Kotler M N, Mintz G S, Panidis I, Morganroth J, Segal B L, Ross J
J Am Coll Cardiol. 1983 Jul;2(1):151-73. doi: 10.1016/s0735-1097(83)80388-x.
Noninvasive techniques are helpful in evaluating the function of mechanical prostheses and tissue valves. Combined phonocardiography and M-mode echocardiography together with cinefluoroscopy are the most useful noninvasive techniques in differentiating normal from abnormal metallic prosthetic valve function. The intensity of the opening and closing clicks and associated murmurs will depend on the type of prosthetic valve, the heart rate and rhythm and the underlying hemodynamic status. Arrhythmias or conduction disturbances, or both, may produce motion patterns that mimic some of the echocardiographic signs of malfunctioning prosthetic valves. Differentiation of thrombus formation or tissue ingrowth from paravalvular regurgitation or dehiscence is possible by noninvasive techniques. Disc variance, a potentially serious and lethal problem with the older Beall valves, can be readily detected by cinefluoroscopy and echophonocardiography. With regard to bioprosthetic valves, two-dimensional echocardiography is superior to M-mode echocardiography in detecting primary valve failure. In addition, detection of vegetations, valve alignment and ring and individual leaflet motion can be best accomplished by two-dimensional echocardiography. Of greater importance is the patient serving as his or her own control in the follow-up assessment of prosthetic valve function by noninvasive techniques.
非侵入性技术有助于评估机械瓣膜和组织瓣膜的功能。联合心音图、M型超声心动图以及荧光电影摄影术是鉴别正常与异常金属人工瓣膜功能最有用的非侵入性技术。开闭喀喇音及相关杂音的强度取决于人工瓣膜的类型、心率和心律以及潜在的血流动力学状态。心律失常或传导障碍，或两者兼有，可能产生类似于人工瓣膜功能异常的一些超声心动图表现的运动模式。通过非侵入性技术可以区分血栓形成或组织长入与瓣周反流或瓣膜裂开。碟片差异是较老式的比尔瓣膜存在的一个潜在严重且致命的问题，通过荧光电影摄影术和超声心动图可以很容易检测到。对于生物瓣膜，二维超声心动图在检测原发性瓣膜功能障碍方面优于M型超声心动图。此外，通过二维超声心动图可以最好地检测赘生物、瓣膜对合情况以及瓣环和单个瓣叶的运动。在通过非侵入性技术对人工瓣膜功能进行随访评估时，患者自身作为对照更为重要。
