Makihata S, Tanimoto M, Yamamoto T, Komasa N, Yasutomi N, Ohgami T, Ando H, Kawai Y, Iwasaki T
J Cardiogr. 1982 Mar;12(1):33-44.
Clinical survey was made on the porcine xenograft valve replacements in 76 patients who underwent the replacement for the past five years at Hyogo College of Medicine Hospital. The follow-up period was from 3 to 84 months after implantation. Seventy-one patients had mitral valve replacements, 1 aortic, 2 mitral and tricuspid and 2 tricuspid. Seven patients were diagnosed as porcine valve dysfunction echocardiographically, and in four of these the dysfunction (two with bacterial endocarditis, one with perivalvular leak and one with ruptured porcine aortic valve) was confirmed at operation, and the echocardiographic features were correlated with surgical findings. M-mode and two-dimensional echocardiograms of one patient with fungal endocarditis demonstrated vegetations on the mitral and tricuspid valves. In another patient with endocarditis, the echocardiographic finding of valve thickening associated with the flail and torn cusp was observed. The two-dimensional echocardiographic study was particularly useful in detecting the dislocation of the stent echo in one patient with paravalvular regurgitation. In one patient with the ruptured and flail porcine aortic valve, the two-dimensional echocardiogram was characterized by rapid diastolic motion of the involved leaflet into the left ventricular outflow tract beyond the line of valve closure. Three patients were not confirmed at operation. In one patient, the two-dimensional echocardiogram demonstrated a systolic prolapse of the porcine mitral valve. In another two patients the M-mode echocardiographic finding included a coarse fluttering of the porcine mitral cusp in diastole. The major M-mode features of prosthetic regurgitation were fuzzy echoes with fluttering of the cusp in systole or diastole or both. In one patient with fluttering, the two-dimensional echocardiogram also demonstrated the thickening of the cusp. But in another patient with fluttering, the two-dimensional echocardiogram revealed no abnormality, and prosthetic regurgitation was not confirmed at cardiac catheterization. It was postulated that this patient had a false positive echocardiogram. Two-dimensional echocardiography complemented the M-mode echocardiographic findings and both techniques were very useful in identifying porcine valve dysfunction. Moreover, we considered that the comparison of the echocardiographic features in the course of individual case was very important in detecting porcine valve dysfunction.
对在兵库医科大学医院过去五年内接受猪异种移植瓣膜置换术的76例患者进行了临床调查。随访期为植入后3至84个月。71例患者进行了二尖瓣置换术，1例进行了主动脉瓣置换术，2例进行了二尖瓣和三尖瓣置换术，2例进行了三尖瓣置换术。7例患者经超声心动图诊断为猪瓣膜功能障碍，其中4例（2例合并细菌性心内膜炎，1例合并瓣周漏，1例猪主动脉瓣破裂）在手术中得到证实，超声心动图特征与手术结果相关。1例真菌性心内膜炎患者的M型和二维超声心动图显示二尖瓣和三尖瓣上有赘生物。在另1例心内膜炎患者中，观察到超声心动图显示瓣膜增厚并伴有连枷样和撕裂的瓣叶。二维超声心动图研究在检测1例瓣周反流患者的支架回声移位方面特别有用。在1例猪主动脉瓣破裂和连枷样病变患者中，二维超声心动图的特征是受累瓣叶在舒张期快速运动进入左心室流出道，超过瓣膜关闭线。3例患者在手术中未得到证实。在1例患者中，二维超声心动图显示猪二尖瓣收缩期脱垂。在另外2例患者中，M型超声心动图表现包括舒张期猪二尖瓣瓣叶的粗糙扑动。人工瓣膜反流的主要M型特征是收缩期或舒张期或两者均有瓣叶扑动的模糊回声。在1例有扑动的患者中，二维超声心动图也显示瓣叶增厚。但在另1例有扑动的患者中，二维超声心动图未显示异常，心脏导管检查未证实人工瓣膜反流。推测该患者超声心动图出现假阳性。二维超声心动图补充了M型超声心动图的发现，两种技术在识别猪瓣膜功能障碍方面都非常有用。此外，我们认为在个体病例过程中比较超声心动图特征对检测猪瓣膜功能障碍非常重要。
