Pearlman A S
Department of Medicine, University of Washington School of Medicine, Seattle.
Circulation. 1991 Sep;84(3 Suppl):I193-7.
The presence, severity, and hemodynamic consequences of mitral and tricuspid stenosis can be determined by echocardiographic techniques. In mitral stenosis two-dimensional echocardiographic imaging allows definition of leaflet anatomy and dynamics, subvalvular disease, ventricular function, and involvement of other valves. Spectral and color Doppler echocardiographic techniques permit accurate measurement of transvalvular gradient, determination of functional orifice area, evaluation of associated valvular regurgitation, and assessment of pulmonary artery pressures. These approaches are of recognized clinical value, and they provide additional diagnostic information that is unavailable from clinical assessment alone in a significant number of patients. Compared with available invasive diagnostic standards of reference, echocardiographic data have been found to be comparable in accuracy. In tricuspid stenosis echocardiographic imaging and Doppler techniques provide an assessment of valve morphology and function that should be similarly useful in clinical management decisions, although rigorous comparative studies have not been performed. Currently, carefully done echocardiographic studies are a definitive means of establishing the presence and significance of mitral stenosis and tricuspid stenosis, thereby obviating the need for invasive evaluation in many patients, reducing risk, and potentially decreasing the cost of diagnostic assessment.
二尖瓣和三尖瓣狭窄的存在、严重程度及其血流动力学后果可通过超声心动图技术来确定。在二尖瓣狭窄中，二维超声心动图成像可明确瓣叶的解剖结构和动态变化、瓣下病变、心室功能以及其他瓣膜的受累情况。频谱和彩色多普勒超声心动图技术能够准确测量跨瓣压差、确定功能性瓣口面积、评估相关瓣膜反流以及评估肺动脉压力。这些方法具有公认的临床价值，并且在大量患者中提供了仅通过临床评估无法获得的额外诊断信息。与现有的有创诊断参考标准相比，超声心动图数据的准确性已被发现具有可比性。在三尖瓣狭窄中，尽管尚未进行严格的对比研究，但超声心动图成像和多普勒技术可对瓣膜形态和功能进行评估，这在临床管理决策中同样应具有实用价值。目前，精心进行的超声心动图检查是确定二尖瓣狭窄和三尖瓣狭窄的存在及其意义的决定性手段，从而在许多患者中无需进行有创评估，降低风险，并有可能降低诊断评估的成本。
