成人双孔二尖瓣畸形的二维及三维超声及临床特点

目的:探讨成人双孔二尖瓣(DOMV)的临床及超声心动图特征。方法:回顾分析经超声心动图诊断双孔二尖瓣13例,分析其临床表现、超声心动图特征及预后。结果:13例成人DOMV中,10例经胸超声心动图明确诊断,3例经食管超声心动图明确诊断。DOMV的典型表现为左心室短轴二尖瓣口水平呈"眼镜"征,四腔心或两腔心切面表现为典型的"海鸥征"。13例成人DOMV中,7例合并先天性心脏病,3例合并心肌梗死。结论:超声心动图可以准确诊断成人先天性双孔二尖瓣畸形。成人DOMV的临床表现与伴随病变相关,多数为偶然发现。     

彩色多普勒超声心动图诊断二尖瓣小腱索断裂19例分析

目的探讨彩色多普勒超声心动图诊断二尖瓣小腱索断裂的诊断价值。方法对19例二尖瓣小腱索断裂患者进行彩色超声心动图检查,检查时尤其注意与二尖瓣相连的小腱索及二尖瓣运动形态。结果19例均显示断裂的细小的腱索随心脏舒缩呈“梿枷样”活动,其中前叶小腱索断裂12例,后叶小腱索断裂7例。CDFI显示“偏心型”二尖瓣返流。结论彩色多普勒超声心动图对二尖瓣小腱索断裂有特异性诊断。     

反流类型结合彩色多普勒血流汇聚征象在定位二尖瓣脱垂部位的应用价值

目的:探讨应用反流类型结合二尖瓣血流汇聚征象在诊断二尖瓣脱垂部位的应用价值。方法:回顾性分析36例经手术证实的二尖瓣脱垂患者的超声心动图资料。与单纯二维超声心动图相比较,评价二尖瓣反流类型及血流汇聚征象在定位二尖瓣小叶脱垂部位的应用价值。结果:在36例二尖瓣脱垂患者中,手术证实有46个小叶脱垂。二维超声诊断准确率为74%;二维+二尖瓣反流类型+血流汇聚诊断的准确率为91%。结论:二尖瓣反流类型结合血流汇聚征象有助于提高经胸超声心动图诊断二尖瓣脱垂部位的准确性。     

经胸二维超声心动图诊断不同部位二尖瓣脱垂的准确性

目的:评价经胸二维超声心动图诊断不同部位二尖瓣脱垂的准确性及其对术式选择的指导作用。方法:本研究共入选39例患者,均经二维超声心动图诊断为二尖瓣脱垂,并对其脱垂部位,脱垂程度,反流程度及各腔室大小进行了详尽的描述。该39例患者均行外科手术治疗,并将术中所见与超声心动图结果对照,首先根据术中所见瓣叶脱垂部位将患者分为前叶病变组(n=15),后叶病变组(n=19)及双叶病变组(n=5),比较各组间临床及超声心动图特点,明确超声心动图诊断不同部位二尖瓣脱垂的准确性。同时根据手术方式将患者分为瓣膜置换者(n=23)与瓣膜成形者(n=16),比较两类患者间的超声心动图特点。结果:39例患者中,超声心动图诊断与术中所见比较二尖瓣前叶病变组,后叶病变组及双叶病变组分别为14例及15例,22例及19例、3例及5例,诊断瓣叶脱垂伴腱索断裂者为17例及22例,与术中所见比较,该四者的准确率分别为92.3%,87.1%,89.7%及72%。在选择不同手术方式的比较的结果为,二尖瓣前叶及双叶脱垂者多行瓣膜置换术,二尖瓣后叶病变者多行瓣膜成形术。结论:二维超声心动图不仅能较准确地诊断不同部位的二尖瓣脱垂,同时对手术方式的选择具有重要的指导作用。     

经胸与经食管超声心动图诊断二尖瓣脱垂并腱索断裂准确性的比较

目的:比较经胸与经食管超声心动图诊断二尖瓣脱垂并腱索断裂的准确性.方法:选择经胸与经食管超声心动图检查诊断为二尖瓣脱垂伴或不伴腱索断裂并行手术治疗的患者21例,以术中所见为标准,明确两者诊断二尖瓣脱垂并腱索断裂的准确性,同时比较它们在判断病因及病变部位等方面的作用.结果:术前检查21例二尖瓣脱垂的患者中,经胸超声心动图诊断有8例患者发生腱索断裂,经食管超声心动图诊断为15例患者发生腱索断裂,与手术结果比较,两者的诊断准确率分别为71%和95%,差异有统计学意义(P＜0.05).结论:经食管超声心动图较经胸超声心动图能更准确地诊断二尖瓣脱垂并腱索断裂,从而为术式的选择提供更可靠的依据.     

彩色多普勒超声心动图对先天性二尖瓣瓣上环的影像学特点及漏误诊分析

目的 总结先天性二尖瓣瓣上环彩色多普勒超声心动图检查的影像学特点及漏误诊情况,探索超声心动图对先天性二尖瓣病变的价值。方法 选取联勤保障部队第910医院收治的经手术已经明确诊断为先天性二尖瓣瓣上环的45例患者。回顾性分析术前患者的彩色多普勒超声心动图结果,查看诊断的结果,并与术后诊断进行对比,分析先天性二尖瓣瓣上环的影像学特点。结果 所有患者中超声心动图术前可诊断为先天性二尖瓣瓣上环的患者有32例,瓣上型和瓣内型分别有13例和19例。通过与手术后结果对比,发现有10例漏诊、3例误诊,漏诊率和误诊率分别为22.22%、6.67%。3例误诊患者均诊断为三房心,除此之外,所有患者均合并有其他心血管系统畸形,二尖瓣狭窄、主动脉缩窄等是最常见的畸形。所有患者经手术治疗均能有效的降低二尖瓣瓣上环的最大峰值压差,差异具有统计学意义（P<0.05）。所有手术患者均得到很好的治疗,且术后1年后也未发现再狭窄者。结论 先天性二尖瓣瓣上环的诊断首选彩色多普勒超声心动图,简便易操作,且误诊、漏诊的概率较低。     

中老年二尖瓣腱索断裂36例超声表现

二尖瓣腱索断裂是一种比较少见的临床急重症,起病急,进展迅速,早期诊断极为重要.由于老年患者常患有多种基础疾病及全身脏器功能减退,老年患者二尖瓣腱索断裂有其临床及超声特点,目前文献报道较少.本文总结36例二尖瓣腱索断裂中老年患者的超声表现,探讨其超声心动图特征.     

彩色多普勒超声心动图诊断二尖瓣腱索断裂的价值

目的　探讨彩色多普勒超声心动图 (CDE)诊断二尖瓣腱索断裂 (RMCT)的价值。方法　对 2 0例 RMCT患者行 M型超声心动图、二维超声心动图 (2 DE)及彩色多普勒 (CD)检查。在 2 DE检查时 ,特别注意与二尖瓣相连的断裂腱索及二尖瓣运动形态。结果　 2 0例患者 2 DE均显示二尖瓣与一段断裂腱索相连。断裂腱索活动度大 ,在收缩期进入左心房。二尖瓣运动呈如下三种改变 :19例患者腱索断裂的二尖瓣呈“连枷样”或“挥鞭样”活动。 2 6例患者二尖瓣尖在收缩期不能合拢 ,对合错位。 3 5例患者表现为二尖瓣脱垂改变。 CD检测在 2 0例患者中均显示“偏心型”二尖瓣反流。结论　 CDE对二尖瓣腱索断裂有特异性诊断价值     

二尖瓣球囊成形术治疗以狭窄为主的先天性二孔型二尖瓣

二孔型二尖瓣(DOMV)是一种少见的先天性心瓣膜病.这种先天畸形多伴有二尖瓣反流,伴二尖瓣狭窄的较为罕见.而对以狭窄为主要表现的先天性二孔型二尖瓣患者作二尖瓣球囊成形术(PBMV),尚未见报道.本文报告一例以狭窄为主要表现的DOMV患者行二尖瓣球囊成形术.并结合文献对二孔型二尖瓣的发生、临床表现、分型及处理作一复习,以及对二尖瓣球囊成形术在这种先天畸形中的适应症及方法作了探讨.     

术中经食管超声心动图监测行二尖瓣成形术

目的　评价术中经食管超声心动图在二尖瓣成形术中的作用。方法　 1993年 3月至 2 0 0 3年 3月 ,6 2例二尖瓣关闭不全病人在经食管超声心动图监测下行二尖瓣成形术 ,男 2 4例 ,女 38例 ,平均年龄 (31 3± 7 5 )岁。病因为退行性变 4 2例 ,先天性 2 0例。重度二尖瓣关闭不全 5 9例 ,中度 3例。根据二尖瓣病变的特征进行相应的成形手术。结果　全组无一例手术死亡 ,8例改行二尖瓣替换术。术后超声心动图检查二尖瓣无返流 3例 ,轻度返流 4 9例 ,中度返流 2例。结论　经食管超声心动图在术中能即时判断二尖瓣成形术的效果 ,并找出失败原因 ,从而指导进一步成形术。     

Stenotic double-orifice mitral valve after surgical repaired partial atrioventricular septal defect

Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly account for 1% of congenital heart disease. However, accurate diagnosis and evaluation of valve stenosis or regurgitation and other concomitant congenital anomalies due to DOMV are required to obtain suitable treatment. Two- and three-dimensional echocardiography can contribute valuable functional and anatomic information that can support to reach this goal. Here, we present a case of complete bridge-type DOMV that causes mitral stenosis after surgical repair of the partial atrioventricular septal defect in childhood.     

Prolapsing mitral valve leaflet syndrome. A spectrum that includes cleft posterior mitral valve

Two patients with a prolapse and cleft posterior mitral leaflet were studied. The first case had an associated ostium secundum type atrial septal defect. In both cases, the pansystolic regurgitation of contrast material during angiography corresponded to the pansystolic configuration of the murmur. In each instance, the systolic murmurs displayed a late systolic accentuation during the maximal prolapse of the mitral valve. The echocardiographic studies demonstrated only a late systolic prolapse which in both patients corresponded angiocardiographically to the maximum buckling of the pansystolic prolapse. Echocardiographic and angiocardiographic features of cleft posterior mitral valve leaflet are discussed.     

Double orifice mitral valve; a coincidental finding.

A double orifice mitral valve (DOMV) represents a rare congenital malformation characterised by two valve orifices with two separate subvalvular apparatus. This case demonstrates the necessity of careful imaging of the mitral valve apparatus, not only in patients with atrioventricular septal defects, but also in patients with congenital left obstructive heart disease.     

Presentation, natural history, and outcome in children and adolescents with double orifice mitral valve

Forty-six children, aged 2 days to 16 years (median 2.4 years) with double orifice mitral valve (DOMV), were studied. Partial atrioventricular septal defect was the most commonly associated cardiac lesion. Symptoms were related to the degree of mitral insufficiency and/or stenosis when present. Surgical intervention directed at DOMV was required in the minority of patients who underwent repair of associated cardiac lesions. The long-term morbidity attributable to DOMV was low.     

Preoperative and postoperative mitral valve prolapse and regurgitation in adult patients with secundum atrial septal defects

Background: Little attention is given to development of mitral regurgitation (MR) in adults with atrial septal defect (ASD). The aim of the study was to determine the associated factors of MR in ASD adults before surgical repair and the fate of moderate to severe MR after surgery. Methods: We examined 71 consecutive patients with secundum ASD (47 ± 16 years) who underwent surgical repair. Clinical and echocardiographic variables including size of left and right heart systems and severity of MR and tricuspid regurgitation (TR) were investigated before and early after surgery. Results: Before ASD closure, 14 patients (20%) had moderate to severe MR and 25 patients (35%) showed mitral valve (MV) prolapse. The ASD patients with moderate to severe MR showed worse cardiovascular symptoms, increased occurrence of atrial fibrillation and MV prolapse, and greater left ventricular (LV) end‐diastolic volume, left atrial area, and TR severity than those with none to mild MR (all P < 0.05). Among preoperative variables, TR severity, left atrial area, LV end‐diastolic volume, and MV prolapse were associated with preoperative MR severity in all the patients (all P < 0.03). Isolated ASD closure (n=46) decreased MV prolapse (P=0.008). Preoperative moderate to severe MR decreased after ASD closure with and without MV surgery (n=9 and 5, respectively; both P < 0.05). Conclusions: Preoperative MR severity was associated with TR severity, dilated left heart chambers, and MV prolapse. MR decreased after ASD closure with and even without MV surgery.     

Spectrum of congenital mitral valve abnormalities associated with solitary undifferentiated papillary muscle in adults

BackgroundCongenital anomaly wherein the mitral valve leaflets are directly attached to the papillary muscle(s) (PM) with or without short under-developed chords is rarely reported in adults. Patients with two PMs with an intervening fibrous bridge have also been included under this head in previous studies.MethodsEchocardiography enables accurate evaluation of the morphology and function of valve leaflets, chordae tendineae, and PM. This report describes a series of six patients aged 56–84 years who had abnormal mitral valve with a large solitary and anomalously inserted PM seen over a period of 3 years. Only those patients who had a single pillar or bridge-like PM and either absent tendinous chords or small under-developed chords were included in the analysis.ResultsAmong 9600 consecutive echocardiograms performed, six patients met the criteria of an abnormal mitral valve with solitary large PM. Two patients underwent mitral valve replacement with partial excision of the PM wherein echocardiographic observations were confirmed. The patients were previously followed with the diagnosis of hypertrophic cardiomyopathy (3) and rheumatic mitral valve disease (3). Multi-planar reconstruction of 3D echocardiographic images provided incremental value in assessing the detailed patho-anatomy of PMs in these cases.ConclusionIn adult patients, a high index of suspicion is required to detect congenital mitral stenosis/regurgitation with large solitary PM (resembling a parachute mitral valve) which may masquerade as hypertrophic cardiomyopathy or rheumatic mitral valve disease.     

Mitral insufficiency with congenital double-orifice mitral valve in an elderly patient.

We describe the case of a 79-year-old woman with mitral insufficiency and a double-orifice mitral valve (DOMV), discovered by echocardiography. Transthoracic echocardiography showed two insufficiency jets. Transesophageal echocardiography revealed a DOMV. Each orifice was provided with a subvalvular apparatus. No associated congenital abnormalities were present. Our case demonstrates that even in elderly patients with a double regurgitant jet, DOMV should be suspected and assessed by transesophageal echocardiography.     

Role of real-time three-dimensional transesophageal echocardiograpny in mitral valve repair

Background and objective Pre-operative assessment of mitral valve(MV)anatomy is essential to surgical design in patientsundergoing MV repair.Although 2-dimensional(2D)echocardiography provides precise information regarding MV anatomy,RT-3DTEE could increase the understanding of MV apparatus and individual scallop identification.We aimed to investigate the value of RT-3DTEE in MV repair. Methods RT-3DTEE was performed in six patients with mitral valve prolapse(MVP) by using Philips IE33with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical mitral valverepair,and quantitative evaluation was performed by QLab 6.0 software before and after surgicalmitralvalve repair.Results RT-3DTEE could display dynamic morphology of MV,the location of prolapse,and spatial relation to the surrounding tissue.It couldprovide surgical views of the valves and the valvular apparatus.These resuIts were consistent with surgical findings.The quantitativeevahuation before and after surgical MV repair indicated that anterolateral to posteromedial diameter of annalus.anterior to posteriordiameter of annulus,perimeter of annullus.,and area of annalus in projectionplane were significantlv smaller after operation comparedwith those before operation(P＜0.05).The length of posterior leaflet,,the area of anterior and posterior leaflet,the maximal prolapseheight,the volume of leaflet prolapse and the length of coaptation in projection planewere significantly reduced after operation(P＜0.05).Conclusion RT-3DTEE is a unique new medality for rapid and accurate evaluation of mitral valve prolapse and miwal valverepair.     

腹部三维超声成像技术检查心脏的可行性研究

目的探讨腹部三维超声成像技术应用于非胎儿心脏检查的可行性及其应用价值。方法在常规二维超声心动图检查基础上,应用具有腹部三维超声成像功能的彩超仪的腹部三维超声探头对28例二尖瓣狭窄与16例房间隔缺损患者(11例儿童和5例成人)的心脏进行三维超声成像,记录二尖瓣最大开放面积与房间隔缺损最大径,并同手术测值和常规二维超声心动图测值进行对比分析。结果腹部三维超声成像技术可以直观地显示二尖瓣狭窄与房间隔缺损的立体形态特征,所测二尖瓣最大开放面积与房间隔缺损最大径同手术测值(r=0.81和r=0.89)和常规二维超声心动图测值(r=0.79和r=0.85)相关性良好,超声与手术方法测值比较差异无统计学意义(P>0.05)。结论腹部三维超声成像技术可以应用于大多数儿童与部分成人的心脏检查,是对常规二维超声心动图的有益补充。     

Transcatheter mitral valve replacement

Transcatheter mitral valve (MV) repair, specifically the edge-to-edge leaflet repair, is a less invasive treatment of symptomatic mitral regurgitation (MR) in patients with high or prohibitive surgical risk. In cases with severe leaflet calcification, small mitral orifice area, and/or extremely wide regurgitation across the entire MV commissure, transcatheter MV repair may rather cause suboptimal or potentially hazardous outcomes. In these cases, MV replacement can be a more suitable option. Recently, percutaneous transcatheter MV replacement has emerged as an acceptable therapeutic option for the treatment of degenerated surgical bioprosthetic disease. Moreover, several transcatheter devices for native MV replacement are under evaluation with a hope to provide more complete and reproducible restoration of MV function. In this article, we will review current status, applications, clinical outcomes, and limitations that need to be overcome for transcatheter MV replacement for both degenerated surgical bioprosthetic disease and native MV disorders.