Stewart W J, Currie P J, Salcedo E E, Klein A L, Marwick T, Agler D A, Homa D, Cosgrove D M
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195.
J Am Coll Cardiol. 1992 Nov 15;20(6):1353-61. doi: 10.1016/0735-1097(92)90248-l.
This study was designed to assess the accuracy of two-dimensional and Doppler echocardiography in determining the mechanism of mitral regurgitation, as compared with direct inspection of the valve at operation.
Valve repair for mitral regurgitation offers substantial advantages over valve replacement, but it is technically more demanding and requires understanding of the mechanism of dysfunction.
We studied 286 patients undergoing mitral valve repair. Intraoperative two-dimensional echocardiography was used to classify mitral leaflet motion as excessive, normal or restricted. Doppler color flow mapping was used to evaluate the direction and origin of the mitral regurgitant jet. Two-dimensional and Doppler echocardiography were compared with intraoperative surgical determination of the mechanism of dysfunction, which also classified leaflet motion as excessive, normal or restricted.
Two-dimensional and Doppler echocardiography accurately diagnosed the mechanism of mitral regurgitation in 123 (93%) of 132 patients with posterior leaflet prolapse or flail, 30 (94%) of 32 patients with anterior leaflet prolapse or flail, 11 (44%) of 25 patients with bileaflet prolapse or flail, 6 (75%) of 8 patients with papillary muscle elongation or rupture, 31 (91%) of 34 patients with restricted leaflet motion or rheumatic thickening, 21 (72%) of 29 patients with ventricular-annular dilation and 8 (62%) of 13 patients with a leaflet perforation or cleft. Of 13 patients with two mechanisms of dysfunction by surgical inspection, two-dimensional and Doppler echocardiography correctly diagnosed one of the two mechanisms in 12 patients (92%), and both mechanisms in 5 patients (38%). Overall, echocardiographic determination of leaflet motion and Doppler determination of jet direction accurately diagnosed the mechanism of dysfunction in 242 (85%) of 286 patients.
Echocardiography before mitral valvuloplasty provides a dynamic appraisal of the mechanism of dysfunction, enabling the surgeon to systematically understand the dysfunction and successfully apply the correct procedures to eliminate mitral regurgitation without valve replacement.
本研究旨在评估二维和多普勒超声心动图在确定二尖瓣反流机制方面的准确性，并与手术中对瓣膜的直接检查进行比较。
二尖瓣反流的瓣膜修复术比瓣膜置换术具有显著优势，但技术要求更高，需要了解功能障碍的机制。
我们研究了286例接受二尖瓣修复术的患者。术中二维超声心动图用于将二尖瓣叶运动分类为过度、正常或受限。多普勒彩色血流图用于评估二尖瓣反流束的方向和起源。将二维和多普勒超声心动图与术中手术确定的功能障碍机制进行比较，后者也将叶运动分类为过度、正常或受限。
二维和多普勒超声心动图在132例后叶脱垂或连枷样病变患者中的123例（93%）、32例前叶脱垂或连枷样病变患者中的30例（94%）、25例双叶脱垂或连枷样病变患者中的11例（44%）、8例乳头肌延长或破裂患者中的6例（75%）、34例叶运动受限或风湿性增厚患者中的31例（91%）、29例心室-瓣环扩张患者中的21例（72%）以及13例叶穿孔或裂缺患者中的8例（62%）中准确诊断出二尖瓣反流机制。在13例经手术检查有两种功能障碍机制的患者中，二维和多普勒超声心动图在12例患者（92%）中正确诊断出两种机制中的一种，在5例患者（38%）中正确诊断出两种机制。总体而言，超声心动图对叶运动的测定和多普勒对反流束方向的测定在286例患者中的242例（85%）中准确诊断出功能障碍机制。
二尖瓣成形术前的超声心动图可对功能障碍机制进行动态评估，使外科医生能够系统地了解功能障碍，并成功应用正确的手术方法消除二尖瓣反流而无需进行瓣膜置换。
