Downes T R, Nomeir A M, Hackshaw B T, Kellam L J, Watts L E, Little W C
Section of Cardiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103.
Am Heart J. 1989 May;117(5):1106-12. doi: 10.1016/0002-8703(89)90869-7.
In acute aortic regurgitation, left ventricular pressure rises rapidly during diastole, which produces presystolic mitral valve closure. This does not occur in chronic aortic regurgitation. Since normal, nonregurgitant mitral valve closure may depend on properly coordinated atrial and ventricular contractions, we hypothesized that abnormal mitral valve closure occurring before systole in acute aortic regurgitation may produce diastolic mitral regurgitation detectable by Doppler echocardiography. Accordingly, we performed ultrasonic Doppler examination of seven patients with acute aortic regurgitation and 12 patients with chronic aortic regurgitation. Regurgitant aortic flow was severe in all cases. Doppler sampling within the left atrium demonstrated regurgitant mitral flow in late diastole in all patients with acute aortic regurgitation. The onset of diastolic mitral regurgitation coincided with mitral valve preclosure in patients with acute aortic regurgitation and occurred regardless of the position of the mitral leaflets at the initiation of closure. In contrast, none of the 12 patients with chronic aortic regurgitation had mitral valve preclosure or diastolic mitral regurgitation (p less than 0.05 versus acute aortic regurgitation). We conclude that diastolic mitral regurgitation accompanies mitral valve preclosure, which occurs in acute but not chronic aortic regurgitation. Thus diastolic mitral regurgitation may be a Doppler sign of acute aortic regurgitation, in the absence of a markedly prolonged PR interval. Furthermore, this observation suggests that normal, nonregurgitant mitral closure requires more than an increase in left ventricular pressure above left atrial pressure, regardless of the position of the mitral leaflets before closure.
在急性主动脉瓣反流时，左心室压力在舒张期迅速升高，导致二尖瓣在收缩期前提前关闭。慢性主动脉瓣反流时则不会出现这种情况。由于正常的、无反流的二尖瓣关闭可能依赖于心房和心室收缩的恰当协调，我们推测急性主动脉瓣反流时收缩期前出现的异常二尖瓣关闭可能会产生可通过多普勒超声心动图检测到的舒张期二尖瓣反流。因此，我们对7例急性主动脉瓣反流患者和12例慢性主动脉瓣反流患者进行了超声多普勒检查。所有病例的主动脉反流均严重。左心房内的多普勒取样显示，所有急性主动脉瓣反流患者在舒张期末期均存在二尖瓣反流。急性主动脉瓣反流患者中，舒张期二尖瓣反流的起始与二尖瓣提前关闭同时出现，且与二尖瓣关闭开始时瓣叶的位置无关。相比之下，12例慢性主动脉瓣反流患者均未出现二尖瓣提前关闭或舒张期二尖瓣反流（与急性主动脉瓣反流相比，P<0.05）。我们得出结论，舒张期二尖瓣反流与二尖瓣提前关闭同时存在，二尖瓣提前关闭发生于急性而非慢性主动脉瓣反流。因此，在没有明显延长的PR间期时，舒张期二尖瓣反流可能是急性主动脉瓣反流的一个多普勒征象。此外，这一观察结果表明，正常的、无反流的二尖瓣关闭所需的不仅仅是左心室压力高于左心房压力，无论二尖瓣关闭前瓣叶的位置如何。
