Boutefeu J M, Bloch A
Arch Mal Coeur Vaiss. 1978 Jul;71(7):742-9.
This report concerns 9 patients in whom rupture of the cordae of the mitral valve was suspected from the echocardiogram. The authors recall the clinical, echocardiographic, arteriographic, haemodynamic and anatomical findings in patients with rupture of the chordae; they emphasise the importance of echocardiograpy in the pre-operative diagnosis of this condition. In this series, the most frequent clinical sign was a loud pan-systolic murmur at the apex. The electrocardiographic abnormalities were nonspecific. Cardiomegaly was present in most cases. The main echocardiographic findings were those of additional echoes between the two cusps of the mitral valve during diastole, or an abnormally posterior or anterior position of the posterior cusp during diastole, or the presence of mitral prolapse. Other nonspecific signs were frequently present. Left cineangioventriculography showed a significant degree of mitral leakage during diastole in all patients. All 9 patients had an operation or came to post mortem; rupture of the chordae was confirmed in 6 of them. As far as the other 3 cases were concerned, two of them had lengthening of the mitral cordae, and the last had mitral prolapse associated with endocardial vegetation. A further group of 60 patients undergoing surgery for mitral incompetence without rupture of the chordae allowed us to establish that there were no false negative results on the echocardiogram.
本报告涉及9例经超声心动图怀疑二尖瓣腱索断裂的患者。作者回顾了腱索断裂患者的临床、超声心动图、血管造影、血流动力学及解剖学表现；强调了超声心动图在该病术前诊断中的重要性。在该系列病例中，最常见的临床体征是心尖部响亮的全收缩期杂音。心电图异常不具有特异性。多数病例存在心脏扩大。主要的超声心动图表现为舒张期二尖瓣两尖瓣叶间有额外回声，或舒张期后叶异常后移或前移，或存在二尖瓣脱垂。其他非特异性征象也较为常见。左心室电影血管造影显示所有患者舒张期均有明显的二尖瓣反流。所有9例患者均接受了手术或进行了尸检；其中6例证实有腱索断裂。另外3例中，2例二尖瓣腱索延长，最后1例伴有心内膜赘生物的二尖瓣脱垂。另有一组60例因二尖瓣关闭不全接受手术但腱索未断裂的患者，由此我们确定超声心动图无假阴性结果。
