Reid C L, Rahimtoola S H
Department of Medicine, LAC-USC Medical Center, University of Southern California School of Medicine.
Circulation. 1991 Sep;84(3 Suppl):I240-9.
Doppler and two-dimensional echocardiography (2DE) have played a major role in the evaluation of patients undergoing catheter balloon treatment of aortic and mitral stenosis. Doppler/2DE has made possible an understanding of the mechanism of increase in valve area. Before the procedure, Doppler/2DE provides a reasonable estimate of the severity of the valvular stenosis and associated cardiac abnormalities. The evaluation of mitral valve morphology by 2DE before catheter balloon treatment has shown that patients with excellent leaflet motion and minimal increase in valve thickness have the greatest increase in mitral valve area. During the procedure, Doppler/2DE can aid in the transseptal puncture, in positioning the balloons across the stenotic orifice, and in the immediate assessment of changes in valve function and complications. The estimate of the aortic and mitral valve gradients and areas by Doppler/2DE before catheter balloon treatment shows a reasonable correlation with hemodynamic measurements. Immediately after the procedure, the Doppler/2DE estimates of aortic valve gradient and area show a fair correlation with data from cardiac catheterization, provided care is taken to avoid technical problems. Doppler/2DE assessment of mitral valve area immediately after catheter balloon commissurotomy (CBC) shows a poor correlation with catheterization data, which has been attributed to rapid changes in left atrial compliance and gradient. However, the correlation of Doppler estimates of mitral valve area with catheterization data improves at 3 months after CBC. Serial evaluations of patients after aortic or mitral catheter balloon dilatation should permit detection of restenosis and valve regurgitation and assessment of ventricular function and may provide valuable insights into the mechanisms of restenosis and changing clinical status.
多普勒和二维超声心动图（2DE）在接受主动脉瓣和二尖瓣狭窄导管球囊治疗患者的评估中发挥了重要作用。多普勒/2DE使得了解瓣膜面积增加的机制成为可能。在手术前，多普勒/2DE能对瓣膜狭窄的严重程度及相关心脏异常做出合理估计。在导管球囊治疗前通过2DE对二尖瓣形态进行评估显示，瓣叶活动良好且瓣膜厚度增加最小的患者二尖瓣面积增加最大。在手术过程中，多普勒/2DE有助于经房间隔穿刺、将球囊放置在狭窄口处，并能即时评估瓣膜功能变化和并发症。在导管球囊治疗前通过多普勒/2DE对主动脉瓣和二尖瓣压力阶差及面积进行的估计与血流动力学测量结果具有合理的相关性。手术后即刻，只要注意避免技术问题，通过多普勒/2DE对主动脉瓣压力阶差和面积的估计与心导管检查数据具有较好的相关性。在导管球囊二尖瓣交界切开术（CBC）后即刻通过多普勒/2DE评估二尖瓣面积与心导管检查数据相关性较差，这归因于左心房顺应性和压力阶差的快速变化。然而，在CBC后3个月时，多普勒对二尖瓣面积的估计与心导管检查数据的相关性有所改善。对主动脉或二尖瓣导管球囊扩张术后患者进行系列评估应能检测到再狭窄和瓣膜反流，并评估心室功能，还可能为再狭窄机制和临床状态变化提供有价值的见解。
