Lesbre J P, Isorni C, Lespérance J, Petitclerc R, Bonan R, Chassat C, Dyrda I, Bourassa M
Arch Mal Coeur Vaiss. 1986 Aug;79(9):1278-86.
The respective diagnostic values of M mode and 2D echocardiography and pulsed and continuous wave Doppler were assessed in bioprosthetic valve dysfunction. The results of the ultrasonic investigations were compared with the operative findings and anatomo pathological appearances in 56 cases of dysfunction. Only cases with surgical confirmation were included. Doppler examinations were carried out in 13 cases. Echocardiographic imaging alone cannot resolve all the diagnostic problems posed: specific signs are rare and were only observed in one out of 7 cases of periprosthetic leak, 7 out of 10 cases of valvular stenosis and 20 out of 36 cases (55 per cent) of valve tear. In cases of valve tear, 2D echocardiography was falsely normal in 15 per cent of cases and gave equivocal results in 30 per cent of cases because it was not possible to visualise the three cusps of the bioprostheses. Doppler echocardiography does not have the same limitations and gives an immediate and accurate assessment of valve function. It is particularly useful for the diagnosis of stenosis and valve tear in which the diagnostic specificity and sensitivity attain 100 per cent (exact diagnosis in all 11 cases of valve tear). At present, continuous wave Doppler seems to be the most reliable diagnostic tool for qualitative and quantitative assessment of primary degeneration of valvular prostheses.
评估了M型、二维超声心动图以及脉冲和连续波多普勒在生物人工瓣膜功能障碍中的各自诊断价值。将56例功能障碍患者的超声检查结果与手术所见及解剖病理学表现进行了比较。仅纳入经手术证实的病例。对13例患者进行了多普勒检查。单纯超声心动图成像无法解决所有提出的诊断问题：特定体征罕见，仅在7例人工瓣膜周漏中的1例、10例瓣膜狭窄中的7例以及36例瓣膜撕裂中的20例（55%）中观察到。在瓣膜撕裂病例中，二维超声心动图在15%的病例中结果假阴性，在30%的病例中结果不明确，因为无法观察到生物人工瓣膜的三个瓣叶。多普勒超声心动图没有同样的局限性，能对瓣膜功能进行即时准确评估。它对狭窄和瓣膜撕裂的诊断特别有用，其中诊断特异性和敏感性达到100%（在所有11例瓣膜撕裂病例中均能准确诊断）。目前，连续波多普勒似乎是对瓣膜假体原发性退变进行定性和定量评估的最可靠诊断工具。
