超声心动图诊断二尖瓣腱索断裂合并赘生物与漏诊分析

目的探讨二尖瓣腱索断裂(RMCT)合并赘生物的超声心动图特征,并分析漏诊原因。方法回顾性分析17例经手术病理证实为RCMT合并赘生物的患者超声心动图声像特征。结果超声心动图诊断15例RCMT,漏诊2例,漏诊率11.76%(2/17);诊断RMCT合并赘生物11例,漏诊赘生物6例,漏诊率35.29%(6/17)。15例表现为二尖瓣前后叶瓣尖对合不良,断裂腱索及对应瓣膜呈"连枷样"运动;2例仅表现为二尖瓣尖在收缩期对合不良、脱垂。赘生物表现为可活动的毛绒样模糊回声,随断裂的腱索在左心房、左心室内摆动。彩色多普勒于所有患者均显示"偏心型"的反流束。结论超声心动图对RMCT诊断率较高,其漏诊原因是断裂的腱索极其细小或超声诊断仪分辨率较低;合并赘生物时易漏诊赘生物的原因是赘生物早期较小,与断裂的腱索回声相似,且与其一起摆动。

Analysis on diagnosis and missed diagnosis of ruptured mitral chordae tendineas complicated with vegetations by echocardiography

Objective To observe the echocardiographic features of ruptured mitral valve chordae tendineas (RMCT) with vegetations, and to analyze the causes of missed diagnosis. Methods Echocardiography characteristics of 17 patients of RCMT with vegetations confirmed by operation and pathological examination were analyzed retrospectively. Results Fifteen patients of RMCT were diagnosed with echocardiography and 2 patients were missed, and the rate of missed diagnosis was 11.76% (2/17). Eleven cases of vegetations were detected, while 6 (6/17, 35.29%) were missed. The leaflets of mitral valve showed "flail-like" close incompletely in 15 patients, while 2 cases only showed mitral valve prolapse. The vegetations were usually described as pluse-like and fuzzy echo-like lumps by echocardiography, swing activities with broken tendineas between the left atrial and left ventricular. CDFI showed "eccentric" regurgitant jet in directions of different chordae tendineas ruptures. Conclusion Echocardiography is valuable in diagnosis of RMCT. The causes of missed diagnosis of RCMT are that the ruptured chordae is extremely small and the resolution of ultrasound diagnostic apparatus is low. The causes of missed diagnosis of vegetations are that they are too small in early phase and may swing with broken tendineas.