Dittrich H, Nicod P, Hoit B, Dalton N, Sahn D
Department of the Medicine, University of California, San Diego.
Am Heart J. 1988 Jan;115(1 Pt 1):133-8. doi: 10.1016/0002-8703(88)90528-5.
We studied the value of two-dimensional Doppler echocardiographic color flow mapping for identifying normal transvalve flow profiles and valve malfunction in 20 patients with Björk-Shiley prosthetic valves. Seven patients had Björk-Shiley prosthetic valves in the aortic position alone, seven in the mitral position, and six had prosthetic valves in both the aortic and mitral positions. In 10 patients with normally functioning mitral valves, the ratios of the maximal major and minor Doppler-imaged orifice flow diameters to the valve ring diameters were 25 +/- 3% (mean +/- SD) and 24 +/- 3%, respectively, similar to values reported in in vitro studies. No mitral regurgitation was found in these patients by two-dimensional Doppler echocardiographic flow mapping or by spectral Doppler. Of the 10 clinically normal aortic Björk-Shiley valves, no valvular regurgitation was found by color flow mapping, whereas mild aortic regurgitation was found in two patients with the use of spectral Doppler. Malfunction of six valves was documented in five patients and was confirmed by cardiac catheterization and/or surgery. These included one case of focal fibrous ingrowth involving primarily the minor orifice of a mitral prosthetic valve, one case of mitral valve prosthetic thrombosis with decreased major and minor orifice flow diameters and valvular regurgitation, and four cases of paravalvular regurgitation involving prosthetic valves in the aortic position (three patients) and the mitral position (one patient). Two-dimensional Doppler echocardiographic flow mapping provides new observations that may aid in identifying Björk-Shiley prosthetic valve malfunction. By localizing precisely the site of prosthetic stenosis or regurgitation, it may also assist in defining the cause of valve malfunction.
我们研究了二维多普勒超声心动图彩色血流图在识别20例植入Björk-Shiley人工瓣膜患者的正常跨瓣血流情况及瓣膜功能障碍方面的价值。7例患者仅在主动脉位置植入了Björk-Shiley人工瓣膜，7例在二尖瓣位置，6例在主动脉和二尖瓣位置均植入了人工瓣膜。在10例二尖瓣功能正常的患者中，多普勒成像的最大主、次瓣口血流直径与瓣环直径的比值分别为25±3%（均值±标准差）和24±3%，与体外研究报道的值相似。通过二维多普勒超声心动图血流图或频谱多普勒检查未发现这些患者存在二尖瓣反流。在10个临床检查正常的主动脉Björk-Shiley瓣膜中，彩色血流图未发现瓣膜反流，而使用频谱多普勒检查发现2例患者存在轻度主动脉反流。5例患者的6个瓣膜出现功能障碍，并通过心导管检查和/或手术得到证实。其中包括1例主要累及二尖瓣人工瓣膜次瓣口的局灶性纤维组织长入，1例二尖瓣人工瓣膜血栓形成伴主、次瓣口血流直径减小及瓣膜反流，以及4例主动脉位置（3例患者）和二尖瓣位置（1例患者）人工瓣膜的瓣周反流。二维多普勒超声心动图血流图提供了有助于识别Björk-Shiley人工瓣膜功能障碍的新观察结果。通过精确确定人工瓣膜狭窄或反流的部位，它还可能有助于明确瓣膜功能障碍的原因。
