Laurent M, Leborgne O, Clement C, Foulgoc J L, Le Helloco A, Almange C, Leborgne P
Division of Cardiology B, Hôtel-Dieu, C.H.U. Rennes, France.
Eur Heart J. 1991 Oct;12(10):1098-106. doi: 10.1093/oxfordjournals.eurheartj.a059844.
Systolic left ventricular flow was studied by pulsed and continuous wave Doppler in 41 patients following aortic valve replacement for severe stenosis (mean valvular area: 0.58 cm2; range 0.3-0.75 cm2). Maximal left ventricular velocities by continuous wave Doppler study, were higher than 2.5 m.s-1 with a sharp peak at end-systole in five patients in basal condition and in four others after amyl nitrite inhalation. Pulsed Doppler study showed that the high velocities started from the apex or mitral papillary muscle level with a marked chamber narrowing at two-dimensional echography. Only one patient had a systolic anterior motion (SAM) of the anterior mitral leaflet with mitral-septal contact. The left ventricular dimensions, as measured by M-mode echography were compared in the various patient groups. High velocities seemed statistically associated with the smaller systolic and diastolic diameters of the left ventricle and outflow tract and the larger relative thickness of the posterior wall. The highest pressure gradients disappeared after correction of hypovolaemia (one patient), clearance of pericardial effusion (one patient), or beta-blocker treatment (three patients). The present study confirms that left intra-ventricular dynamic gradients can occur after clearance of fixed outflow obstruction, for which Doppler examination is a reliable and innocuous diagnostic means. Haemodynamically, this syndrome resembles hypertrophic obstructive cardiomyopathy, but the scarcity of the systolic anterior motion of the mitral leaflets is suggestive of a different mechanism that could be cavity obliteration or mid-ventricular obstruction.
对41例因严重狭窄（平均瓣膜面积：0.58平方厘米；范围0.3 - 0.75平方厘米）接受主动脉瓣置换术的患者，采用脉冲和连续波多普勒研究左心室收缩期血流情况。在基础状态下，5例患者及吸入亚硝酸异戊酯后4例患者的连续波多普勒研究显示，左心室最大速度高于2.5米/秒，在收缩末期有一个尖峰。脉冲多普勒研究表明，高速血流始于心尖或二尖瓣乳头肌水平，二维超声心动图显示心室明显变窄。仅1例患者二尖瓣前叶有收缩期前向运动（SAM）并伴有二尖瓣 - 室间隔接触。通过M型超声心动图测量不同患者组的左心室尺寸。高速血流似乎在统计学上与左心室和流出道较小的收缩期和舒张期直径以及后壁较大的相对厚度相关。在纠正低血容量（1例患者）、清除心包积液（1例患者）或β受体阻滞剂治疗（3例患者）后，最高压力梯度消失。本研究证实，在清除固定性流出道梗阻后可出现左心室内动态梯度，多普勒检查是一种可靠且无害的诊断方法。从血流动力学角度看，该综合征类似于肥厚性梗阻性心肌病，但二尖瓣叶收缩期前向运动较少提示可能存在不同机制，可能是心室腔闭塞或心室中部梗阻。
