Grayburn P A, Berk M R, Spain M G, Harrison M R, Smith M D, DeMaria A N
Division of Cardiology, University of Kentucky Medical Center, Lexington.
Am Heart J. 1990 May;119(5):1095-102. doi: 10.1016/s0002-8703(05)80240-6.
Few data exist regarding the relationship of valvular anatomy and coaptation to the presence of mitral regurgitation (MR) in patients with mitral valve prolapse (MVP). Therefore this study was undertaken to assess the ability of two-dimensional echocardiographic features of mitral valve morphology to predict the presence, direction, and magnitude of MR as assessed by color Doppler flow imaging. MR was present in 21 of 46 patients with MVP on two-dimensional echocardiography. Echocardiograms were specifically evaluated for leaflet apposition, leaflet morphology, and mitral anulus diameter. Color flow images were analyzed for presence of MR, direction of the regurgitant jet, and area encompassing the largest jet visible in any view. Abnormal mitral leaflet coaptation on two-dimensional echocardiography was strongly associated with the presence of MR (p = 0.003), being present in 15 of 21 patients with as compared with 5 of 25 patients without MR. Similarly, mitral leaflet thickness and MR were closely associated (p = 0.0035), with the latter being present in 9 of 30 patients with normal and 12 of 16 patients with excessive leaflet thickness. MR jet direction tended to be anterior to central with posterior leaflet prolapse and posterior or central with anterior leaflet prolapse (p = 0.02). Maximal jet area of MR tended to be larger in patients with compared with those without mitral annular dilatation (5.4 +/- 2.3 versus 2.1 +/- 1.9 cm2, p = 0.001), and in those with abnormal rather than normal leaflet thickness (4.5 +/- 2.7 versus 2.0 +/- 1.6 cm2, p = 0.009). Thus the presence, direction, and size of MR jets in MVP are related to structural abnormality of the mitral apparatus on echocardiography.
关于二尖瓣脱垂（MVP）患者瓣膜解剖结构和瓣叶对合与二尖瓣反流（MR）存在之间的关系，现有数据较少。因此，本研究本研究，以评估二尖瓣形态的二维超声心动图特征预测经彩色多普勒血流成像评估的MR的存在、方向和程度的能力。在二维超声心动图检查中，46例MVP患者中有21例存在MR。对超声心动图进行了专门评估，包括瓣叶对合、瓣叶形态和二尖瓣环直径。分析彩色血流图像以确定MR的存在、反流束方向以及在任何视图中可见的最大反流束所包含的面积。二维超声心动图显示二尖瓣瓣叶对合异常与MR的存在密切相关（p = 0.003），21例有MR的患者中有15例存在瓣叶对合异常，而25例无MR的患者中有5例存在。同样，二尖瓣瓣叶厚度与MR密切相关（p = 0.0035），瓣叶厚度正常的30例患者中有9例存在MR，瓣叶厚度增加的16例患者中有12例存在MR。后叶脱垂时MR反流束方向倾向于向前至中央，前叶脱垂时倾向于向后或中央（p = 0.02）。与无二尖瓣环扩张的患者相比，有二尖瓣环扩张的患者MR最大反流束面积往往更大（5.4±2.3对2.1±1.9 cm²，p = 0.001），瓣叶厚度异常的患者比瓣叶厚度正常的患者更大（4.5±2.7对2.0±1.6 cm²，p = 0.009）。因此，MVP中MR反流束的存在、方向和大小与超声心动图上二尖瓣装置的结构异常有关。
