Akasaka T, Yoshikawa J, Yoshida K, Shakudo M, Okumachi F, Koizumi K, Shiratori K, Takao S, Jyo Y, Fukaya T
Department of Cardiology, Kobe General Hospital.
J Cardiol. 1988 Mar;18(1):163-78.
Non-invasive techniques were assessed for their capabilities of detecting prosthetic valve malfunctions in 70 consecutive patients with angiographically-documented or surgically-proven prosthetic valve dysfunction. Their 74 dysfunctioning valves were studied using phonocardiography, M-mode and two-dimensional echocardiography and Doppler methods, including pulsed and continuous wave (CW) Doppler echocardiography and two-dimensional Doppler color flow mapping (2DD). These results were compared among the examinations, and also compared between 43 patients with 44 dysfunctioning mechanical valves and 27 patients with 30 dysfunctioning bioprosthetic valves. Symptoms related to valve malfunction were recognized in all patients with prosthetic valve endocarditis and in all patients but one with stenotic condition. In patients with valvular regurgitation, however, symptoms were observed in only six of the 21 patients with mechanical prostheses and in 12 of the 25 patients with bioprosthetic valves (p less than 0.01). Among 43 patients with 44 mechanical valve dysfunctions, the sensitivities of phonocardiography, M-mode and two-dimensional echocardiography and Doppler techniques were 85, 65 and 86 percent, respectively, in 20 patients with stenosis; 100, 57 and 80 percent in seven patients with transvalvular regurgitation; and 100, 50 and 100 percent in 14 patients with paravalvular regurgitation. Similarly, among 27 patients with bioprosthetic valve dysfunctions, the sensitivities of phonocardiography, M-mode and two-dimensional echocardiography and Doppler methods were 67, 100 and 100 percent, respectively, in three patients with stenotic condition; 85, 65 and 100 percent in 20 patients with transvalvular regurgitation; and 60, 40 and 100 percent in five patients with paravalvular regurgitation. Furthermore, 26 of the 27 patients with malfunctioning mechanical valves and 20 of the 24 patients with malfunctioning bioprostheses had abnormal findings using more than two techniques. In addition, each patient had at least one abnormal finding. In conclusion, malfunctioning mechanical or bioprosthetic prostheses could be detected using non-invasive techniques. The combined use of phonocardiography, M-mode and two-dimensional echocardiography and Doppler techniques is most helpful in detecting malfunctioning prostheses.
对70例经血管造影证实或手术证实存在人工瓣膜功能障碍的连续患者，评估了非侵入性技术检测人工瓣膜故障的能力。使用心音图、M型和二维超声心动图以及多普勒方法（包括脉冲和连续波（CW）多普勒超声心动图以及二维多普勒彩色血流图（2DD））对他们的74个功能异常的瓣膜进行了研究。对这些检查结果进行了相互比较，还对43例有44个功能异常机械瓣膜的患者和27例有30个功能异常生物瓣膜的患者进行了比较。所有人工瓣膜心内膜炎患者以及除1例狭窄患者外的所有患者都出现了与瓣膜功能障碍相关的症状。然而，在瓣膜反流患者中，21例机械瓣膜患者中只有6例出现症状，25例生物瓣膜患者中有12例出现症状（p<0.01）。在43例有44个机械瓣膜功能障碍的患者中，心音图、M型和二维超声心动图以及多普勒技术在20例狭窄患者中的敏感性分别为85%、65%和86%；在7例跨瓣反流患者中分别为100%、57%和80%；在14例瓣周反流患者中分别为100%、50%和100%。同样，在27例有生物瓣膜功能障碍的患者中，心音图、M型和二维超声心动图以及多普勒方法在3例狭窄患者中的敏感性分别为67%、100%和100%；在20例跨瓣反流患者中分别为85%、65%和100%；在5例瓣周反流患者中分别为60%、40%和100%。此外，27例机械瓣膜功能异常的患者中有26例，24例生物瓣膜功能异常的患者中有20例使用了两种以上技术有异常发现。此外，每个患者至少有一项异常发现。总之，使用非侵入性技术可以检测出功能异常的机械或生物人工瓣膜。心音图、M型和二维超声心动图以及多普勒技术联合使用对检测功能异常的人工瓣膜最有帮助。
