Veyrat C, Witchitz S, Lessana A, Ameur A, Abitbol G, Kalmanson D
Br Heart J. 1985 Sep;54(3):273-84. doi: 10.1136/hrt.54.3.273.
Thirty patients with 33 mitral or aortic prostheses or both were examined using the pulsed Doppler technique combined with cross sectional echocardiography to study the applicability of the Doppler technique in the diagnosis and evaluation of the severity of prosthetic dysfunction and to assess the ability of the mapping procedure to estimate the site and the size of the prosthetic defect. The dysfunction was valvar regurgitation in 29 instances and stenoses in eight, all of which were confirmed by invasive procedures. The severity of the dysfunction was graded on a three point scale. A control group of 73 subjects with 88 normal prostheses also underwent pulsed Doppler and cross sectional echocardiography. The pulsed Doppler study followed the usual procedure for a valvar disease including two and three dimensional mapping for regurgitation. Eight patients also underwent a continuous wave Doppler examination. The diagnostic reliability of the pulsed Doppler technique was greater than or equal to 90%. The severity of the dysfunction was accurately assessed in 86% of cases. In the case of aortic regurgitation, mapping of the jets was performed as easily for prostheses as for native regurgitant valves. In the case of mitral regurgitation, the mapping patterns depended on the cause of the dysfunction. With valvar tears, a jet was detected at the centre of the annulus, and with paravalvar leaks eccentric atrial jets were seen opposite the site of the leak. The pulsed Doppler and the surgical findings correlated well for both the site of the dysfunction (16/20 (80%) patients) and the size of the leak (13/16 (81%) patients). Thus, despite some limitations, pulsed Doppler and particularly the mapping procedure provide sufficient information to give an accurate non-invasive assessment of prosthetic valve dysfunction.
对30例植入33个二尖瓣或主动脉瓣人工瓣膜或二者皆有的患者，采用脉冲多普勒技术结合横断面超声心动图进行检查，以研究多普勒技术在人工瓣膜功能障碍诊断及严重程度评估中的适用性，并评估标测程序估计人工瓣膜缺损部位和大小的能力。功能障碍表现为瓣膜反流29例，狭窄8例，所有这些均经有创检查证实。功能障碍的严重程度按三分制分级。73例植入88个正常人工瓣膜的受试者组成的对照组也接受了脉冲多普勒和横断面超声心动图检查。脉冲多普勒研究遵循瓣膜疾病的常规检查程序，包括对反流进行二维和三维标测。8例患者还接受了连续波多普勒检查。脉冲多普勒技术的诊断可靠性大于或等于90%。86%的病例中功能障碍的严重程度得到了准确评估。在主动脉瓣反流的情况下，对人工瓣膜和天然反流瓣膜一样容易进行射流标测。在二尖瓣反流的情况下，标测模式取决于功能障碍的原因。瓣膜撕裂时，在瓣环中心检测到射流，瓣周漏时，在漏口相对处可见偏心的心房射流。对于功能障碍部位（16/20（80%）患者）和漏口大小（13/16（81%）患者），脉冲多普勒检查结果与手术结果相关性良好。因此，尽管存在一些局限性，脉冲多普勒尤其是标测程序可提供足够信息，以准确无创评估人工瓣膜功能障碍。
