Pennestri F, Boccardi L, Minardi G, Di Segni M, Pucci E, Biasucci L M, Ferrari O, Lombardo A, Giovannini E, Loperfido F
Department of Cardiology, Catholic University, Sacro Cuore, Rome, Italy.
Am J Cardiol. 1989 Jun 1;63(18):1390-4. doi: 10.1016/0002-9149(89)91054-0.
Using phonocardiography, continuous- and pulsed-wave Doppler, 51 patients with precordial "musical" murmurs (49 with cardiac abnormalities) and 21 patients with noisy murmurs were examined. With M-mode echocardiography, fine fluttering of the structure generating the murmur was evident in 23 patients with musical murmurs and in 5 with noisy murmurs. A continuous-wave Doppler spectral signal characterized by parallel harmonics (Doppler musical signal) was evident in all patients with musical murmurs and in none with a noisy murmur. With pulsed-wave Doppler, the musical signal had less defined spectral features because of range ambiguity. Such a signal was experimentally reproduced by activating a diapason bathed in saline solution. The source of the musical murmur was established in all 51 patients by Doppler. The musical signal was associated with a valvular regurgitation signal in 36 patients and with a ventricular septal defect in 1 patient. The musical signal always disappeared when the pulsed-wave Doppler sample volume was placed 2 cm away from the generating structure. In 11 patients with musical murmur examined by color Doppler, no abnormal bidirectional flow signal was observed in the structures generating the signal. In 6 of the patients without valvular regurgitation, no flow disturbance was found. In conclusion, Doppler is valuable in determining the source of musical murmurs, and musical murmurs are caused by a vibrating structure even in the absence of flow turbulence.
使用心音图、连续波和脉冲波多普勒，对51例心前区“音乐样”杂音患者（49例有心脏异常）和21例噪音样杂音患者进行了检查。M型超声心动图显示，23例音乐样杂音患者和5例噪音样杂音患者中，产生杂音的结构有细微颤动。所有音乐样杂音患者均出现以平行谐波为特征的连续波多普勒频谱信号（多普勒音乐信号），而噪音样杂音患者均未出现。对于脉冲波多普勒，由于距离模糊，音乐信号的频谱特征不太明确。通过激活浸在盐溶液中的音叉，实验性地再现了这样的信号。通过多普勒确定了所有51例患者音乐样杂音的来源。36例患者的音乐信号与瓣膜反流信号相关，1例与室间隔缺损相关。当脉冲波多普勒取样容积置于距产生结构2cm处时，音乐信号总是消失。在11例经彩色多普勒检查的音乐样杂音患者中，在产生信号的结构中未观察到异常双向血流信号。在6例无瓣膜反流的患者中，未发现血流紊乱。总之，多普勒在确定音乐样杂音的来源方面很有价值，即使在没有血流紊乱的情况下，音乐样杂音也是由振动结构引起的。
