超声心动图与右心导管对肺动脉瓣狭窄患者跨瓣压测量的相关性分析

目的:探讨肺动脉瓣狭窄患者右心导管跨瓣压力测定与超声心动图多普勒法测定的相关性。方法:对27例经右心导管检查与超声心动图确诊的单纯肺动脉瓣狭窄的患者应用超声心动图测量肺动脉瓣跨瓣压，并与右心导管测量的结果进行对比。结果：超声心动图在经皮肺动脉瓣球囊成形术前后测出的单纯肺动脉瓣狭窄跨瓣压值与经皮肺动脉瓣球囊成形术前后右心导管所测跨瓣压值显著相关(P<0．01)，可定量评估单纯肺动脉瓣狭窄程度，且可用于术前评估及术后随访，有临床应用价值。结论：应用超声心动图测量对单纯肺动脉瓣狭窄临床无创诊断及评估具有重要意义。     

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。     

二尖瓣平均跨瓣压差的简便计算新方法

对１０５例行经皮球囊二尖瓣扩张术（ＰＢＭＶ）患者的血液动力学进行了分析，提出了一种新的计算二尖瓣平均跨瓣压差的公式，即ＭＶＰＧ＝ＭＬＡＰ－ＬＶＥＤＰ／２。结果表明，本方法与标准方法计算的二尖瓣平均跨瓣压差差异无显著性（Ｐ＞０．０５），且二者间有高度相关性（ｒ＝０．９７５，Ｐ＜０．００１）。我们认为该方法简便、可靠、具有重要的临床价值。     

多普勒超声心动图评价体外主动脉位人工瓣血流动力学(摘要)

多普勒超声心动图评价体外主动脉位人工瓣血流动力学（摘要）周维新王继海朱晓东杨浣宜陈立军孟哲李建蓉刘汉英谢峰人工瓣有效瓣口面积结合流率和压差资料可较好表达人工瓣功能。传统的瓣口面积是用有创性心导管检查经Ｇｏｒｌｉｎ方程和所测流体力学资料计算。应用无创...     

左心声学造影对二尖瓣狭窄跨瓣压的测量价值

目的　经静脉注射东冠注射液声学造影剂进行左心室声学造影 ,探讨其对二尖瓣狭窄跨瓣压的测量价值。方法　对 10例二尖瓣狭窄患者注射声学造影剂 0 .0 8ml/kg ,测量造影前后二尖瓣狭窄跨瓣压差并与心导管资料对比。结果　造影前后跨瓣压分别为 ( 13 .7± 4.6)mmHg及( 15 .5± 4.4)mmHg ,两者比较差异有显著性 (P <0 .0 5 ) ;造影后跨瓣压与心导管所测跨瓣压的相关系数为 0 .90 ,两者比较差异有非常显著性 (P <0 .0 0 1)。结论　声学造影可增加超声仪检查二尖瓣狭窄血流频谱的准确性。     

连续波多普勒和双心导管同步测量动脉导管未闭分流压差的研究

在30例动脉导管未闭患者中,应用连续波多替勒超声心动图和双心导管技术,同步测量了跨动脉导管的分流压差。结果显示:两种技术测量的最大瞬时压差、舒张末期压差和平均压差均高度相关(r分别为0.99,0.96和0.98),三种多普勒压差分别与肺动脉收缩压、舒张压和平均压呈高度负相关(r分别为-0.85、-0.89和-0.90),表明多普勒超声心动图是估测跨动脉导管压差和肺动脉压力的可靠技术。     

四种多普勒超声方法定量评价二尖瓣返流的比较

探讨多普勒超声技术定量评价二尖瓣返流（ＭＲ）的临床价值。采用四种多普勒超声方法测定ＭＲ患者（４８例）的每搏返流量（ＲＶ）及返流分数（ＲＦ），其中２７例与心导管方法的测值进行比较。结果显示：（１）二尖瓣口平均面积血流量法、二尖瓣环圆形截面积血流量法、二维超声容积法及血流会聚法（ＦＣＭ）的ＲＶ、ＲＦ测值与心导管法比较相关显著（ｒ分别为０．８４～０．９４，０．８３～０．８９），以ＦＣＭ的ＲＶ相关最佳（ｒ＝０．９４），且误差小。（２）四种超声方法中，ＦＣＭ与二尖瓣口平均面积血流量法的ＲＶ测值相关最明显（ｒ＝０．９３）。表明ＦＣＭ测定ＭＲ最为准确、简便，而当会聚法不合适时，可用二尖瓣口平均面积血流量法测定     

有症状和无症状的20岁以上主动脉瓣狭窄患者转归之比较

本研究分成2个阶段进行,首先确认连续波多普勒超声测定跨(主动脉)瓣(收缩期)压差的准确性,然后前瞻性评价经导管检查证实的无症状的中～重度主动脉瓣狭窄(AS)患者之临床转归。(一)第一阶段:65±8(36～83)岁的101(男73,女28)例有症状的 AS 患者接受连续波多普勒超声检查和心导管检查,相隔不超过24小时。多普勒跨瓣压差峰值分别用导管法瞬时跨瓣压差峰值和(左室)峰值-(主动脉)峰值跨瓣压差密切相关(r=0.92.p<0.0001;r=0.91,p<0.0002)。(二)第二阶段:A 组51(男38,女13)例 AS 患者     

连续波多普勒和心导管同步测量右室压力最大上升…

在３１例三尖瓣返流患者中，利用连续波多普勒超声和右心导管技术，同步测量了右室压力最大上升速率（ｄｐ／ｄｔｍａｘ）和右室心肌最大生理缩短速度（Ｖｐｍ）。结果显示，两种技术测量的ｄｐ／ｄｔｍａｘ和Ｖｐｍ均高度相关（ｒ分别为０．８７和０．８９），表明连续波多普勒三尖瓣返流压差法为无创性测量右室收缩功能提供了新的途径。     

近端等流速面面积法测算二尖瓣狭窄之瓣口面积

近端等流速面面积（ＰＩＳＡ）法是根据近端血流汇聚（ＰＦＣ）原理，用彩色多普勒血流显像（ＣＤＦＭ）技术测定狭小孔径流量的一种新方法。本研究用ＰＩＳＡ法测算二尖瓣狭窄瓣口的面积（ｃＭ－ＶＡ）与手术标本实测值（ａＭＶＡ）相比较。结果表明，所有病人均可清晰显示二尖瓣口左房侧的ＰＦＣ区，ｃＭＶＡ与ａＭＶＡ具有良好的相关性。本研究证实了ＰＩＳＡ法估测二尖瓣口面积是可行，且精确的，可以在临床应用     

Doppler echocardiographic evaluation of Hancock and Bj?rk-Shiley prosthetic values

Doppler echocardiographic characteristics of normally functioning Hancock and Bj?rk-Shiley prostheses in the mitral and aortic positions were studied in 50 patients whose valvular function was considered normal by clinical evaluation. Doppler studies were also performed in 46 patients with suspected malfunction of Hancock and Bj?rk-Shiley valves and who subsequently underwent cardiac catheterization. Mean gradients were estimated for both mitral and aortic valve prostheses and valve area was calculated for the mitral prostheses. Doppler prosthetic mitral valve gradient and valve area showed good correlation with values obtained with cardiac catheterization (r = 0.93 and 0.97, respectively) for both types of prosthetic valves. The correlation coefficient (r = 0.93) for mean prosthetic aortic valve gradient was also good, although Doppler echocardiography overestimated the mean gradient at lower degrees of obstruction. Regurgitation of Hancock and Bj?rk-Shiley prostheses in the mitral and aortic positions was correctly diagnosed. These results suggest that Doppler echocardiography is a reliable method for the characterization of normal and abnormal prosthetic valve function.     

Hemodynamic evaluation of porcine bioprostheses in the mitral position by doppler echocardiography

Twenty-four patients with porcine bioprostheses in the mitral position were studied by Doppler echocardiography followed by cardiac catheterization within 24 hours. Doppler mean diastolic mitral valve gradient was calculated by a 3-point method and mitral valve area was determined by the pressure half-time method. Data from Doppler echocardiography and cardiac catheterization were compared. There was a strong correlation between Doppler echocardiography and catheterization-determined mean diastolic gradient: r = 0.9, standard error of estimate (SEE) = 1.4 mm/Hg (regression equation y = 0.63x + 1.41), p <0.001. There was also a strong correlation between Doppler echocardiography and catheterization-determined mitral valve area: r = 0.86, SEE = 0.18 cm² (regression equation y = 0.64x + 0.52), p <0.001. Fourteen patients whose valvular function was considered normal by clinical evaluation had Doppler-calculated mean diastolic gradients of 4.5 to 9.5 mm Hg (mean 6.5 ± 1.4); the Doppler-determined valve area was 1.15 to 2.0 cm² (mean 1.54 ± 0.3). Ten patients had a malfunctioning bioprosthesis, 7 had severe mitral regurgitation and 3 had stenosis. Valvular malfunction in all 10 patients was detected by Doppler echocardiography and confirmed by catheterization and angiocardiography. Nine patients underwent reoperation. Doppler hemodynamic evaluation of porcine bioprostheses in the mitral position provided noninvasive information comparable to that obtained by cardiac catheterization.     

Serial assessment of mitral regurgitation by pulsed Doppler echocardiography in patients undergoing balloon aortic valvuloplasty

Mitral regurgitation was serially assessed by pulsed Doppler echocardiography in 144 patients undergoing balloon aortic valvuloplasty for symptomatic aortic stenosis. Regurgitant scores of 0, 1, 2 and 3 were assigned to pulsed Doppler patterns corresponding to no, mild, moderate and severe mitral regurgitation, respectively. Before balloon aortic valvuloplasty, mitral regurgitant score correlated significantly (p less than 0.005) but weakly with aortic valve area (r = -0.24), left ventricular ejection fraction (r = -0.34) and left ventricular systolic pressure (r = 0.23). There was no significant correlation between mitral regurgitation and either mean catheterization or mean Doppler aortic valve gradient. Balloon aortic valvuloplasty produced significant decreases in both catheterization and Doppler mean transvalvular aortic valve gradients (56 +/- 19 to 31 +/- 12 and 60 +/- 19 to 48 +/- 16 mm Hg, respectively; both p less than 0.0001) and a significant increase (p less than 0.0001) in aortic valve area assessed by catheterization (0.6 +/- 0.2 to 0.9 +/- 0.3 cm2). Left ventricular ejection fraction did not change, but cardiac output increased (p less than 0.001) and pulmonary capillary wedge pressure decreased (p less than 0.0001). Pulsed Doppler findings of mitral regurgitation were present in 102 of the 144 patients. Eighty-eight patients had a score compatible with mild or more severe degrees of mitral regurgitation, and 49 had a score indicative of moderate or severe valvular insufficiency. In the entire group of 144 patients, mitral regurgitant score decreased significantly from 1.1 +/- 1.0 to 1.0 +/- 1.0 (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Doppler echocardiographic assessment of transmitral gradients and mitral valve area before and after mitral valve balloon dilatation

This is a comparative study of 60 sets of observations of mitral valve end-diastolic gradient, mean diastolic gradient, and mitral valve area obtained by Doppler echocardiography and cardiac catheterization. The studies were performed in 28 patients, 16 of whom underwent mitral valve balloon valvuloplasty. These 16 patients had studies performed before, immediately after valvuloplasty, and one week later. Thus 28 studies were performed before or without valvuloplasty (Group I) and 32 after valvuloplasty (Group II). The time interval between Doppler echocardiography and cardiac catheterization was less than 24 hours in 44 studies and 24 to 72 hours in 16 studies. In Doppler echocardiography the gradients were obtained by simplified Bernoulli's equation and the mitral valve area by pressure half-time method. There was excellent correlation between end-diastolic gradients (r = 0.96, p less than 0.001) and mean diastolic gradients (r = 0.92, p less than 0.001) measured by the two techniques. A statistically significant correlation also existed in the mitral valve area values (r = 0.53, p less than 0.005). On separate analysis Group I showed excellent correlation for all three variables (r values of 0.90, 0.87, and 0.82 for end-diastolic gradients, mean-diastolic gradients, and mitral valve area, respectively). Group II also showed excellent correlation of end-diastolic gradients (r = 0.80) and mean diastolic gradients (r = 0.87), but poor correlation of the mitral valve areas (r = 0.17; p = NS) by the two techniques. Doppler echocardiography can accurately measure transmitral gradients both before and after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)     

Accuracy of aortic stenosis severity assessment by Doppler echocardiography: importance of image quality

The aim of the present study was to investigate which factors could influence the accuracy of aortic stenosis severity assessment by Doppler echocardiography in an unselected population. Doppler echocardiographic determination of mean transvalvular pressure gradient and aortic valve area by continuity equation was performed in 101 patients before catheterization. According to the catheterization data, aortic stenosis was classified into 2 categories: mild to moderate (orifice area [Gorlin formula] > 0.75 cm², mean transvalvular gradient < 50 mmHg) and severe (orifice area < 0.75 cm², mean transvalvular gradient 50 mmHg). The influence of eight factors on the absolute difference in aortic valve area and mean transvalvular pressure gradient and on the concordant classification in the same category by both methods was investigated.Results. By multivariate analysis, the absolute difference in aortic valve area by both methods was significantly associated with poor image quality, absolute difference between mean catheterization and Doppler transvalvular gradient and inversely related to body mass index. Absolute difference in mean transvalvular gradients by both methods was significantly associated only with image quality. Poor image quality emerged as the only significant factor influencing the concordant classification between invasive and noninvasive studies according to orifice area (but not according to transvalvular pressure gradient).Conclusion. Echographic image quality significantly influences the accuracy of Doppler echocardiographic determination of aortic valve area and, to a lesser extent, of transvalvular pressure gradient. Therefore, the mere noninvasive approach is not suitable to every consecutive patient with aortic stenosis. Qualifications concerning overall image quality should identify patients most likely to benefit from catheterization.     

Determination of aortic valve area by two-dimensional and Doppler echocardiography in patients with normal and stenotic bioprosthetic valves

To assess the feasibility and accuracy of determining bioprosthetic aortic valve area from two-dimensional and Doppler echocardiographic measurements, three partially overlapping groups were selected from 55 patients with such bioprosthetic valves and adequate Doppler studies. These were Group 1, 37 patients with recent aortic valve replacement surgery and no clinical or echocardiographic evidence of valve dysfunction; Group 2, 12 patients with prosthetic valve stenosis documented by cardiac catheterization; and Group 3, 22 patients with both Doppler and catheterization studies in whom noninvasive and invasive determinations of aortic valve area could be directly compared. Left ventricular outflow tract diameter was measured from two-dimensional still frame images. Flow velocity proximal to the aortic valve, transvalvular velocity and acceleration time were determined from pulsed and continuous wave Doppler spectra. Aortic valve gradient was calculated with the modified Bernoulli equation and valve area by the continuity equation. In the 37 patients with a normally functioning valve, the calculated mean gradient ranged from 5 to 25 mm Hg (average 13.6 +/- 5.2) and valve area from 1.0 to 2.3 cm2 (mean 1.6 +/- 0.31). Linear regression analysis of prosthetic aortic valve area determined by Doppler imaging and cardiac catheterization demonstrated a high correlation (r = 0.93) between the two techniques. Comparison of the patients with and without prosthetic valve stenosis revealed statistically significant differences in mean gradient (42.8 +/- 12.3 versus 13.6 +/- 5.2 mm Hg; p = 0.0001), acceleration time (116 +/- 15 versus 80 +/- 13 ms; p = 0.0001) and valve area by the continuity equation (0.80 +/- 0.16 versus 1.6 +/- 0.31 cm2; p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

经食管超声心动图评价人工心脏瓣膜的功能

本文利用经胸及经食管超声技术观察了51例人工瓣膜置换术后的瓣膜功能及反流程度,并比较了两种技术在评价人工瓣膜中的优缺点。结果表明:(1)经食管超声心动图(TEE)在观察左房及左心耳血栓,判定二尖瓣位人工机械瓣反流程度及鉴别反流与瓣周漏方面均优于经胸超声心动图(TTE)技术,(2)TEE在检出人工二尖瓣反流方面明显优于TTE,且TEE及TTE对人工二尖瓣反流的检出率分别为87.76%和14.29%,(3)TEE在检出主动瓣反流方面与TTE比较,无显著性差异(P>0.05),但可低估瓣膜反流程度。经食管超声技术是判定二尖瓣位人工瓣功能异常的敏感、可靠方法。     

Effect of atrial fibrillation and mitral regurgitation on calculated mitral valve area in mitral stenosis

Forty-nine patients with mitral stenosis (MS) were studied by Doppler echocardiography and 2-dimensional (2-D) echocardiography to assess the ability of Doppler ultrasound to accurately measure mitral valve orifice area and to assess whether atrial fibrillation (AF) or mitral regurgitation (MR) affected the calculation. Twenty-four patients underwent cardiac catheterization. Mitral valve area by Doppler was determined by the pressure half-time method. Mean mitral valve area of all 49 patients by Doppler and 2-D echocardiography correlated well (r = 0.90). There was good correlation between Doppler and 2-D echocardiography in patients with pure MS in sinus rhythm (r = 0.88), in patients with MR (r = 0.93) and in patients with AF (r = 0.96). In the 7 patients with pure MS in sinus rhythm, there was good correlation between Doppler, 2-D echocardiography and cardiac catheterization (r = 0.95). In patients with either MR or AF, cardiac catheterization appeared to underestimate mitral valve orifice compared with both Doppler and 2-D echocardiography (p less than 0.05). Doppler echocardiography can estimate valve area in patients with MS regardless of the presence of MR or AF.     

Determination of the stenotic aortic valve area in adults using Doppler echocardiography

The severity of aortic stenosis was evaluated by Doppler echocardiography in 48 adults (mean age 67 years) undergoing cardiac catheterization. Maximal Doppler systolic gradient correlated with peak to peak pressure gradient (r = 0.79, y = 0.63x + 25.2 mm Hg) and mean Doppler gradient correlated with mean pressure gradient (r = 0.77, y = 0.59x + 10.0 mm Hg) by manometry. The transvalvular pressure gradient is flow dependent, however, and associated left ventricular dysfunction was common in our patients (33%). Thus, of the 32 patients with an aortic valve area less than or equal to 1.0 cm2 at catheterization, 6 (19%) had a peak Doppler gradient less than 50 mm Hg. To take into account the influence of volume flow, aortic valve area was calculated as stroke volume, measured simultaneously by thermodilution, divided by the Doppler systolic velocity integral in the aortic jet. Aortic valve areas calculated by this method were compared with results at catheterization in the total group (r = 0.71). Significant aortic insufficiency was present in 71% of the population. In the subgroup without significant coexisting aortic insufficiency, closer agreement of valve area with catheterization was noted (n = 14, r = 0.91, y = 0.83x + 0.24 cm2). Transaortic stroke volume can be determined noninvasively by Doppler echocardiographic measures in the left ventricular outflow tract, just proximal to the stenotic valve. Aortic valve area can then be calculated as left ventricular outflow tract cross-sectional area times the systolic velocity integral of outflow tract flow, divided by the systolic velocity integral in the aortic jet.(ABSTRACT TRUNCATED AT 250 WORDS)     

Continuous wave Doppler echocardiographic measurement of prosthetic valve gradients. A simultaneous Doppler-catheter correlative study

Studies correlating prosthetic valve gradients determined by continuous wave Doppler echocardiography with gradients obtained by cardiac catheterization have, to date, been limited to patients with mitral and tricuspid prostheses or have compared nonsimultaneous measurements. Simultaneous Doppler and catheter pressure gradients in 36 patients (mean age, 63 +/- 13 years) with 42 prosthetic valves (20 aortic, 20 mitral, one tricuspid, and one pulmonary) were studied. Catheter gradients were obtained using a dual-catheter technique. The simultaneous pressure tracings and Doppler flow velocity profiles were digitized at 10-msec intervals to derive the corresponding maximal and mean gradients. The correlation between the maximal Doppler gradient and the simultaneously measured maximal catheter gradient was 0.94 (SEE = 6), and that between the Doppler gradient and the simultaneously measured mean catheter gradient was 0.96 (SEE = 3). There were no significant differences in correlation between gradients for the 32 mechanical valves (maximal gradients: r = 0.95, SEE = 6; mean gradients: r = 0.96, SEE = 3) and the 10 bioprosthetic valves (maximal gradients: r = 0.89, SEE = 6; mean gradients: r = 0.93, SEE = 3). In patients with mitral prostheses, Doppler gradients correlated well with the corresponding catheter gradients obtained with direct measurement of left atrial pressure (maximal gradients: r = 0.96, SEE = 2; mean gradients: r = 0.97, SEE = 1.2). A close correlation between corresponding Doppler and catheter gradients also was found in patients with aortic prostheses (maximal gradients: r = 0.94, SEE = 6; mean gradients: r = 0.94, SEE = 3). Thus, continuous wave Doppler echocardiography can accurately predict the pressure gradient across prosthetic valves.