Arikawa K, Tei C, Kisanuki A, Otsuji Y, Natsugoe K, Minagoe S, Tanaka H
J Cardiogr. 1985 Dec;15(4):1275-81.
This case report describes a mitral systolic honk originating from the mitral valve and adjacent structures in a 52 year-old woman with mitral stenosis. The patient was hospitalized because of dyspnea. Auscultation of the heart revealed a grade 3/6 apical early systolic honk accompanied by an increased first heart sound, an opening snap and a diastolic rumble. The phonocardiogram demonstrated an early systolic honk at a frequency of 115 Hz. Intensity of the honk varied on beat to beat basis, increasing in the short preceding R-R interval compared to that in the long one. The M-mode echocardiogram showed early systolic fluttering of the mitral valve and chordae tendineae at the same frequency as the honk. The two-dimensional echocardiogram showed bulging of the anterior mitral leaflet toward the left atrium in early systole. After treatment with digitalis and diuretics, the early systolic honk disappeared in beats with preceding long R-R intervals (greater than 1100 msec). In beats without the honk, systolic fluttering of the mitral valve was not observed. The genesis of the early systolic honk is analogous to that of the honk audible in mitral or tricuspid valve prolapse. The bulging of the anterior mitral leaflet into the left atrium may produce vibrations of the mitral valve leaflets and adjacent structures.
本病例报告描述了一名52岁二尖瓣狭窄女性患者源自二尖瓣及其相邻结构的二尖瓣收缩期尖音。该患者因呼吸困难入院。心脏听诊发现心尖部有3/6级收缩期早期尖音，伴有第一心音增强、开瓣音和舒张期隆隆样杂音。心音图显示频率为115Hz的收缩期早期尖音。尖音强度逐搏变化，与较长的R-R间期相比，在较短的前一个R-R间期时增强。M型超声心动图显示二尖瓣和腱索在与尖音相同的频率上出现收缩期早期扑动。二维超声心动图显示二尖瓣前叶在收缩早期向左心房膨出。在用洋地黄和利尿剂治疗后，在有较长前一个R-R间期（大于1100毫秒）的搏动中，收缩期早期尖音消失。在无尖音的搏动中，未观察到二尖瓣的收缩期扑动。收缩期早期尖音的发生机制与二尖瓣或三尖瓣脱垂时可闻及的尖音类似。二尖瓣前叶向左心房膨出可能会引起二尖瓣叶及其相邻结构的振动。
