Gu Xiaoyan, He Yihua, Luan Shurong, Zhao Ying, Sun Lin, Zhang Hongjia, Nixon J V Ian
Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China The Pauley Heart Center, Virginal Commonwealth University School of Medicine, Richmond, VA, USA.
Medicine (Baltimore). 2017 Mar;96(10):e6191. doi: 10.1097/MD.0000000000006191.
Dissection of the interventricular septum (IVS) is an extremely rare entity. An institutional echocardiographic database was retrospectively reviewed; 13 patients with a diagnosis of IVS dissection were found and confirmed by cardiac surgery. The purposes of the study were: to determine the value of transthoracic echocardiography (TTE) in establishing the diagnosis of IVS dissection, and to detail the TTE features of IVS dissection.Thirteen patients with IVS dissection diagnosed by TTE, 8 males and 5 females were taken from 789,114 TTE studies performed between 1985 and 2014. All underwent cardiac surgery during which their diagnosis was confirmed. The etiology, location, 2-dimensional morphology, and color Doppler findings of IVS dissection were noted.The right sinus of Valsalva (SOV) was involved in 11 of the 13 patients. In 5 patients, a single aneurysm of the right SOV was seen dissecting into the IVS. One patient with a combination of a bicuspid aortic valve and a right SOV aneurysm dissected into the IVS. In 4 patients, aortic valve infective endocarditis resulted in IVS dissection. In 1 patient, mechanical aortic valve prosthetic replacement was complicated by annular detachment and a severe paravalvular leak causing IVS dissection. In all 11 patients, TTE showed a dissecting cystic-like mass in the IVS from the base to the mid-septum or confined to the septal base. The path of the dissection in these 11 patients was traced to the right SOV and communications between the IVS dissection and the aortic root were identified. In the remaining 2 patients, IVS dissection followed septal rupture due to a myocardial infarction, and communication was seen between the IVS dissection and the right ventricle.The study showed that most of the dissections of the IVS commence in the right SOV, due to either congenital anomalies or infective endocarditis, or following aortic valve replacement or myocardial infarction. The TTE characteristic of IVS dissection is a cystic-like mass seen in the IVS.
室间隔夹层是一种极其罕见的病症。对某机构的超声心动图数据库进行了回顾性分析；发现13例诊断为室间隔夹层的患者，并经心脏手术确诊。本研究的目的是：确定经胸超声心动图（TTE）在室间隔夹层诊断中的价值，并详细描述室间隔夹层的TTE特征。从1985年至2014年进行的789,114例TTE检查中选取了13例经TTE诊断为室间隔夹层的患者，其中男性8例，女性5例。所有患者均接受了心脏手术，术中确诊。记录了室间隔夹层的病因、位置、二维形态及彩色多普勒表现。13例患者中有11例累及主动脉瓣右冠窦（SOV）。5例患者可见单个右SOV动脉瘤破入室间隔。1例合并二叶式主动脉瓣及右SOV动脉瘤的患者，动脉瘤破入室间隔。4例患者因主动脉瓣感染性心内膜炎导致室间隔夹层。1例患者在机械主动脉瓣置换术后发生瓣环脱离及严重瓣周漏，并发室间隔夹层。在所有11例患者中，TTE显示室间隔从基部至中隔或局限于间隔基部有一个夹层样囊性肿物。这11例患者的夹层路径追溯至右SOV，并发现室间隔夹层与主动脉根部之间存在交通。其余2例患者，室间隔夹层继发于心肌梗死所致的室间隔破裂，可见室间隔夹层与右心室之间存在交通。研究表明，大多数室间隔夹层起源于右SOV，原因包括先天性异常、感染性心内膜炎、主动脉瓣置换术后或心肌梗死后。室间隔夹层的TTE特征是在室间隔可见一个囊性肿物。
