricular Papillary Muscles in Patients with Mitral Regurgitation

ObjectiveArrhythmogenic mitral valve prolapse (MVP) is an important cause of sudden cardiac death characterized by fibrosis of the papillary muscles or left ventricle (LV) wall, and an association between late gadolinium enhancement (LGE) of the LV papillary muscles and ventricular arrhythmia in MVP has been reported. However, LGE of the papillary muscles may be observed in other causes of mitral regurgitation, and it is not limited to patients with MVP. This study was to evaluate the association of LGE of the LV papillary muscles or ventricular wall on cardiac magnetic resonance imaging (CMR) and ventricular arrhythmia in patients with mitral regurgitation.Materials and MethodsThis study included 88 patients (mean age ± standard deviation, 58.3 ± 12.0 years; male, 42%) with mitral regurgitation who underwent CMR. They were allocated to the MVP (n = 43) and non-MVP (n = 45) groups, and their LGE images on CMR, clinical characteristics, echocardiographic findings, and presence of arrhythmia were compared.ResultsLV myocardial wall enhancement was more frequent in the MVP group than in the non-MVP group (28% vs. 11%, p = 0.046). Papillary muscle enhancement was observed in 7 (7.9%) patients. Of the 43 patients with MVP, 15 (34.8%) showed LGE in the papillary muscles or LV myocardium, including 12 (27.9%) with LV myocardial wall enhancement and 4 (9.3%) with papillary muscle enhancement. One patient with bilateral diffuse papillary muscle enhancement experienced sudden cardiac arrest due to ventricular fibrillation. Univariable logistic regression analysis showed that high systolic blood pressure (BP; odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01–1.09; p = 0.027) and ventricular arrhythmia (OR, 6.84; 95% CI, 1.29–36.19; p = 0.024) were significantly associated with LGE of the papillary muscles.ConclusionLGE of the papillary muscles was present not only in patients with MVP, but also in patients with other etiologies of mitral regurgitation, and it was associated with high systolic BP and ventricular arrhythmia. Papillary muscle enhancement on CMR should not be overlooked.