Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
Int J Cardiol. 2023 Nov 15;391:131273. doi: 10.1016/j.ijcard.2023.131273. Epub 2023 Aug 19.
To explore the value of echocardiography in diagnosing papillary muscle rupture (PMR) of the mitral valve, and summarize the characteristic echocardiographic features of different types.
Echocardiograms of 13 PMR patients confirmed by surgery in Wuhan Union Hospital between January 2009 and December 2022 were retrospectively analyzed and their preoperative transthoracic echocardiography (TTE) was compared with surgical findings.
A total of 9020 patients underwent mitral valve repair or replacement surgery during the study period including 13 (0.14%) for PMR. Of the 13 PMRs, 8 cases were partial PMR(P-PMR), 5 cases were complete PMR(C-PMR); 3 cases were anterolateral PMR, and 10 were posteromedial PMR. The diagnostic accuracy, sensitivity, and specificity of the preoperative TTE were 99.9%, 53.8% and 99.9% respectively. Echocardiographic features of 10 patients (5-C-PMR and 5 P-PMR) with detailed TTE and intraoperative transesophageal echocardiography (TEE) data included: both anterior and posterior leaflets prolapse (C-PMR 60% vs P-PMR 60%); flail leaflet (C-PMR100% vs P-PMR 40%); All C-PMRs and P-PMRs have severe, eccentric and lateral regurgitation; flail attachment (chordae tendinae and ruptured PM) at the tip of prolapsed leaflet (C-PMR100% vs P-PMR 60%); high-echo masses resembled "champagne glasses" in 100% of the C-PMR; high-echo masses resembled "lotus-seedpod" in 60% and "dumbbell-shaped" torn PM in remaining 40% of the P-PMR.
Different PMR subtypes have different echocardiographic characteristics. Combining TTE and TEE can accurately identify the typical features of PMR such as ipsilateral hemipetal leaflet prolapse, high-echoic mass at the tip of the leaflet, massive eccentricity and lateral regurgitation.
探讨超声心动图诊断二尖瓣乳头肌断裂（PMR）的价值，并总结不同类型的特征性超声心动图特征。
回顾性分析 2009 年 1 月至 2022 年 12 月期间在武汉协和医院接受手术证实的 13 例 PMR 患者的超声心动图，并与手术发现进行比较。
在研究期间，共有 9020 例患者接受了二尖瓣修复或置换手术，其中 13 例（0.14%）为 PMR。13 例 PMR 中，8 例为部分 PMR（P-PMR），5 例为完全 PMR（C-PMR）；3 例为前外侧 PMR，10 例为后内侧 PMR。术前 TTE 的诊断准确率、敏感度和特异度分别为 99.9%、53.8%和 99.9%。10 例（5 例 C-PMR 和 5 例 P-PMR）患者具有详细的 TTE 和术中经食管超声心动图（TEE）数据，包括：前、后瓣叶脱垂（C-PMR 60% vs P-PMR 60%）；瓣叶游离（C-PMR 100% vs P-PMR 40%）；所有 C-PMR 和 P-PMR 均有严重、偏心和外侧反流；脱垂瓣叶尖端的游离附着（腱索和断裂的 PM）（C-PMR 100% vs P-PMR 60%）；100%的 C-PMR 可见高回声团块类似“香槟酒杯”；60%的 P-PMR 可见高回声团块类似“莲子荚”，其余 40%的 P-PMR 可见“哑铃状”撕裂的 PM。
不同的 PMR 亚型具有不同的超声心动图特征。结合 TTE 和 TEE 可以准确识别 PMR 的典型特征，如同侧半瓣叶脱垂、瓣叶尖端高回声团块、大量偏心和外侧反流。
