实时三维超声心动图对主动脉瓣二叶畸形的再探讨

【】 目的：探讨实时三维超声心动图( RT-3DE)诊断主动脉瓣二叶畸形(bicuspid aortic valve malformation,BAV)的应用价值。方法：采用Philips iE Elite彩色多普勒超声诊断仪, S5-1和X3-1探头,检测36例BAV患者,经胸二维超声心动图( 2DE) 和RT-3DE通过胸骨旁左心室长轴切面及大动脉短轴切面, 观察主动脉瓣瓣膜数目、形态、启闭情况及血流动力学改变。结果：2DE确诊BAV28例,漏诊2例,不能明确6例,上述均经 RT-3DE复查并被临床证实,其中横裂式20例、纵裂式11例、斜裂式5例。钙化28例,占78%;瓣膜狭窄22例,占61%,轻度狭窄18例,中度狭窄4例,无重度狭窄;瓣膜关闭不全14例,占39%,轻度关闭不全11例,轻-中度关闭不全3例,无重度关闭不全。结论：RT-3DE对诊断BAV有重要价值,明显提高诊断符合率。     

二叶主动脉瓣畸形的胸主动脉超声特征与临床意义

目的利用超声心动图研究二叶主动脉瓣（BAV）患者胸主动脉的形态学特征。方法回顾性分析1991年4月至2006年2月诊断的273例BAV患者的超声心动图及临床资料。结果（1）无明显主动脉瓣（AV）病变的BAV患者的主动脉瓣环、窦部、窦管结合部、升主动脉较正常对照组明显增宽（P≤0．001）;而二者胸降主动脉比较差异无统计学意义（P=0．061）。（2）BAV患者的AV排列位置对各级胸主动脉内径无影响（P〉0．05）。（3）主动脉瓣环、窦部内径与AV最大压力阶差、平均压力阶差呈低度负相关;主动脉瓣环、窦部、窦管结合部内径与AV反流程度呈低度正相关。结论BAV患者的胸主动脉可发生独立于血流动力学影响之外的扩张。AV的功能变化对胸主动脉内径影响略有不同。在临床上,主动脉内径可作为手术时机选择的参考指标。     

彩色多普勒超声心动图对室间隔缺损并发畸形的诊断价值

目的 :探讨超声心动图检测室间隔缺损 （室缺 ）并发畸形的价值。方法 :将手术证实的室缺并发畸形与超声检查进行比较 ,分析超声检测敏感度、特异度及准确度。结果 :超声心动图检出室缺并发畸形的敏感度为 5 8.8% ,特异度 92 .9% ;准确度 80 .6 %。结论 :室缺并发卵圆孔未闭及并发右室流出道较易漏诊 ,其他一些少见并发畸形多因主观忽视而漏诊。注意全面扫查及改善检查技巧有助于提高室缺并发畸形的检出和减少误诊。     

主动脉瓣感染性心内膜炎并主动脉瓣穿孔的临床特点及超声心动图应用

目的 :探讨主动脉瓣感染性心内膜炎 ( AVIE)并发主动脉瓣穿孔 ( AVP)的临床及超声心动图( UCG)的特点。方法 :对 11例经临床及 UCG诊断的 AVIE并发 AVP患者的资料进行分析 ,并与手术结果进行对照。结果 :临床特点 :基础心脏病以主动脉瓣畸形多见 ;主要表现发热、贫血、心脏杂音、急性左心衰竭 ;UCG特点 :二维超声心动图 ( 2 DE)显示瓣体的回声连续缺失 ,彩色多普勒血流显像 ( CDFI)显示穿瓣偏心血流 ,U CG诊断 AVP特异性为 90 .9% ;术后患者的心脏血流动力学均明显改善。结论 :U CG检查是正确诊断 AVIE并发 AVP及评价其手术治疗效果的首选方法 ,对早期正确诊断本病有十分重要的临床意义     

超声心动图在主动脉瓣狭窄经导管主动脉瓣植入术中的应用价值

目的探讨超声心动图在主动脉瓣狭窄患者经导管主动脉瓣植入术中的作用。方法3例重度主动脉瓣瓣膜狭窄患者接受经导管主动脉瓣人工瓣膜植入术。使用PhilipS iE33型彩色多普勒超声诊断仪,配备经胸探头S5—1和经食道探头S7—2,X7—2t。超声观察内容包括明确主动脉瓣膜病变范围和程度,测量主动脉瓣环前后径,人工瓣膜植入术后瓣膜功能等。结果3例患者经导管主动脉瓣植入术均取得了成功,人工瓣膜位置稳定,常规超声心动图3例患者术前经胸超声心动图与术中经食管超声心动图诊断相符,跨瓣压差较术前明显下降,主动脉瓣瓣上流速明显下降,瓣周漏瞬时反流量平均约1．2mL。结论经导管主动脉瓣人工瓣膜植入术在治疗严重主动脉瓣瓣膜狭窄中方法可行,效果良好;超声心动图在这项工作中具有重要的辅助作用。     

二维超声心动图诊断先天性二叶式主动脉瓣畸形

本文报告7例经手术和病理证实的先天性二叶式主动脉瓣畸形的二维及M型超声心动图特征。二维超声正确地诊断了6例,符合率为85.7%,,而M型超声主动脉瓣关闭偏心指数(EI),诊断符合率仅57%。     

胎儿二叶式主动脉瓣畸形的超声心动图特征分析

目的：探讨确诊二叶式主动脉瓣（BAV）畸形的胎儿超声心动图特征及预后。方法：对生后确诊BAV的患者产前超声心动图进行回顾和分析,并对其特征进行总结。结果：14例生后确诊患者产前胎儿超声心动图均有异常超声征象提示,包括直接征象（主动脉瓣增厚、回声增强、融合嵴、两个交界及“鱼嘴样开口”、活动及开放受限、一字型关闭线或偏心关闭线）及间接征象（主动脉瓣上流速增快,升主动脉增宽）。其中2例患者产前均进行了3次胎儿超声心动图检查,发现主动脉瓣上流速及升主动脉内径随着孕周的增大而增加。14例患者中,2例（14.3%）出生后因主动脉瓣中重度狭窄出现生长发育受限,其中1例于2个月龄进行主动脉瓣球囊扩张治疗。结论：胎儿BAV主要依靠产前超声心动图筛查,直接超声征象结合间接超声征象可帮助诊断。超声医师疑诊胎儿BAV应建议其父母规律随访患儿主动脉瓣及主动脉情况,有助于确诊及预后咨询。     

二叶主动脉瓣的超声分析

目的 探讨二叶主动脉瓣的超声心动图特征。方法 采用回顾性方法分析了26例先天性二叶主动脉瓣,其中主动脉瓣狭窄17例（有或无主动脉瓣关闭不全）和单纯主动脉瓣关闭不全9例。结果 在主动脉瓣狭窄组、轻度狭窄14例（82％）;二叶主动脉瓣感染性心内膜炎的发生率为42％;主动脉瓣狭窄组与单纯主动脉瓣反流组相比,主动脉瓣增厚钙化有极显性差异（P＜0．00005）,结果表明,二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。结论：二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。二叶主动脉瓣感染性心内膜炎的发生率较高。彩色多普勒二维超声心动图对二叶主动脉瓣的诊断具有重要价值。     

基于超声心动图的钙化性主动脉瓣疾病患病情况的回顾性研究

目的分析钙化性主动脉瓣疾病(CAVD)的患病情况。方法收集并回顾性分析行超声心动图检查年龄≥45岁患者的临床资料17 826例,男性9725例,女性8101例,其中45⁶4岁11 274例,6564岁11 274例,65⁷4岁4250例,7574岁4250例,75⁸4岁2052例,≥85岁250例。结果CAVD总患病率为12.8%,男性CAVD患病率明显高于女性(13.6%vs11.9%),CAVD发生年龄明显低于女性[(70±10)岁vs(71±10)岁,P=0.001]。CAVD患病率随着年龄增长明显增高,4584岁2052例,≥85岁250例。结果CAVD总患病率为12.8%,男性CAVD患病率明显高于女性(13.6%vs11.9%),CAVD发生年龄明显低于女性[(70±10)岁vs(71±10)岁,P=0.001]。CAVD患病率随着年龄增长明显增高,45⁶4岁,6564岁,65⁷4岁,7574岁,75⁸4岁,≥85岁4个年龄段患病率分别为5.3%、20.5%、32.9%和54.4%。CAVD患者最常受累及的瓣叶为无冠瓣,其次是右冠瓣+无冠瓣、右冠瓣和左冠瓣。CAVD患者常见的功能异常为主动脉瓣反流,且主动脉瓣反流较狭窄明显多见(77.1%vs 15.0%,P<0.01)。CAVD患者左心房扩大发生率明显高于左心室扩大(56.3%vs 22.2%),室间隔肥厚发生率明显高于左心室后壁(51.7%vs 24.2%,P<0.01)。结论 CAVD患病率随年龄增长显著增高。     

超声心动图临床应用研究的现状与展望

自 1 95 5年Ｅｄｌｅｒ首次提出超声心动图以来 ,已经 40余年。此项技术已在临床上得到了广泛的应用 ,随着声学基础理论研究的深入和计算机技术的飞速发展 ,二维及彩色多普勒图像的质量有很大提高。目前 ,成熟应用于临床的超声心动图技术主要有Ｍ型和二维超声心动图、彩色和频谱多普勒显像、心腔和心肌声学造影、经食管超声心动图、血管腔内超声等。这些技术的综合应用通常能对心脏的形态结构与功能作出准确的评价。为推进这一技术的发展和应用 ,本期集中选载了几篇有关超声心动图的文稿。侯传举等对 344例先天性心脏病大动脉右转位的二维超…     

Aortic elasticity and size in bicuspid aortic valve syndrome.

AIMS: To investigate the relation between aortic elastic properties and size in bicuspid aortic valves (BAVs). METHODS AND RESULTS: 127 BAV outpatients (121 males; age 23 +/- 10 years) with no or mild valvular impairment, were recruited with 114 control subjects comparable for age, gender, and body size. Aortic distensibility (DIS) and stiffness index (SI) were derived by M-mode evaluation of the aortic root together with blood pressure measured by cuff sphygmomanometer. BAVs vs. controls had increased aortic diameter (P < 0.0001), higher systolic (P = 0.02) and pulse (P = 0.04) pressures. DIS was lower in BAVs than in controls (4.71 +/- 3.67 vs. 7.44 +/- 3.94 10(-6) cm(2)dyne(-1), respectively; P < 0.0001) and SI was greater in BAVs (7.21 +/- 4.93 vs. 3.57 +/- 1.88, respectively; P < 0.0001). Definite impairment in aortic elasticity was present in 53 (42%) BAVs. Both DIS and SI were related (P < 0.0001) to aortic size in BAVs and controls. After adjusting for aortic size and blood pressure, the regression relations between SI and aortic diameter of BAVs were significantly different from controls (P = 0.0052). CONCLUSION: Abnormal aortic elasticity is a common finding in BAVs with no or mild aortic valve impairment. However, impaired aortic stiffness is not due to aortic dilation. Simple assessment of aortic size may thus fail to identify early abnormal load bearing characteristics of the aortic wall in BAVs.     

Echocardiographic prevalence of bicuspid aortic valve in the population

INTRODUCTION: The exact prevalence of bicuspid aortic valve (BAV) is controversial. We studied the prevalence of BAV using two large independent echocardiographic databases. METHODS: We analyzed 24,265 echocardiograms performed at our academic institution between 1984 and 1998 for various clinical reasons and 1742 echocardiograms that were obtained by screening teenage athletes in Southern California. The total prevalence of BAV was calculated. RESULTS: The first database revealed a gender distribution of 11,339 (47%) male and 12,926 (53%) female patients. The second database consisted of 1172 (67%) male and 570 (33%) female athletes. The echocardiographic prevalence of BAV was 0.6% in the larger database and 0.5% in the smaller athletic database. CONCLUSION: We found the prevalence of bicuspid aortic valve in two large databases to be between 0.5% and 0.6%. This figure was consistent across different ages, in both databases.     

先天性二叶式主动脉瓣畸形所致主动脉瓣狭窄的外科治疗体会

目的总结先天性主动脉瓣二叶式畸形所致的主动脉瓣狭窄手术治疗的经验。方法1995年9月至2010年12月福建医科大学附属协和医院心外科共为46例二叶式主动脉瓣畸形所致主动脉瓣狭窄患者实施了瓣膜置换术。对这些患者的手术效果及其影响因素进行回顾性总结。结果术后随访3个月至12年,死亡1例（为猝死）,1例出现与抗凝有关的脑部并发症;心功能Ⅰ级36例,心功能Ⅱ级9例。术后超声心动图测得主动脉瓣跨瓣压差17～51（29．2±11．5）mmHg。结论主动脉瓣置换术是治疗先天性主动脉瓣二叶式畸形所致主动脉瓣的有效疗法,应尽可能选择有效瓣口面积较大的人造瓣膜,这样可以有效降低术后主动脉跨瓣压差,提高手术安全性和远期疗效。     

经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄的术中投照角度预测值分析

目的在二叶式主动脉瓣(BAV)行经导管主动脉瓣置换术(TAVR)中,分析术前多排螺旋CT(MDCT)预测的最佳导丝跨瓣角度、球囊预扩张角度和瓣膜释放角度规律,总结三种投照角度预测值的规律。方法回顾性分析2019年7月至2020年6月在复旦大学附属中山医院因严重症状性重度主动脉瓣狭窄(AS)而行TAVR的BAV患者31例。收集基线资料、术前评估和手术情况。使用MDCT预测TAVR最佳导丝跨瓣角度、球囊预扩张角度和瓣膜释放角度,按照横裂式BAV和纵裂式BAV分组,比较两组之间的差异和规律。结果最佳导丝跨瓣角度,横裂式BAV为右前斜(RAO)8°(18°,3°)、足位(CAU)25°(29°,17°),纵裂式BAV为左前斜(LAO)26°(21°,34°)、头位(CRA)13°(6°,22°),两者差异均有统计学意义(均P<0.001);最佳球囊预扩张角度(显示左冠状动脉开口),横裂式BAV为LAO 11°(9°,26°)、CRA 8°(1°,19°),纵裂式BAV为LAO 36°(30°,39°)、CRA 22°(14°,25°),两者差异均有统计学意义(均P<0.05);最佳球囊预扩张角度(显示右冠状动脉开口),横裂式BAV为LAO 48°(43°,60°)、CRA 26°(3°,29°),纵裂式BAV为LAO 48°(39°,70°)、CRA 25°(22°,33°),两者差异均无统计学意义(P=0.320、P=0.560);最佳瓣膜释放角度,横裂式BAV为RAO 12°(16°,4°)、CAU 25°(28°,19°),纵裂式BAV为LAO 21°(17°,26°)、CRA 3°(-2°,12°),两者差异均有统计学意义(均P<0.001)。结论术前MDCT可预测BAV行TAVR的最佳导丝跨瓣、球囊预扩张和瓣膜释放投照角度,这些角度与BAV为横裂式还是纵裂式相关,存在明显规律。     

二叶式与三叶式主动脉瓣狭窄患者的临床对照研究

目的 通过对二叶式与三叶式主动脉瓣狭窄患者进行临床特征及围术期指标的回顾性对比分析,以期指导二叶式主动脉瓣狭窄患者的术前管理、手术方案制定及术后治疗。方法 选取我院心外科自 2011 年 01 月至 2017 年 12 月期间收治的所有因主动脉瓣狭窄而单纯行主动脉瓣置换术的患者90例（术中处理主动脉、马凡综合征、主动脉夹层及临床资料不全等患者未纳入本研究）,根据瓣叶特点分为二叶式主动脉瓣组（BAV组,n=45）和三叶式主动脉瓣组（TAV组,n=45）。分别收集两组患者围术期临床资料,从术前、术中、术后三个方面对比两组差异,所有资料均应用SPSS20.0进行相关统计分析。结果 BAV组患者中男性29名、女性16名,约2:1。在术前指标对比方面,相比较TAV组,BAV组发病年龄明显较小（47.76±10.80 vs.54.58±9.29 岁,P=0.002）,合并升主动脉扩张的比例高（66.7％ vs.37.8％,P=0.006）,且升主动脉直径更大（39.55±6.77 vs.35.55±4.78 mm,P=0.002）;BAV组合并三尖瓣反流的比例明显高于TAV组（62.2％ vs.40.0％,P=0.035）;对比两组左室内径、主动脉瓣口流速及跨瓣压差,差异无统计学意义（P ＞0.05）。在术中指标对比方面,BAV组主动脉阻断时间明显长于TAV组(72.07±22.05 vs.55.80±16.77 min,P=0.000)。在术后指标对比方面,两组患者在ICU时间、ICU呼吸机时间、住院时间及复查超声上差异无统计学意义（P ＞0.05）。结论 二叶式主动瓣狭窄患者容易较早发病,并且具有男性优势,所以应提高心脏疾病筛查能力,以便于早诊断、早治疗。同时,二叶式主动脉瓣狭窄患者易合并升主动脉扩张和三尖瓣反流,且升主动脉直径和主动脉阻断时间明显大于三叶式主动脉瓣狭窄患者,因此依据指南并结合手术经验术中积极处理扩张主动脉、修复三尖瓣是非常必要的,此外还应加强围手术期心肌保护、缩短阻断时间来减少术中损害。     

Valve preserving surgery in patients with bicuspid aortic valve

Bicuspid aortic valve can be associated with clinically important aortic regurgitation and dilatation of ascending aorta. Aortic valve repair seems to be optimal therapeutic option how to avoid valve-related and anticoagulation-related complications. We have analyzed midterm outcomes of patients after bicuspid aortic valve repair.MethodsBetween January 2008 and December 2015, 91 patients (mean age 40.9 ± 12.2) with bicuspid aortic valve (type 0 or 1) underwent valve-sparing surgery for aortic valve insufficiency or aortic aneurysm. Urgent procedures and patients of age more than 65 were not included. The cohort of patients was retrospectively divided into two groups. Forty-nine patients underwent aortic valve-sparing procedure with root replacement (group 1). Forty-two patients underwent aortic valve repair without root replacement (group 2). The mean length of follow-up was 57.5 months.ResultsThere was no death in connection with aortic valve repair during follow up. Three patients from group 2 required in-hospital reoperation for early repair failure. Another seven patients (4 from group 1 and 3 from group 2) were reoperated for recurrent aortic insufficiency during follow-up period. Freedom from aortic valve reoperation at 5 years was 90% in group 1 and 87% in group 2. Freedom from recurrent aortic insufficiency (>2°) at 5 years was 85% in group 1 and 78% in group 2.ConclusionBicuspid aortic valve repair is a safe procedure, which can be performed with acceptable midterm results. Risk of repair failure depends on preoperative valve morphology and choice of repair technique. Repair technique needs to be tailored to the specific anatomy of the valve.     

Hereditary patterns of bicuspid aortic valve in a hundred families

Background

To study the following characteristics of bicuspid aortic valves (BAVs): 1) the recurrence rate in our population, 2) patterns of hereditary transmission in different BAV morphologies and 3) the aortic dimensions of BAVs in first-degree relatives (FDRs).

Methods

A cross-sectional, prospective study of 100 consecutive families of BAV patients attending a university hospital. The following aortic valve morphologies were analysed and categorised: fusion of the right and left coronary cusps (BAV type A), right and noncoronary cusps (type B) and of the left and noncoronary cusps (type C).

Results

There were 553 subjects studied, 100 cases with a BAV (46.8 ± 15 years, 66% male, type 67% A, 32% B and 1% C; 42% with aortic dilatation), 348 FDRs (44.8% male), and 105 healthy control subjects (50% male). We detected 16 BAVs among 348 FDRs. The recurrence rates were 15% for families, 4.6% for FDRs, 7.05% in men and 2.60% in women. The morphologic concordance in family members was 68.8%. The aortic dimensions in 270 adult FDRs with a tricuspid aortic valve were significantly smaller compared with BAV patients (sinus index diameter 1.60 ± 0.19 cm/m² vs. 1.82 ± 0.29 cm/m², p < 0.001; tubular index diameter 1.51 ± 0.23 cm/m² vs. 2.00 ± 0.45 cm/m², p < 0.001) and similar to 103 control subjects(sinus index diameter 1.60 ± 0.19 cm/m² vs. 1.59 ± 0.17 cm/m², p = 0.600 and tubular index diameter 1.51 ± 0.23 cm/m² vs. 1.53 ± 0.18 cm/m², p = 0.519).

Conclusions

In our population, the BAV recurrence rate in FDRs was low (4.6%). The hereditary transmission of morphologic BAV types seems by chance, and the aortic dimensions in tricuspid FDRs are normal.