Lange H W, Olson J D, Pedersen W R, Kane M A, Daniel J A, Mooney M R, Goldenberg I F
Abbott-Northwestern Hospital, Minneapolis, MN.
Am Heart J. 1991 Aug;122(2):489-94. doi: 10.1016/0002-8703(91)91006-9.
Transesophageal color flow Doppler findings are reported in 36 patients with a St. Jude Medical mechanical mitral valve prosthesis who had no auscultatory evidence for prosthetic valve dysfunction. Multiple jets consistent with mitral regurgitation originating from the central and lateral portion of the prosthesis were found in all patients. Maximum jet length ranged from 11 to 51 mm (mean 21 +/- 9 mm). Maximum jet area ranged from 0.2 to 4.1 cm3 (mean 1.2 +/- 0.9 cm2). The color M-mode Doppler interrogation showed two distinct components of the regurgitant jet: brief early systolic flow consistent with valve closure followed by holosystolic regurgitant flow consistent with transvalvular leakage. Four patients (11%) had a maximum regurgitant jet length exceeding 30 mm and absence of early systolic closure regurgitant flow by M-mode color imaging, suggesting clinically silent paravalvular leakage. Two pin-sized paravalvular suture line defects were confirmed in one patient at cardiac transplantation. We conclude that transesophageal echocardiography is a highly sensitive method for detection of mitral regurgitation in the St. Jude Medical mitral prosthesis. Clinically silent paravalvular leakage should be suspected if the maximum jet length exceeds 30 mm and color M-mode interrogation fails to demonstrate an early systolic closure regurgitant flow component.
对36例使用圣犹达医疗机械二尖瓣假体且听诊未发现人工瓣膜功能障碍证据的患者进行了经食管彩色血流多普勒检查。所有患者均发现多个与二尖瓣反流相符的射流，起源于假体的中央和外侧部分。最大射流长度为11至51毫米（平均21±9毫米）。最大射流面积为0.2至4.1平方厘米（平均1.2±0.9平方厘米）。彩色M型多普勒检查显示反流射流有两个不同的成分：与瓣膜关闭一致的短暂早期收缩期血流，随后是与跨瓣漏血一致的全收缩期反流血流。4例患者（11%）最大反流射流长度超过30毫米，且M型彩色成像未显示早期收缩期关闭反流血流，提示临床上无症状的瓣周漏。1例患者在心脏移植时证实有两个针孔大小的瓣周缝线缺损。我们得出结论，经食管超声心动图是检测圣犹达医疗二尖瓣假体二尖瓣反流的高度敏感方法。如果最大射流长度超过30毫米且彩色M型检查未能显示早期收缩期关闭反流血流成分，则应怀疑存在临床上无症状的瓣周漏。
