Robertson W S, Stewart J, Armstrong W F, Dillon J C, Feigenbaum H
J Am Coll Cardiol. 1984 Feb;3(2 Pt 1):431-6. doi: 10.1016/s0735-1097(84)80031-5.
The normal anatomic relation of the anterior mitral leaflet to the left ventricular outflow tract suggests that significant aortic regurgitation should have a predictable hemodynamic effect on the motion and configuration of the leaflet, an effect that should be seen by two-dimensional echocardiography. Previous reports have identified an abnormality of mitral opening in the short-axis view that was quite specific but not sensitive. This study was undertaken to evaluate mitral valve motion and configuration in aortic insufficiency using two-dimensional echocardiography. A characteristic pattern of anterior leaflet motion was found in patients with moderately severe and severe aortic regurgitation. This pattern, termed "reverse doming," was seen in the apical and long-axis views in 19 of 22 such patients. The previously described "diastolic indentation" in the short-axis view was found in 16 of these 22 patients. Only 2 of 16 patients with lesser degrees of insufficiency had reverse doming. The sign was not seen in normal subjects nor in 16 patients with cardiomyopathy. For each of the few false positive and false negative findings, there is a seemingly logical hemodynamic explanation. It is concluded that reverse doming of the anterior mitral leaflet appears to be a sensitive and specific sign for moderately severe and severe aortic regurgitation.
二尖瓣前叶与左心室流出道的正常解剖关系表明，显著的主动脉瓣反流应对瓣叶的运动和形态产生可预测的血流动力学影响，这种影响应能通过二维超声心动图观察到。先前的报告已确定在短轴视图中二尖瓣开放存在一种异常，该异常相当特异但不敏感。本研究旨在使用二维超声心动图评估主动脉瓣关闭不全时二尖瓣的运动和形态。在中重度和重度主动脉瓣反流患者中发现了前叶运动的一种特征性模式。这种模式被称为“反向圆顶征”，在22例此类患者中的19例的心尖和长轴视图中可见。在这22例患者中的16例发现了先前描述的短轴视图中的“舒张期切迹”。在16例轻度反流患者中只有2例有反向圆顶征。该征象在正常受试者和16例心肌病患者中均未见到。对于少数假阳性和假阴性结果中的每一个，都有一个看似合理的血流动力学解释。得出的结论是，二尖瓣前叶的反向圆顶征似乎是中重度和重度主动脉瓣反流的一个敏感且特异的征象。
