Takahashi H, Sakamoto T, Hada Y, Amano K, Takenaka K, Hasegawa I, Suzuki J, Shiota T, Sugimoto T, Furuse A
Second Department of Internal Medicine, University of Tokyo.
J Cardiol. 1989 Sep;19(3):893-900.
To evaluate the prevalence, causes and clinical significance of mitral valve prolapse (MVP) associated with surgically-closed atrial septal defect (ASD), 90 patients (M: 41, F: 49) were studied using two-dimensional and color-coded Doppler echocardiography. Among the 90 patients, preoperative echocardiograms were available in 27. MVP was found in 21 of the 27 patients (78%) preoperatively, but it was found in 59% (16/27) postoperatively. In total, MVP was detected in 50 of the 90 patients (56%) postoperatively. The postoperative MVP group had higher pulmonary-to-systemic flow ratios (3.6 +/- 1.9 vs 2.8 +/- 1.1, p less than 0.05) and higher mean pulmonary arterial pressures (21 +/- 11 vs 13 +/- 5 mmHg, p less than 0.01) at the time of surgery. Between the two groups with or without MVP postoperatively, there was no difference (p less than 0.05) in age at surgery, the postoperative duration and left ventricular (LV) deformity index both in pre- and postoperative states. A mitral regurgitant (MR) murmur was recorded in seven patients postoperatively. However, only two had clinically severe MR. It was concluded that MVP is frequently detected in patients with closure of ASD and it is related neither to degree of the LV deformity nor to age at operation; rather, it is related to the severity of the preoperative hemodynamic state. Clinically significant MR is rare in the postoperative period.
为评估与手术闭合房间隔缺损(ASD)相关的二尖瓣脱垂(MVP)的患病率、病因及临床意义,我们使用二维和彩色编码多普勒超声心动图对90例患者(男41例,女49例)进行了研究。在这90例患者中,27例有术前超声心动图资料。术前,27例患者中有21例(78%)发现有MVP,但术后发现率为59%(16/27)。总体而言,90例患者中有50例(56%)术后检测到MVP。术后有MVP的患者组在手术时肺循环与体循环血流量比值较高(3.6±1.9 vs 2.8±1.1,p<0.05),平均肺动脉压也较高(21±11 vs 13±5 mmHg,p<0.01)。术后有或无MVP的两组患者在手术年龄、术后病程以及术前和术后左心室(LV)畸形指数方面均无差异(p<0.05)。术后有7例患者记录到二尖瓣反流(MR)杂音。然而,只有2例有临床严重MR。结论是,在ASD闭合患者中经常检测到MVP,它与LV畸形程度和手术年龄均无关;相反,它与术前血流动力学状态的严重程度有关。术后临床上有意义的MR很少见。