Leech G, Mills P, Leatham A
Br Heart J. 1978 Sep;40(9):941-50. doi: 10.1136/hrt.40.9.941.
Follow-up of a group of subjects in whom an aortic ejection sound was the only abnormal finding revealed a bicuspid aortic valve at necropsy or operation in 6 cases. High speed echophonocardiographic studies in 15 subjects with aortic stenosis and known to have bicuspid valves, showed the ejection sound to be exactly synchronous with final halting of the opening aortic valve cusps. Echocardiographic visualisation of the aortic valve from the apex, looking up the left ventricular outflow tract, showed valve echoes during systole indicating abnormal cusp configuration. This proved a more sensitive indicator of a bicuspid aortic valve than the finding of an eccentric aortic valve closure line. These findings were used to evaluate 37 subjects with the auscultatory finding of an isolated aortic ejection sound and the diagnosis of a non-stenotic bicuspid aortic valve was confirmed in 30. The usual cause of misdiagnosis was a sound associated with late tricuspid valve closure. The auscultatory finding of an aortic ejection sound, in the absence of other signs of aortic stenosis, indicates a non-stenotic, bicuspid aortic valve. Confirmation of aortic valvar origin of the sound can be provided by a simultaneous echophonocardiogram.
对一组仅以主动脉喷射音为唯一异常发现的受试者进行随访，结果显示6例在尸检或手术时发现二叶式主动脉瓣。对15例已知患有二叶式瓣膜的主动脉瓣狭窄受试者进行的高速超声心动图研究表明，喷射音与开放的主动脉瓣叶最终停止运动完全同步。从心尖向上观察左心室流出道对主动脉瓣进行超声心动图显像，显示收缩期瓣膜回声，提示瓣叶形态异常。这被证明是比发现偏心的主动脉瓣关闭线更敏感的二叶式主动脉瓣指标。这些发现被用于评估37例听诊发现孤立性主动脉喷射音的受试者，其中30例确诊为非狭窄性二叶式主动脉瓣。误诊的常见原因是与三尖瓣关闭延迟相关的声音。在没有其他主动脉瓣狭窄体征的情况下，听诊发现主动脉喷射音提示非狭窄性二叶式主动脉瓣。同时进行的超声心动图检查可证实该声音起源于主动脉瓣。
