Greenberg M A, Herman L S, Cohen M V
Circulation. 1979 May;59(5):902-9. doi: 10.1161/01.cir.59.5.902.
12 patients who had atrial flutter without clinical, echocardiographic or angiographic evidence of aortic insufficiency were studied with simultaneous echo- and phonocardiograms. In patients with high-grade atrioventricular (AV) block, the mitral valve opened and closed with each flutter wave. Of seven patients, two had persistent and five had intermittent early mitral valve closure before QRS inscription. In five patients (three with 2:1 AV block) the mitral valve closed on time. In one patient with a mitral valve prosthesis, echocardiography and cinefluorography demonstrated closure during mid-diastole, with reopening in late diastole after a flutter wave. Final valve closure occurred before the onset of the QRS, and each closure was associated with a click. Simultaneous phonocardiographic analysis in these patients demonstrated that the first heart sound intensity was inversely related to the degree of mitral valve preclosure. This relationship was independent of the length of the RR interval. Thus, atrial flutter independent of any other cause of abnormal hemodynamics may produce early mitral valve closure. The echocardiographic finding of premature mitral arrhythmias, may not have the same diagnostic or prognostic significance previously described in patients with sinus rhythm and normal AV conduction.
对12例无临床、超声心动图或血管造影证据表明存在主动脉瓣关闭不全的心房扑动患者进行了同步超声心动图和心音图研究。在高度房室传导阻滞患者中，二尖瓣随每次扑动波开闭。7例患者中，2例出现持续性、5例出现间歇性二尖瓣提前关闭，均在QRS波群起始之前。5例患者（3例为2:1房室传导阻滞）二尖瓣按时关闭。1例人工二尖瓣患者，超声心动图和电影荧光造影显示舒张中期关闭，扑动波后舒张晚期重新开放。最终瓣膜关闭发生在QRS波群起始之前，每次关闭均伴有喀喇音。对这些患者同步进行的心音图分析表明，第一心音强度与二尖瓣提前关闭程度呈负相关。这种关系与RR间期长度无关。因此，与任何其他异常血流动力学原因无关的心房扑动可能导致二尖瓣提前关闭。二尖瓣过早心律失常的超声心动图表现，可能与窦性心律且房室传导正常患者中先前描述的具有不同的诊断或预后意义。
