Pozzoli M, Febo O, Torbicki A, Tramarin R, Calsamiglia G, Cobelli F, Specchia G, Roelandt J R
Divisione di Cardiologia, Fondazione Clinica del Lavoro, Centro Medico di Montescano, (Pavia), Italy.
J Am Soc Echocardiogr. 1991 Sep-Oct;4(5):435-41. doi: 10.1016/s0894-7317(14)80376-3.
The blood flow velocity patterns within the left atrial appendage were studied by transesophageal color flow imaging and pulsed Doppler in 84 patients. At the time of the study, 57 of the patients were in sinus rhythm, 25 were in atrial fibrillation, and two were in atrial flutter. The relationships between atrial rhythm, blood flow pattern and the presence/absence of spontaneous echocardiographic contrast or thrombus within the appendage were investigated. Transesophageal echocardiography allowed recording of blood flow velocities in 81 of the 84 patients studied. In 51 of the 55 patients in sinus rhythm the pulsed Doppler study showed a biphasic blood flow pattern, whereas a multiphasic pattern was found in the two patients with atrial flutter and in 14 patients with atrial fibrillation. In four patients with sinus rhythm and 10 patients with atrial fibrillation, no significant blood flow velocity could be detected. Thrombus or spontaneous echocardiographic contrast were found within the left atrial appendage in 20 patients, and in all these patients blood flow was either absent or significantly reduced. Our findings indicate that an absent or low blood flow velocity within the left atrial appendage represents a predisposing factor for thrombosis. Isolated left atrial appendage dysfunction has been documented in four patients during sinus rhythm, which may lead to thrombosis. This observation may offer an explanation for cardioembolic events that occur occasionally in patients without apparent heart disease and sinus rhythm.
通过经食管彩色血流成像和脉冲多普勒对84例患者左心耳内的血流速度模式进行了研究。在研究时，57例患者为窦性心律，25例为心房颤动，2例为心房扑动。研究了心房节律、血流模式与心耳内是否存在自发超声心动图造影或血栓之间的关系。经食管超声心动图能够记录84例研究患者中81例的血流速度。在55例窦性心律患者中的51例，脉冲多普勒研究显示为双相血流模式，而在2例心房扑动患者和14例心房颤动患者中发现为多相血流模式。在4例窦性心律患者和10例心房颤动患者中，未检测到明显的血流速度。在20例患者的左心耳内发现有血栓或自发超声心动图造影，并且在所有这些患者中血流要么不存在要么显著降低。我们的研究结果表明，左心耳内血流速度缺失或降低是血栓形成的一个诱发因素。在4例窦性心律患者中记录到孤立性左心耳功能障碍，这可能导致血栓形成。这一观察结果可能为无明显心脏病和窦性心律的患者偶尔发生的心源性栓塞事件提供一种解释。
