M'Zah N, Drobinski G, Klimczak K, Béjean-Lebuisson A, Evans J I, Eugène M, Grosgogeat Y
Ann Cardiol Angeiol (Paris). 1984 Jul-Sep;33(5):295-9.
The echocardiographic findings of six patients with pure mitral stenosis associated with pure aortic stenosis were compared with the findings from a series of ten cases of pure aortic stenosis without mitral disease. Each patient also underwent haemodynamic studies in order to quantitate the severity of the stenoses. The aortic stenosis was of the same degree of severity in both series (0.71 +/- 0.24 cm2 and 0.73 +/- 0.16 cm2). The systolic separation of the aortic valve was greater than 1 cm in 4 of the 6 cases on echocardiography, corresponding to a false negative of tight aortic stenosis. This appearance corresponded to a doming of the aortic valve on 2D echocardiography. The wall thickness was significantly less in the AS + MS series than in pure SA series (1.13 +/- 0.13 cm compared with 1.52 +/- 0.21 cm; p less than 0.01). The wall was found to be thicker, the tighter the MS. Overall, the diagnostic criteria of the severity of AS on echocardiography (restricted opening of the valve and the severity of ventricular wall hypertrophy) were absent in the association of AS + MS. The absence of myocardial hypertrophy can not be fully explained. It could be related to a decreased filling on the left ventricle and therefore a smaller systolic ejection volume because of the mitral obstruction.
将6例单纯二尖瓣狭窄合并单纯主动脉瓣狭窄患者的超声心动图检查结果与10例无二尖瓣病变的单纯主动脉瓣狭窄患者的检查结果进行了比较。每位患者还接受了血流动力学研究，以量化狭窄的严重程度。两个系列中主动脉瓣狭窄的严重程度相同（分别为0.71±0.24平方厘米和0.73±0.16平方厘米）。在6例患者中，有4例在超声心动图上显示主动脉瓣收缩期分离大于1厘米，这相当于严重主动脉瓣狭窄的假阴性结果。这种表现与二维超声心动图上主动脉瓣的圆顶状形态相对应。主动脉瓣狭窄合并二尖瓣狭窄系列患者的室壁厚度明显低于单纯主动脉瓣狭窄系列患者（分别为1.13±0.13厘米和1.52±0.21厘米；p<0.01）。发现二尖瓣狭窄越严重，室壁越厚。总体而言，在主动脉瓣狭窄合并二尖瓣狭窄的情况下，超声心动图上用于诊断主动脉瓣狭窄严重程度的标准（瓣膜开放受限和心室壁肥厚的严重程度）并不适用。心肌肥厚的缺失无法得到充分解释。这可能与左心室充盈减少有关，因此由于二尖瓣梗阻导致收缩期射血量较小。
