Magherini A, Urciuolo A, Tommassini C R, Boldrini R, Rossi M, Iadevaia A, Parri A, Milio C, Romani C
Department of Pediatrics, University of Florence, Italy.
Eur Heart J. 1990 Jul;11(7):601-10. doi: 10.1093/oxfordjournals.eurheartj.a059765.
This study using pulsed and continuous wave Doppler echocardiography was designed to achieve a cross-sectional echocardiographic categorization of the fibrous tissues in the environs of perimembranous ventricular septal defects, to determine the mechanism involved in its formation and for qualitative and quantitative evaluation of the anomalies associated with the entity. A total of 67 patients was studied, 23 presented cross-sectional echocardiographic evidence of perimembranous ventricular septal defect in isolation, 12 associated with tissue 'tags' and 32 combined with 'restrictive' tissue in the area of the defect. Four echocardiographic features of the 'restrictive' tissue were observed. In 23 of these 32 patients, it was possible to identify the exact anatomic origin of the 'restrictive' tissue (in seven complete and, in 15, partial involvement of the septal leaflet of the tricuspid valve; in one, prolapse of the aortic valve with a partial involvement of the tricuspid septal leaflet) while in nine the origin remained undetermined. In 20, the 'restrictive' tissue simultaneously protruded into the right atrium and ventricle; only in 12 did it extend exclusively into the right ventricle. Tricuspid insufficiency was detected by pulsed Doppler in 78% of the patients with 'restrictive' tissue and in 23% of the remaining patients. Tricuspid incompetence was severe in only two patients of the first group. Three patients with 'restrictive' tissue (9%) had obstruction to the outlet of the right ventricle and four (13%) patients presented aortic insufficiency. Five patients (16%) with 'restrictive' tissue closing the defect did not present pulsed Doppler evidence of a shunt at the ventricular level.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究采用脉冲和连续波多普勒超声心动图，旨在对膜周部室间隔缺损周围的纤维组织进行超声心动图横断面分类，确定其形成机制，并对与该病变相关的异常进行定性和定量评估。共研究了67例患者，其中23例仅有膜周部室间隔缺损的横断面超声心动图证据，12例伴有组织“条索”，32例在缺损区域合并“限制性”组织。观察到“限制性”组织的四个超声心动图特征。在这32例患者中的23例中，能够确定“限制性”组织的确切解剖起源（7例完全累及、15例部分累及三尖瓣隔叶；1例主动脉瓣脱垂并部分累及三尖瓣隔叶），而9例起源仍未确定。20例中，“限制性”组织同时突入右心房和右心室；仅12例仅延伸至右心室。在有“限制性”组织的患者中，78%通过脉冲多普勒检测到三尖瓣关闭不全，其余患者中23%检测到三尖瓣关闭不全。第一组中仅有2例患者三尖瓣关闭不全严重。3例有“限制性”组织的患者（9%）存在右心室流出道梗阻，4例（13%）患者存在主动脉瓣关闭不全。5例（16%）有“限制性”组织关闭缺损的患者未出现心室水平分流的脉冲多普勒证据。（摘要截断于250字）
