Shah P M, Taylor R D, Wong M
Am J Cardiol. 1981 Aug;48(2):258-62. doi: 10.1016/0002-9149(81)90605-6.
Two dimensional echocardiographic evaluation utilizing the apical four chamber and apical long axis views was made in 10 normal subjects and 35 patients with hypertrophic cardiomyopathy, including 16 without and 19 with systolic anterior motion of the mitral valve. Mitral valve leaflets were imaged throughout the cardiac cycle. The normal subjects and the patients with hypertrophic cardiomyopathy without systolic anterior motion demonstrated mitral valve coaptation that seemed to involve the distal tip of the anterior leaflet. In contrast, patients with hypertrophic cardiomyopathy with systolic anterior motion demonstrated abnormal coaptation, so that the posterior leaflet coapted with a mid portion of the anterior leaflet, leaving a distal "residual" anterior leaflet in the left ventricle during systole. A sharp angulation of this distal leaflet in mid systole toward the interventricular septum is thought to represent systolic anterior motion. It is speculated that abnormal mitral leaflet coaptation in necessary for development of leaflet systolic anterior motion, which is correlated with dynamic left ventricular outflow gradients in hypertrophic obstructive cardiomyopathy.
利用心尖四腔心和心尖长轴切面进行二维超声心动图评估，对10名正常受试者和35例肥厚型心肌病患者进行了检查，其中16例无二尖瓣收缩期前向运动，19例有二尖瓣收缩期前向运动。在整个心动周期中对二尖瓣叶进行成像。正常受试者和无二尖瓣收缩期前向运动的肥厚型心肌病患者显示二尖瓣瓣叶对合似乎涉及前叶的远端。相比之下，有二尖瓣收缩期前向运动的肥厚型心肌病患者表现出异常瓣叶对合，使得后叶与前叶的中部对合，在收缩期左心室内留下远端“残余”前叶。认为该远端瓣叶在收缩中期向室间隔的急剧成角代表收缩期前向运动。据推测，二尖瓣叶异常对合是瓣叶收缩期前向运动发生所必需的，而瓣叶收缩期前向运动与肥厚型梗阻性心肌病的动态左心室流出道梯度相关。
