Villavicencio R, Vargas Barrón J, Andrade A, Cárdenas M
Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Arch Inst Cardiol Mex. 1991 Jan-Feb;61(1):43-6.
The "papillary muscle dysfunction" concept includes a disrupted sequence of one or more structures of the mitral valve complex and not merely a disturbance of a papillary muscle itself. We studied a group of seventeen patients, 14 men and 3 women (mean age 51 and 39 years, respectively). Acute myocardial infarction was the first evidence of heart disease. In all of them, Doppler and M mode echocardiography were performed and correlation clinical features were done. In addition a tricuspid regurgitation flow patterns was scanned on each patient. Mitral regurgitation was found in 29% of them by Doppler echocardiography and only 17% had a mitral systolic murmur suggestive of this entity. In those patients with mitral regurgitation-flow patterns, the infarct site was similar to those with anterior and inferior infarction and serum CPK-level was greater in these patients than the non-mitral regurgitation flow pattern group. The evidence of tricuspid regurgitation by pulsed-Doppler echocardiography was associated with mitral regurgitation in 80% of patients, mainly those with right ventricular extension of acute myocardial infarction, and with the greatest hemodynamic impairment. It seems likely in this study, that mitral regurgitation was due to valve ring dilation with an increase of left ventricular diameter and a decrease on ventricular systolic function.
“乳头肌功能障碍”这一概念包括二尖瓣复合体一个或多个结构的连续性中断，而不仅仅是乳头肌本身的紊乱。我们研究了一组17名患者，其中14名男性和3名女性（平均年龄分别为51岁和39岁）。急性心肌梗死是心脏病的首发证据。对所有患者均进行了多普勒和M型超声心动图检查，并分析了相关临床特征。此外，对每位患者的三尖瓣反流血流模式进行了扫描。通过多普勒超声心动图发现其中29%的患者存在二尖瓣反流，只有17%的患者有提示该病症的二尖瓣收缩期杂音。在那些有二尖瓣反流血流模式的患者中，梗死部位与前壁和下壁梗死患者相似，且这些患者的血清肌酸磷酸激酶水平高于无二尖瓣反流血流模式组。脉冲多普勒超声心动图显示三尖瓣反流的证据与80%的二尖瓣反流患者相关，主要是那些急性心肌梗死累及右心室的患者，且血流动力学损害最大。在本研究中，二尖瓣反流似乎是由于瓣环扩张，伴有左心室直径增加和心室收缩功能降低。
