Jacobs L E, Parry W R, Kotler M N
Division of Cardiovascular Disease, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141.
J Card Surg. 1988 Sep;3(3 Suppl):429-35. doi: 10.1111/jocs.1988.3.3s.429.
We studied the value of pulsed, continuous, and color flow Doppler echocardiography for identifying normal and abnormal function in 51 Ionescu-Shiley bovine pericardial valves. In 15 patients with clinically normal functioning mitral valves, the peak and mean pressure gradients as calculated by the modified Bernoulli equation were 8.5 +/- 4.9 mmHg (mean +/- SD) and 2.6 +/- 2.9 mmHg, respectively. The mitral valve area as calculated by the pressure half-time method was 2.2 +/- 0.6 cm2. In 18 patients with normally functioning aortic valves, the peak and mean pressure gradients were 22.9 +/- 9.0 mmHg and 11.1 +/- 5.0 mmHg, respectively. In five patients with suspected mitral prosthetic dysfunction, two-dimensional and Doppler echocardiography showed: two had mitral stenosis with a mean gradient of 14.2 mmHg and mean mitral valve area of 1.0 cm2, two had severe mitral regurgitation, and one was thickened but nonstenotic. In 13 patients with suspected aortic prosthetic dysfunction, two-dimensional and Doppler echocardiography showed: two patients had markedly thickened leaflets and mean aortic gradient of 41.5 mmHg, two patients had mild aortic regurgitation, four patients had severe aortic regurgitation, and five patients had systolic murmurs secondary to pathology unrelated to the prosthetic aortic valve. Of the three patients with severe aortic regurgitation who had color Doppler, the site and direction of the regurgitant jet was correctly identified in all compared to intraoperative assessment. Pulsed, continuous, and color flow Doppler are useful as noninvasive techniques in assessing Ionescu-Shiley valve hemodynamics and function.
我们研究了脉冲、连续及彩色血流多普勒超声心动图在识别51个伊奥内斯库-希利牛心包瓣膜正常和异常功能方面的价值。在15例临床二尖瓣功能正常的患者中，根据改良伯努利方程计算的峰值和平均压力阶差分别为8.5±4.9 mmHg（均值±标准差）和2.6±2.9 mmHg。通过压力减半时间法计算的二尖瓣面积为2.2±0.6 cm²。在18例主动脉瓣功能正常的患者中，峰值和平均压力阶差分别为22.9±9.0 mmHg和11.1±5.0 mmHg。在5例怀疑二尖瓣人工瓣膜功能障碍的患者中，二维和多普勒超声心动图显示：2例有二尖瓣狭窄，平均压力阶差为14.2 mmHg，平均二尖瓣面积为1.0 cm²；2例有严重二尖瓣反流；1例瓣膜增厚但无狭窄。在13例怀疑主动脉人工瓣膜功能障碍的患者中，二维和多普勒超声心动图显示：2例患者瓣膜叶明显增厚，平均主动脉压力阶差为41.5 mmHg；2例患者有轻度主动脉反流；4例患者有严重主动脉反流；5例患者有与人工主动脉瓣无关的病理因素导致的收缩期杂音。在3例有严重主动脉反流且进行了彩色多普勒检查的患者中，与术中评估相比，反流束的部位和方向均被正确识别。脉冲、连续及彩色血流多普勒作为无创技术，在评估伊奥内斯库-希利瓣膜的血流动力学和功能方面很有用。
