Susmano A, Kefer J, Kumar L V
Chest. 1978 Jul;74(1):45-9. doi: 10.1378/chest.74.1.45.
The findings in two patients with angiographically proven massive pulmonary embolism and with clinical and phonocardiographic evidence of abnormal respiratory movement of the pulmonic sound are reported. One patient with complete right bundle-branch block and another with normal conduction had a wide and fixed split second sound with a loud pulmonic component. Both patients had a moderate degree of pulmonary hypertension. Approximately two weeks after administration of heparin, the pulmonic sound moved normally during respiration in both patients. Thromboembolic pulmonary hypertension regressed in one patient and remained unchanged in the other. Changes in impedance through the large pulmonary arteries are are postulated to be responsible for the abnormal movement of the pulmonic valve during both phases of respiration. Wide expiratory splitting of the second sound should be an important clue in the diag nosis of acute massive pulmonary embolism, and the reappearance of a normal inspiratory splitting could be used at the beside to assess indirectly the rate of resolution of the blood clots.
报告了两例经血管造影证实为大面积肺栓塞且有临床及心音图证据表明肺动脉音呼吸运动异常的患者的研究结果。一例完全性右束支传导阻滞患者和另一例传导正常患者出现第二心音宽而固定分裂，肺动脉成分增强。两名患者均有中度肺动脉高压。在使用肝素约两周后，两名患者的肺动脉音在呼吸时均恢复正常运动。一名患者的血栓栓塞性肺动脉高压消退，另一名患者则保持不变。推测在呼吸的两个阶段，通过大肺动脉的阻抗变化是导致肺动脉瓣异常运动的原因。第二心音呼气时宽分裂应是急性大面积肺栓塞诊断的重要线索，而正常吸气分裂的再次出现可在床边用于间接评估血凝块的溶解速度。
