二尖瓣位机械瓣梗阻的彩色多普勒评价

目的评价彩色多普勒超声在诊断二尖瓣位机械瓣(单叶碟瓣)梗阻的价值。方法对比二尖瓣位机械瓣梗阻12例的彩色多普勒超声结果与手术所见。结果左心长轴切面和心尖四腔切面可较清晰地显示二尖瓣位机械瓣梗阻患者的瓣叶活动显著受限,瓣叶开放角度平均10°(0°-25°),彩色血流束呈单束或双束狭窄的边缘血流束,无瓣周漏及中度以上的瓣关闭不全,最大跨瓣血流速度及压差无显著改变:术中见12例瓣叶均被“卡”在近关闭状态位,开放角度小于300°,瓣周纤维肉芽组织增生伴血栓形成,瓣口狭小(0-0．5mm),其中4例瓣口及瓣周完全被血栓块“封堵”。结论彩色多普勒超声心动图显示机械瓣梗阻特征为瓣叶开放角度和幅度显著减小,瓣口呈边缘性狭窄血流束,与手术所见一致,但瓣口血流速度及压差指数等特异改变在彩色多普勒超声心动图不明显;虽然彩色多普勒超声心动图对异常增生组织和血栓的显示不清晰,但仍不失为诊断二尖瓣位机械瓣梗阻的简便有效的手段。

Mechanical heart valve obstruction evaluated by color Doppler echocardiography

Objectives To further research the value of mechanical heart valve obstruction evaluated by color Doppler echocardiography. Methods The finding by color Doppler echocardiography were compared with finding in re-operation. Results The motion obstructing of mechanical moncaspid disc valves were shown easily in left paraslernal long-axis view and apical four-chamber view. The monocspid disc valves showed open to 0-25 degree angle (mean 10 degree angle). The color flow jets were all seriously eccentric narrow. The changes of velocity and pressure grade were not significant. The thrombus clot and fibrous tissue growth in the orifice and sewing of the prosthetic valves were shown obviously during re-operation, but not by color Doppler echocardiography. Conclusions The open angles and width of serious eccentric color flow jets shown by color Doppler echocardiography is an effective and practical method to evaluate the mechanical monocaspid disc valve obstruction.