Weisse Allen B
New Jersey Medical School, Springfield, NJ, USA.
Am J Cardiol. 2007 Jan 1;99(1):129-33. doi: 10.1016/j.amjcard.2006.07.075. Epub 2006 Nov 13.
Mitral valve prolapse has been recognized as a clinical entity for only the past 50 years, although the auscultatory findings of this condition had been recognized since the mid-19th century. On the evidence of only a few autopsies, it was concluded that the basis for these were pleuropericardial adhesions. Left ventricular angiographic studies performed in the 1960s clearly documented the true nature of the condition, although it was not until the advent of echocardiography that large numbers of patients began to be referred for evaluation by this new technique. Because of the wide variety of symptoms in patients with suspected mitral valve prolapse, similar to those with other conditions, many patients with the latter were referred for evaluation and diagnosed with mitral valve prolapse because of misleading M-mode and then 2-dimensional criteria. It is now recognized, with the use of improved, more restrictive echocardiographic criteria, that the prevalence of the disorder is much less than previously believed. No test has been devised that will prove 100% sensitive and 100% specific for any disorder. In conclusion, this sobering fact should encourage the use of all modalities available, including clinical skills, to make proper diagnoses when these may be in doubt.
二尖瓣脱垂作为一种临床实体被认识仅仅是在过去50年里，尽管这种病症的听诊发现自19世纪中叶就已被认识。仅根据少数尸检的证据，得出其病因是胸膜心包粘连的结论。20世纪60年代进行的左心室血管造影研究清楚地记录了该病的真实性质，尽管直到超声心动图出现后，大量患者才开始通过这项新技术接受评估。由于疑似二尖瓣脱垂患者存在各种各样的症状，与其他病症患者的症状相似，许多患有其他病症的患者因M型超声心动图以及后来二维超声心动图标准具有误导性而被转诊进行评估并被诊断为二尖瓣脱垂。现在认识到，随着使用改进的、更具限制性的超声心动图标准，该病的患病率远低于先前认为的水平。还没有设计出对任何病症都能100%敏感且100%特异的检测方法。总之，这一令人警醒的事实应促使在诊断存疑时使用所有可用的方法，包括临床技能，来做出正确诊断。
