经食管动态三维重建超声显像在二尖瓣脱垂治疗中的应用

目的　探讨经食管动态三维重建超声的二尖瓣装置声像图特征及其在术中评估二尖瓣修复术后即时疗效的价值。方法　 3 3例行二尖瓣手术的患者 (16例瓣膜重建术患者和 17例瓣膜置换术患者 )于术前或术中予以三维超声重建 ,观察两组瓣膜脱垂的部位、范围 ,对瓣膜重建术患者行即时疗效评估 ,并明确残余反流机制。结果　瓣膜重建组 16例患者均为后叶脱垂 ,脱垂累及 2个段者 4例 ,脱垂平均面积(0 .80± 1.5 9)cm2 。换瓣组 17例患者中 ,单纯后叶脱垂 3例 ,脱垂累及 2个段者 13例 ,脱垂平均面积 (1.3 9± 0 .91)cm2 (P <0 .0 5 )。与二维超声显像比较 ,三维超声新发现腱索冗长 2例 ,二尖瓣前叶脱垂 4例。瓣膜修复术后即刻经食管彩色多普勒血流显像示 :无或轻微二尖瓣反流 10例 ,轻度反流 5例 ,轻中度反流 1例。 5例轻度二尖瓣反流的患者再次三维重建发现 3例瓣膜对合欠佳 ,2例存在后叶轻度残余脱垂而二维超声未能发现。结论　三维超声显像能很好地显示二尖瓣装置 ,尤其在精确定位二尖瓣脱垂的部位和测量其大小、范围上占有优势。     

彩超诊断老年人三尖瓣脱垂的临床意义

目的探讨老年人三尖瓣脱垂的原因及临床意义。方法应用彩色多普勒观察分析7例老年人三尖瓣脱垂的超声表现和血流动力学改变。结果7例三尖瓣脱垂为轻度一中度，以前瓣脱垂多见，部分伴有偏心性三尖瓣返流及轻度肺动脉高压。结论老年人三尖瓣脱垂多由退行性变和右室心肌缺血引起。     

彩色多普勒超声心动图监测人工机械瓣异常93例分析

本文总结了93例瓣膜替换术后机械瓣异常的超声表现，并与再手术中的发现（43例）和临床病情对比分析。结果表明彩色多普勒血流显像（CDFI）检出瓣周漏敏感度极高，本组为100％，二维超声心动图（2DE）显示瓣周裂隙的敏感度为63％。但2DE可显示瓣膜赘生物、瓣架摆动及居室增大等。机械瓣的CDFI与2DE异常程度与临床病情及预后相关。     

超声诊断老年退行性心瓣膜病变的特点及意义

目的：探讨彩色多普勒超声心动图对老年性退行性心瓣膜病变的诊断特点、临床应用及对临床治疗的指导意义。材料与方法：对来我院进行心脏超声体检者年龄在45~90岁的635例人群进行彩色多普勒超声心动图检查,观察房室大小,瓣膜及瓣环的形态改变、活动的状态,其返流的部位与程度。结果：检出老年性退行性心瓣膜病变的患者285例,主要在60岁以上人群中发生,并随年龄增大发病率升高,男性多发于女性。老年性退行性心瓣膜病变以主动脉瓣及二尖瓣环发生率最高,主动脉瓣受累率明显高于二尖瓣,单纯性三尖瓣、肺动脉瓣少受累及,均与其它瓣膜受累并存。结论：彩色多普勒超声心动图可直接观察瓣膜厚度、回声强度及活动度,并可发现瓣环的钙化及返流程度,能明确诊断退行性心瓣膜病,对临床医师诊断及治疗有直接指导意义。     

经胸彩色多普勒超声心动图在室间隔缺损合并主动脉瓣脱垂介入封堵术中的应用价值

目的 探讨经胸彩色多普勒超声心动图在室间隔缺损(VSD)合并主动脉瓣(AV)脱垂封堵术中的临床价值.方法 30例VSD合并不同程度的AV脱垂的患者,全部行介入封堵术,术前我们将AV脱垂的程度分为3度,Ⅰ度为AV轻度脱垂,舒张期AV窦略大,未超过瓣环连线,彩色血流未见明显反流.Ⅱ度AV窦明显扩大,舒张期超过瓣环连线脱向左室流出道并瓣膜轻度反流,反流量不超过0.7 ml,舒张期未堵塞缺损口.Ⅲ度AV脱垂,瓣窦明显扩大,有形态改变,舒张期瓣窦大部分脱入VSD口,瓣根与VSD 口部分粘连,瓣叶僵硬,活动度差,彩色血流示明显反流,反流量大于1 ml.结果 30例VSD合并AV脱垂患者,AV右冠瓣脱垂15例,AV无冠瓣脱垂13例,右、无冠瓣同时脱垂2例.15例右冠瓣脱垂Ⅰ度9例,Ⅱ度4例,Ⅲ度2例.13例AV无冠瓣脱垂,Ⅰ度8例,Ⅱ度4例,Ⅲ度1例.2例双瓣(右、无冠瓣)脱垂,均Ⅰ度脱垂.30例患者行VSD封堵术,28例封堵成功,2例封堵失败(其中1例嵴下型VSD,另1例嵴内型VSD合并AV脱垂),2例VSD均合并Ⅲ度AV右冠瓣脱垂并瓣膜反流.术中释放封堵伞后超声检查AV反流量明显大于术前,反流量大于1 ml.结论 经胸彩色多普勒超声心动图在VSD合并AV脱垂术前程度的判断,介入术中封堵器是否加重AV的脱垂,瓣膜反流量是否大于术前,超声检查对VSD介入手术的成功,封堵器的选择起到重要的作用和诊断价值.     

彩色多普勒超声对三尖瓣下移畸形的诊断价值

目的 探讨二维及彩色多普勒超声心动图诊断三尖瓣下移畸形的诊断价值。方法 分析45例经手术证实三尖瓣低位的超声心动图表现。结果 45例三尖瓣下移畸形超声均做出定性诊断，下移瓣叶及合并畸形的诊断灵敏度不一，2例三尖瓣发育不全超声诊断为三尖瓣低位畸形。结论 彩色多普勒超声心动图是诊断三尖瓣低位畸形的有效方法，且具有临床实用价值。     

三尖瓣病变外科手术的疗效评估

目的:探讨三尖瓣病变的不同手术方法和术后长期疗效。方法:1979年7月至1998年6月施行三尖瓣病变外科手术51例中,三尖瓣病变中有三尖瓣下移畸形33例,三尖瓣发育不全10例,感染性三尖瓣内膜炎3例,外伤性三尖瓣关闭不全、人工瓣膜功能异常各2例和Uhl’s病1例。51例中,瓣膜替换术37例,瓣膜成形术14例。附加手术有房缺修补术、室缺修补术、房化心室折叠术和缝补术。结果:住院死亡5例,死亡率为9.8％。死亡病例中3例为低心排综合征,2例气管套管并发症。长期随访生物瓣膜死亡4例,为心力衰竭、心律失常;机械瓣死亡1例,为瓣膜栓塞;瓣膜成形术14例无死亡,心功能明显改善。讨论:超声多普勒可明确诊断三尖瓣病变,三维超声可了解瓣叶、瓣下结构和瓣叶下移程度。病变中—重度、瓣叶发育较好、前瓣叶足够大小可施行瓣膜成形术。瓣膜发育不全、严重关闭不全可施行瓣膜替换术。成形手术疗效好,无瓣膜替换术潜在并发症。瓣膜成形术尽可能作为首选手术方案。     

彩色多普勒超声对小儿肺炎合并心衰的诊断价值

目的　探讨彩色多普勒超声对小儿肺炎合并心衰的诊断价值。方法　选择肺炎合并心衰患儿１５例, 利用二维彩色多普勒超声检测心脏瓣口的１６项血流参数及左室收缩功能。结果　心衰组肺动脉峰值下降, 左、右心室射血时间均缩短, 二、三尖瓣Ｅ峰减速时间缩短, 左室收缩功能下降。结论　彩色多普勒超声不仅可通过心脏血流参数反映肺炎合并心衰时患儿的心功能状态, 而且能为临床治疗提供重要的参考依据     

肺动脉高压型胎儿房间隔缺损彩超诊断方法的研究

目的：探讨彩色多普勒超声诊断胎儿伴肺动脉高压型间隔缺损的方法。方法：应用彩色多普勒超声观察胎儿各房室腔大小,主、肺动脉起源,三尖瓣返流及三尖瓣返流压差。将产前超声诊断与产后超声检查结果对照。结果：产前诊断伴肺动脉高压型胎儿房间隔缺损12例,产后11例证实原诊断,1例误诊。认为伴肺动脉高压型胎儿房间隔缺损的主要诊断依据为：右房室腔增大,三尖瓣返流且最大返流压差明显增高,二维超声排除房室腔结构异常。结论：彩色多普勒超声观察房室腔大小及三尖瓣返流情况产前诊断伴肺动脉高压型房间隔缺损具有重要价值。     

彩色多普勒超声心动图对中间型房室间隔缺损的诊断

目的 探讨彩色多普勒超声心动图对中间型房室间隔缺损的诊断价值。方法 应用彩色多普勒超声心动图检查15例中间型房室间隔缺损患者,观察其超声心动图特征,与手术所见进行对照。结果 15例患者均经手术治疗并证实术前超声心动图诊断。中间型房室间隔缺损的彩色多普勒超声心动图特征包括：①所有15例患者均存在原发孔型房间隔缺损及流入道室间隔缺损;②所有患者房室瓣分为单独的二尖瓣和三尖瓣,二尖瓣前叶与三尖瓣隔叶位于同一平面,接近半数患者存在二尖瓣或／和三尖瓣裂;③CDFI及频谱多普勒均清晰显示房室水平分流及房室瓣反流。结论 彩色多普勒超声心动图对中间型房室间隔缺损具有重要诊断价值。     

Mitral Valve Prolapse and Pre-Excitation

Two out of 118 patients with mitral valve prolapse were found to have pre-excitaiton. The presence of mitral valve prolapse in one patient with Lown-Ganong-Levine syndrome and the persistence of prolapse in (he presence and absence of pre-excitation in another patient with intermittent type B Wolff-Parkinson-White syndrome suggest that mitral valve prolapse in pre-excitation syndrome may not be secondary to the abnormal activation pattern of the left ventricle, which has been suggested as a possible mechanism by some investigators. (PACE, Vol. 5, September-October, 1982)     

AV Node Dysfunction in the Mitral Valve Prolapse Syndrome

The mitral valve prolapse syndrome is associated with a variety of atrial and ventricular arrhythmias. A portion of these patients manifest bradyarrhythmias, which in turn, may be the cause of lightheadedness and syncope. Thie study details the clinical and electrophysiologic characteristics of seven patients with symptomatic mitral valve prolapse and AV node dysfunction. The electrophysiology study demonstrated either a prolonged AH interval or abnormal response to atrial pacing in six of seven patients. A significant proportion of these patients had abnormalities of sinus node function and distal His-Purkinje conduction in addition to AV node dysfunction. AV node dysfunction in symptomatic patients with mitral valve prolapse may be secondary to autonomic dysfunction of diffuse conduction system disease.     

不同原因所致二尖瓣脱垂超声,手术及病理对比分析

本文回顾性分析１６例不同原因所致二尖瓣脱垂超声心动图表现，结合手术及病理改变，评价超声诊断价值。除二尖瓣不同程度脱垂外，９例粘液样变性的瓣叶冗长、活动幅度增强，青少年与老年瓣膜厚度及瓣口面积有所不同。５例瓣膜感染性炎性病变中４例瓣叶不厚或瓣尖轻度增厚，见赘生物；另１例瓣膜增厚、严重变形、穿孔。以上１４例均有不同程度腱索延长、断裂。２例风湿性瓣膜病变的瓣叶增厚，部分钙化，１例无交界粘连，腱索延长     

Malignant Ventricular Arrhythmias in Patients with Mitral Valve Prolapse and Mild Mitral Regurgitation

Mitral valve prolapse (MVP) is a common disorder that, in general, has a good prognosis. Rare occasions of sudden death have been reported in patients with MVP and it is presumed that the basis of sudden death is arrhythmic. We report seven patients with moderate to severe MVP and malignant ventricular arrhythmias. All patients had trivial to mild mitral regurgitation and normal left ventricular function. Three patients presented with syncope, two with out-of-hospital cardiac arrest, and three with recurrent palpitations and presyncope. In a mean follow-up period of 2.5 years (range 6 months to 5 years), two patients died suddenly despite successful control of their nonsustained ventricular tachycardia (VT) with sotalol as shown by ambulatory monitoring. Two patients, who had sustained VT despite antiarrhythmic drug therapy, had mitral valve surgery, however, monomorphic VT could be induced in both even after surgery. The arrhythmias in the remaining three patients are controlled on antiarrhythmic drugs. We conclude that a selected subset of patients with MVP, malignant ventricular arrhythmias, and miid mitral regurgitation are at risk of sudden death. Syncope, inferolateral repolarization changes, complex ventricular ectopy, and a markedly myxomatous valve may be pointers to higher risk of sudden death and mitral valve surgery may not provide control of ventricular arrhythmias.     

白塞病致二尖瓣脱垂行瓣膜置换术患者一例的术后护理

目的探讨白塞病致二尖瓣脱垂行瓣膜置换术患者的术后护理方法。方法回顾性分析2011年12月浙江省嘉兴市第一医院收治的1例白塞病致二尖瓣脱垂行瓣膜置换术患者的病例资料,并总结临床护理方法。结果患者术后恢复良好,术后4个月复查超声心动图未发现瓣周漏,人工机械瓣功能良好。结论严密观察白塞病致二尖瓣脱垂行瓣膜置换术术后患者的病情变化、及时发现并处理各种并发症、重视激素治疗的护理及相关健康指导,对提高手术治疗效果有重要作用。     

Monomorphic Right Ventricular Tachycardia in a Patient with Mitral Valve Prolapse

A patient with mitral valve prolapse and symptomatic ventricular ectopy underwent an electrophysiological study during which a sustained monomorphic ventricular tachycardia with a left bundle branch block/right axis deviation morphology was induced. This morphology was replicated by pace mapping at the right ventricular outflow tract. To the best of our knowledge, this finding has not been previously described and suggests that the association between ventricular arrhythmias and mitral valve prolapse may not necessarily be causal.     

Minimally-Invasive Mitral Valve Surgery

Minimally-invasive surgery is increasingly being utilised in patients with isolated valve disease who do not require concomitant coronary bypass. Minimally-invasive valve surgery has been performed at the Brigham and Women's Hospital, Harvard Medical School since July 1996 and has now been used in over 273 mitral valve operations, primarily valve repairs. The incisions used have evolved; we used a right para-sternal approach at first and have now changed to a lower mini-sternotomy. The operative techniques employed through this incision are identical to those used in a complete sternotomy. Operative mortality in our mitral valve series is zero. There have been five re-operations. The length of hospital stay and amount of blood utilised are both less than with a complete sternotomy. Most importantly, the patients' return to normality after complete recovery was quicker by approximately 2 weeks versus the conventional sternotomy. Minimally-invasive mitral valve surgery is a technique that can be utilised reproducibly for all techniques of repair or replacement.     

Mid-systolic Click and Echocardiographic Evidence of Mitral Valve Prolapse During Electrical Pacing

A mid-systolic click was present in a patient during three years of follow-up after implantation of a permanent transvenous pacemaker. Echocardiography revealed posterior motion of the anterior leaflet which resembled mitral valve prolapse. Both the click and echocardiographic evidence of prolapse disappeared simultaneously with resumption of sinus rhythm and during supraventricular tachyarrhythmias. With spontaneous change in the position of the electrode three years after initial implantation, both the click and the posterior motion of the mitral valve disappeared. The association of mitral valve prolapse with electrical pacing is most unusual and appears to have a distinct pathophysiological mechanism. (PACE, Vol. 4, November-December, 1981)     

二尖瓣脱垂合并胸廓骨骼畸形

本文对83例二尖瓣脱垂进行了X线分析,发现有40例至少合并有一种胸廓骨骼畸形,占48％;其中扁胸直背27例,占27％,胸椎侧弯9例,占11％,漏斗胸4例,占5％。指出,胸廓骨骼畸形是二尖瓣脱垂的重要征象之一。胸廓骨骼畸形也可能影响二尖瓣脱垂的X线诊断。