经食管二维和三维超声心动图对二尖瓣人工机械瓣瓣周漏定位诊断价值

目的:探讨经食管实时二维和三维超声心动图诊断二尖瓣瓣人工机械瓣瓣周漏的临床价值。方法:回顾分析二尖瓣人工机械瓣瓣周漏26例的二维、三维经食管超声心动图表现特征,并与术中所见进行对比。结果:26例二尖瓣人工机械瓣瓣周漏患者,术中发现二尖瓣人工机械瓣瓣周漏36处,其中6例同时存在2处漏口,2例同时存在3处漏口。经食管实时三维超声心动图共发现瓣周漏30处,与术中发现符合率100%,二维经食管超声心动图共发现瓣周漏28处,与术中发现符合率77.8%。结论:经食管实时三维超声心动图能够清晰显示二尖瓣人工机械瓣瓣周漏的位置、形态和大小,有利于术前手术计划的选择和制定。     

风湿性心脏瓣膜病的彩色多普勒超声心动图分析

目的分析186例风湿性心脏瓣膜病(RHD)的彩色多普勒超声心动图,探讨彩色多普勒超声在RHD诊断中的意义。方法采用常规超声心动图测量病人心脏各房室大小、室壁厚度及运动情况,血栓形成情况,瓣叶回声,瓣口面积,瓣口血流速度,反流面积,瓣膜形态、结构及启闭情况,并估测肺动脉压。结果所累及瓣膜增厚,回声增强,交界粘连,活动受限,继发房室增大,室壁增厚,左房血栓及肺动脉高压等。RHD以二尖瓣累及最为多见,其次为主动脉瓣与三尖瓣,肺动脉瓣几乎不受侵犯。结论彩色多普勒超声心动图对RHD的诊断及治疗具有重要的指导意义。     

人工机械瓣功能障碍的超声诊断

目的　评价人工机械瓣功能障碍彩色多普勒超声心动图的诊断价值。方法　使用 Sequoia2 5 6、HP5 5 0 0、ATL超 9彩色多普勒超声诊断仪检查 42例 (4 4个人工瓣 )术后重复出现临床症状的病人 ,并与手术结果进行比较。结果超声诊断瓣膜梗阻 12个 ,瓣周漏 16个 ,瓣内漏 16个 ,与手术相符率为 :人工瓣膜梗阻为 10 0 %,瓣周漏为 81%,瓣内漏为 87%。引起功能障碍原因有血栓、赘生物、缝线撕脱、碟片磨损。结论　超声诊断人工机械瓣功能障碍准确性高 ,是临床上评价人工机械瓣功能障碍的最重要检查方法。     

多普勒超声心动图检测早期新生儿心功能指标的正常值范围

目的 :建立早期新生儿心功能指标的正常值范围。方法 :采用彩色多普勒显象仪 ,对 35 0例出生一周以内的新生儿心脏大血管各瓣口血流进行多普勒超声心动图检测 ,并进行统计学处理。结果 :得出了早期新生儿主动脉瓣口和肺动脉瓣口检测的 11项心功能指标、二尖瓣口和三尖瓣口检测的 2 0项心功能指标的正常值范围。结论 :提供早期新生儿多普勒超声心动图心功能指标正常值范围 ,具有临床应用价值。     

双腔右心室的超声心动图诊断

本文报告应用超声心动图诊断81例双腔右心室患者，其中手术治疗72例，超声诊断符合率833％。结果表明：室间隔缺损是最常见的并发畸形。通过不同切面可清晰地显示分割右室腔引起流出道狭窄的异常肌束。大动脉短轴、剑突下二尖瓣水平短轴及右室流出道长轴切面可提供双腔右心室的诊断和鉴别诊断非常有价值的信息。多普勒技术也有助于诊断和评价血流动力学，超声心动图是目前诊断双腔右心室最为实用的方法。     

经皮球囊二尖瓣成形术前后三种计算二尖瓣口面积方法的比较

对３３例以二尖瓣狭窄为主的风湿性心脏病患者进行研究，比较了经皮球囊二尖瓣成形术（ＰＢＭＶ）前后３种计算二尖瓣瓣口面积的方法。统计表明，ＰＢＭＶ前Ｇｏｒｌｉｎ公式，多普勒超声心动图压差减半时间及二维超声心动图测量的二尖瓣口面积间有显著相关，但ＰＢＭＶ后仅二维超声心动图测量二尖瓣口面积（ＭＶＡＥ）与连续波多普勒超声心动图测量二尖瓣口面积（ＭＶＡＤ）维持ＰＢＭＶ前相似的相关性；３种方法计算的瓣口面积在ＰＢＭＶ前后的变化率亦不相关。ＰＢＭＶ后血液动力学改变对Ｇｏｒｌｉｎ公式及压差减半时间计算的二尖瓣口面积有明显影响，３种计算二尖瓣口面积的方法不能混用，ＰＢＭＶ术后测量二尖瓣口面积应以二维超声心动图方法为准。     

经皮二尖瓣球囊扩张术前后经食道及 经胸壁超声心动图评价的比较

经皮二尖瓣球囊扩张术(PTMB)自1982年首次由Inoue等临床应用以来正日益受到人们的关注。在术前对二尖瓣狭窄的严重度、二尖瓣形态包括瓣下结构、二尖瓣反流及左房血栓的存在必须重点检查。已往其主要的无创性检查方法为经胸壁超声心动图(TTE),联合运用多普勒频谱及彩色血流显     

超声心动图在二尖瓣球囊成形术中应用价值的研究

本文在１５例经皮穿刺二尖瓣球翼成形术（ＰＢＭＶ）中应用超声心动图对导管装置进行监视和引导。术中二维超声心动日不仅能清晰显示左心房、右心房、房间隔和二尖瓣等心脏结构，而且也可显示穿刺针、球囊导管，其中６０％（９／１５）的病例可清晰显示穿刺针穿房间隔过程，所有病例均可清晰显示球囊导管通过并扩张狭窄的二尖瓣口的经过。术中及时结合二锥、频谱和彩色多普勒仔细观察扩张前后二尖瓣口面积、舒张期二尖瓣口峰值跨瓣压及二尖瓣返流的变化，可较准确评价扩张效果。表明：超声心动图是ＰＢＭＶ术中直观、快速、简便的评价疗效的手段。但经胸壁超声仍有一定的局限性，只能部分取代常规的Ｘ线透视。     

GE Vivid E9多普勒超声心动图在二叶式主动脉瓣畸形诊断中的应用价值

目的基于GE Vivid E9多普勒超声心动图探讨二叶式主动脉瓣畸形的超声心动图特征和诊断价值。方法采用二维超声和基于GE Vivid E9的彩色多普勒技术观察26例二叶式主动脉瓣畸形情况,并观察大动脉短轴及左室长轴切面主动脉瓣的形态、数目、活动情况及血流动力学状态。结果先天性二叶式主动脉瓣畸形在大动脉短轴切面显示为两个瓣叶及两个瓣叶附着点,舒张期呈单一关闭线,26例病人中合并升主动脉扩张12例(46.2%),合并主动脉瓣狭窄15例(57.7%),合并主动脉瓣关闭不全19例(73.1%),合并主动脉瓣脱垂4例(15.4%),合并主动脉瓣赘生物3例(11.5%),并发其他先天性心血管畸形5例(19.2%)。结论 GE Vivid E9彩色多普勒超声心动图对二叶式主动脉瓣畸形的诊断有重要价值。     

膜周部室间隔缺损合并三尖瓣反流的机制探讨

目的通过术前、术后超声心动图和彩色多普勒检查及手术所见,评价及明确膜周部室间隔缺损合并三尖瓣反流的机制.方法通过13例膜周部室间隔缺损合并三尖瓣反流的临床资料,经胸超声心动图术前诊断及术后复查,结合术中所见,观察膜周部室间隔缺损和三尖瓣反流的关系.结果所有病例均为中等膜周部室间隔缺损,中等量的左向右分流,心室收缩期,二维超声心动图可见典型的三尖瓣前向运动及三尖瓣呈开放状态.彩色多普勒血流显象,大多数病例表现为经室缺的部分穿隔血流被隔瓣阻挡,但主要血流经三尖瓣隔瓣下缘穿过,冲击到三尖瓣的前瓣,导致三尖瓣反流.室缺修补后,三尖瓣反流消失.结论膜周室缺的穿隔血流可导致膜周室缺合并三尖瓣反流.二维超声心动图及彩色多普勒血流显象发现该现象,这是外科手术修补室缺的良好指征.     

Comparison of transthoracic and transesophageal color Doppler flow imaging in patients with mechanical prostheses in the mitral valve position

This study determined the relative value of transthoracic and transesophageal color Doppler flow imaging to systolic flow patterns in the left atrium in different types of mechanical prostheses in the mitral valve. Thirty-nine patients were investigated. Based on clinical findings, 36 of 39 patients had normal prosthetic valve function. Seventeen patients were interrogated within a few days after surgery. Systolic regurgitant jets in the left atrium were absent in all patients by both transthoracic pulsed and color Doppler flow imaging. Using transthoracic continuous wave Doppler, however, jets were demonstrated in 8 of 39 patients (21%). Transesophageal color Doppler flow imaging demonstrated systolic regurgitant jets originating from the prosthesis in all patients. Tilting disc valves showed jets during the entire systole (closure and leakage backflow). Each type of prosthesis generated a specific jet pattern. Pathologic regurgitant jets were crescent-shaped, more extensive and turbulent than jets caused by normal closure and leakage backflow. Thus, transthoracic color Doppler flow imaging is not sensitive for detecting regurgitant jets in mechanical prostheses in the mitral valve. All mechanical prostheses show a specific jet pattern, which should be helpful when transesophageal echocardiography is used to identify pathologic backflow.     

Patterns of normal transvalvular regurgitation in mechanical valve prostheses

The magnitude and spatial distribution of normal leakage through mechanical prosthetic valves were studied in an in vitro model of mitral regurgitation. The effective regurgitant orifice was calculated from regurgitant rate at different transvalvular pressure differences and flow velocities. This effective orifice area was 0.6 to 2 mm2 for three tilting disc prostheses (Medtronic-Hall sizes 21, 25 and 29) and 0.2 to 1.1 mm2 for three bileaflet valves (St. Jude Medical sizes 21, 25 and 33). In the single disc valves, Doppler color flow examination disclosed a prominent central regurgitant jet around the central hole for the strut, accompanied by minor leakage along the rim of the disc (central to peripheral jet area ratio 3.3 +/- 1.2). The bileaflet prostheses showed a peculiar complex pattern: in planes parallel to the two disc axes, convergent peripherally arising jets were visualized, whereas in orthogonal planes several diverging jets were seen. Mounting the disc and bileaflet valves on a water-filled tube allowed reproduction and interpretation of this pattern: for the bileaflet valve, the jets originated predominantly from valve ring protrusions that contained the axis hinge points and created a converging V pattern in planes parallel to the leaflets and a diverging V pattern in orthogonal planes. Similar patterns were observed during transesophageal echocardiography in 20 patients with a normally functioning St. Jude prosthesis. In 10 patients with a Medtronic-Hall valve, a dominant central jet was observed with one or more smaller peripheral jets. The median central to peripheral jet area ratio was 5 to 1.(ABSTRACT TRUNCATED AT 250 WORDS)     

Doppler color flow evaluation of prosthetic mitral valves: experimental epicardial studies

More than 300 epicardial Doppler color flow mapping studies on 23 different types of clinical and preclinical valves were performed after implantation in the mitral position in sheep. The transducers were placed directly on the heart to obtain the greatest possible resolution. Studies were performed in each animal under different hemodynamic conditions by varying heart rate and cardiac output. Eighty-six valves were studied late (20 to 52 weeks), whereas the remainder were studied early (0 to 10 days) after operation. The valves included 3 types of ball and cage valves, 3 types of disc and cage valves, 7 types of tilting disc valves, 1 type of bileaflet hemidisc mechanical valve, 13 types of porcine aortic valves and 5 types of bovine pericardial valves. The results of these studies were compared with those obtained in 40 studies of 20 native mitral valves. Doppler color velocity/flow profiles were imaged in real time with simultaneous electrocardiographic gating; the aortic flow was also displayed for the timing of velocity/flow events. Native normal mitral valves had no in-orifice flow disturbances and laminar low velocity/flow directed toward the left ventricular apex. Ball and cage and disc and cage valves had high velocity peripheral jets and vortices of velocity/flow reversals distal to the occluders. Tilting disc valves had differing velocity/flow patterns determined by their orientation in the mitral anulus. Bileaflet hemidisc valves had three jets, which decayed 1.5 cm downstream. Porcine aortic and bovine pericardial bioprosthetic valves had high velocity, turbulent, nonaxisymmetric jets (more severe for the latter).(ABSTRACT TRUNCATED AT 250 WORDS)     

Value and limitations of color Doppler flow mapping in the detection and semiquantification of valvular regurgitation

Summary We compared color Doppler flow mapping data to angiographic data in 294 patients with suspected valvular regurgitation. Thirty-one patients had rheumatic mitral regurgitation and 37 had mitral regurgitation due to mitral valve prolapse by angiography. Ten patients had no angiographic regurgitation (4 rheumatic, 6 prolapse). The remaining patients included 86 with suspected aortic regurgitation and 130 with suspected tricuspid regurgitation. Angiographically 74 had aortic regurgitation and 111 tricuspid regurgitation. The maximum size of regurgitant jets was evaluated in each patient by color flow mapping. The width of the jets was also taken into consideration. In 29 of the 31 with rheumatic regurgitation and 67 of the 74 with aortic regurgitation by angiography, abnormal regurgitant signals were detected by color flow mapping. In both rheumatic mitral regurgitation and aortic regurgitation, color Doppler estimation of the jets correlated well with angiographic grading. The regurgitant jets in these regurgitation were not eccentric. In the 37 with mitral regurgitation in mitral valve prolapse by left ventriculography, abnormal jets were detected in 35 by color flow mapping. However, the regurgitant jets were eccentric and color Doppler estimation of the jets correlated poorly with angiographic grading. In patients with tricuspid regurgitation, color Doppler grading of regurgitation correlated poorly with right ventriculographic grading. A color Doppler underestimation was observed in 48%. In conclusion, color Doppler flow mapping is useful in the noninvasive detection and semiquantification of rheumatic mitral regurgitation and aortic regurgitation having non-eccentric jets, although this technique often underestimates the severity of regurgitation in mitral valve prolapse.     

Diagnosis of prosthetic heart valve thrombosis. The respective values of transthoracic and transoesophageal Doppler echocardiography

Early diagnosis of acute prosthetic thrombosis remains a challenge,in 20 patients with 23 thrombosed cardiac valves, we evaluatedthe respective value of transthoracic (TTE) and transoesophageal(TEE) Doppler echocardiography. According to the presence orabsence of prosthetic obstruction by continuous-wave Doppler,prostheses were separated into two groups. Group 1 included nine thrombosed prostheses (8 mitral, 1 aortic)with severe obstruction. All patients presented with severesymptoms of heart failure. Transthoracic Doppler echocardiographyallowed immediate diagnosis of prosthetic thrombosis, even incritically ill patients, showing (1) eccentric transprostheticcolour flow jets in all eight mitral prostheses, (2) severeobstruction on Doppler examination (mean gradient = 18 to 36mmHg in eight mitral prostheses, and 69 mmHg in one aortic valve),and (3) direct echocardiographic evidence of thrombosis (i.e.thrombus or abnormal disc or leaflet motion) in four patients.All nine patients were immediately treated by surgery (n=8)or fibrinolysis (n =1) on the basis of TTE results only. TEEallowed better visualization of thrombus and restricted leafletor disc motion, but had little influence on patient management. Group 2 included 14 thrombosed prostheses (10 mitral, 4 aortic)with mild or absent obstruction, in three patients with massivemitral prosthetic thrombosis, an associated minimal thrombosisof a prosthetic aortic valve was found at surgery, but was detectedneither by TTE, nor by TEE. The 11 remaining patients presentedwith isolated partial mitral (n = 10) or aortic (n = 1) thrombosis.Clinical presentation was fever, cerebral embolism, or milddyspnoea, but no heart failure. TTE was normal in all. Continuous-waveDoppler showed normal prosthetic function in five patients andmild obstruction in six. TEE allowed diagnosis of prostheticthrombosis in all, showing an abnormal mobile echo around theprosthesis, despite normal disc or leaflet motion. In conclusion, transthoracic Doppler echocardiography is thediagnostic procedure of choice in patients with severely obstructiveprosthetic thrombosis, while the transoesophageal approach appearspromising in partial thrombosis with mild or absent obstruction.     

Single-plane transesophageal echocardiography for assessing function of mechanical or bioprosthetic valves in the aortic valve position.

To assess the value and limitations of single-plane transesophageal echocardiography in the evaluation of prosthetic aortic valve function, 89 patients (69 mechanical and 20 bioprosthetic aortic valves) were studied by combined transthoracic and transesophageal 2-dimensional and color flow Doppler echocardiography. In the assessment of aortic regurgitation, the transthoracic and transesophageal echocardiographic findings were concordant in 71 of 89 patients (80%). In 8 patients, the degree of aortic regurgitation was underestimated by the transthoracic approach; in each case the quality of the transthoracic echocardiogram was poor. In 10 patients, transesophageal echocardiography failed to detect trivial aortic regurgitation due to acoustic shadowing of the left ventricular outflow tract from a mechanical valve in the mitral valve position. Transesophageal echocardiography was superior to transthoracic echocardiography in diagnosing perivalvular abscess, subaortic perforation, valvular dehiscence, torn or thickened bioprosthetic aortic valve cusps, and in clearly distinguishing perivalvular from valvular aortic regurgitation. Transesophageal echocardiography correctly diagnosed bioprosthetic valve obstruction in 1 patient, but failed to diagnose mechanical valve obstruction in another. In conclusion, transesophageal echocardiography offers no advantage over the transthoracic approach in the detection and quantification of prosthetic aortic regurgitation unless the transthoracic image quality is poor. Transesophageal echocardiography is limited in detecting mechanical valve obstruction and in detecting aortic regurgitation in the presence of a mechanical prosthesis in the mitral valve position. However, it is superior to transthoracic echocardiography in identifying perivalvular pathology, differentiating perivalvular from valvular regurgitation and in defining the anatomic abnormality responsible for the prosthetic valve dysfunction. Combined transthoracic and transesophageal examination provides complete anatomic and hemodynamic assessment of prosthetic aortic valve function.     

Transesophageal Doppler color flow imaging in the detection of native and Bj?rk-Shiley mitral valve regurgitation

Regurgitant blood flow of mitral valves was studied by transesophageal Doppler color flow echocardiographic imaging in 11 healthy volunteers (Group 1), 25 cardiac patients with a native mitral valve (Group 2), 10 patients with a normally functioning Bj?rk-Shiley mitral prosthesis without clinical evidence of mitral regurgitation (Group 3) and 10 patients with angiographic or surgical evidence of Bj?rk-Shiley mitral valve regurgitation (Group 4). Holosystolic regurgitant color jets were classified as type I or type II. The data were compared with results obtained with precordial techniques, i.e., continuous wave and Doppler color flow echocardiographic imaging (Groups 1 to 4) and left ventricular angiography or surgery (Groups 2 and 4). In Group 1, transesophageal Doppler color flow imaging revealed no mitral regurgitant flow in 7 of the 11 patients and a type I jet in 4 patients that was detected in only 1 patient by precordial techniques. In Group 2, angiography showed no mitral regurgitation in 20 patients and documented mitral regurgitation in 5. Transesophageal Doppler color flow imaging detected in 4 of the 20 patients a type I jet that was not visualized with precordial techniques in 2 patients. Type II jets were detected by the transesophageal technique in all five patients with proven mitral regurgitation and were also visualized with precordial echocardiography. All patients in Group 3 showed two identical type I jets that were not detected with precordial echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)     

Late complications of valve replacement: the benefits of non-invasive assessment

Non-invasive techniques were assessed for their capabilities of detecting prosthetic valve malfunctions in 70 consecutive patients with angiographically-documented or surgically-proven prosthetic valve dysfunction. Their 74 dysfunctioning valves were studied using phonocardiography, M-mode and two-dimensional echocardiography and Doppler methods, including pulsed and continuous wave (CW) Doppler echocardiography and two-dimensional Doppler color flow mapping (2DD). These results were compared among the examinations, and also compared between 43 patients with 44 dysfunctioning mechanical valves and 27 patients with 30 dysfunctioning bioprosthetic valves. Symptoms related to valve malfunction were recognized in all patients with prosthetic valve endocarditis and in all patients but one with stenotic condition. In patients with valvular regurgitation, however, symptoms were observed in only six of the 21 patients with mechanical prostheses and in 12 of the 25 patients with bioprosthetic valves (p less than 0.01). Among 43 patients with 44 mechanical valve dysfunctions, the sensitivities of phonocardiography, M-mode and two-dimensional echocardiography and Doppler techniques were 85, 65 and 86 percent, respectively, in 20 patients with stenosis; 100, 57 and 80 percent in seven patients with transvalvular regurgitation; and 100, 50 and 100 percent in 14 patients with paravalvular regurgitation. Similarly, among 27 patients with bioprosthetic valve dysfunctions, the sensitivities of phonocardiography, M-mode and two-dimensional echocardiography and Doppler methods were 67, 100 and 100 percent, respectively, in three patients with stenotic condition; 85, 65 and 100 percent in 20 patients with transvalvular regurgitation; and 60, 40 and 100 percent in five patients with paravalvular regurgitation. Furthermore, 26 of the 27 patients with malfunctioning mechanical valves and 20 of the 24 patients with malfunctioning bioprostheses had abnormal findings using more than two techniques. In addition, each patient had at least one abnormal finding. In conclusion, malfunctioning mechanical or bioprosthetic prostheses could be detected using non-invasive techniques. The combined use of phonocardiography, M-mode and two-dimensional echocardiography and Doppler techniques is most helpful in detecting malfunctioning prostheses.     

Three-dimensional Doppler. Techniques and clinical applications.

AIMS: Colour Doppler is the most widely used technique for assessing valve disease, but eccentric regurgitant jets cannot be visualized and measured by conventional 2D techniques. We have developed a new procedure for three-dimensional (3D) reconstruction of colour Doppler signals. METHODS AND RESULTS: Fifty patients with mitral regurgitation underwent transoesophageal echocardiography and 3D acquisition. The severity of mitral regurgitation was assessed by angiography and the regurgitant volumes were measured by pulsed Doppler. The jet areas were calculated by planimetry from conventional colour Doppler; the jet volumes were obtained by 3D Doppler. A higher degree of mitral regurgitation was found in the patients with eccentric jets. While jet areas showed poor correlation with regurgitant volumes (r = 0.61), jet volumes correlated significantly with regurgitant volumes (r = 0.93; P < 0.001). While jet areas failed to identify patients with different grades of regurgitation, jet volumes could so discriminate. CONCLUSIONS: 3D Doppler revealed new patterns of regurgitant flow and allowed a more accurate semiquantitative assessment of complex asymmetrical regurgitant jets. Three-dimensional colour Doppler has a great potential for becoming a reference method for the assessment of patients with heart valve disease.     

Assessment of normal and abnormal prosthetic mitral valves by Doppler echocardiography Doppler in prosthetic mitral valves

Pulsed, continuous-wave, and color Doppler were performed in 165 normal mitral prostheses and 58 patients with prosthetic dysfunction (46 regurgitant and 12 obstructive valves) proved by catheterization and/or surgery. Mean mitral gradient (MG) and pressure half-time (PHT) were determined in all cases.Among normal prostheses, a wide range of both MG and PHT was observed in each type of valve and a considerable overlap between valves of different size. St-Jude's valve had the most optimal hemodynamics. Mild mitral insufficiency was detected in 14% of tissue and 24% of mechanical mitral valves.Repeat studies were performed in 30 patients over a 2.4 years period. Nine patients developed Doppler evidence of new prosthetic dysfunction, while Doppler parameters remained unchanged in 21 patients during the follow-up period.Among malfunctioning valves, Doppler correctly identified all cases of prosthetic obstruction (n=12), and 42 of 46 regurgitant valves.We conclude that Doppler echocardiography is a very useful technique in both non-invasive assessment and follow-up of normal prosthetic valves in the mitral position and in detecting prosthetic dysfunction, especially when prosthetic obstruction is present.