Ramirez J, Flowers N C
Clin Cardiol. 1980 Aug;3(4):284-7. doi: 10.1002/clc.4960030212.
In mitral annular calcifications, hemodynamic documentation of a significant diastolic gradient across the mitral valve has been rarely demonstrated, and then only with the associated finding of a small left ventricular cavity with hypertrophic left ventricular wall. We present a patient with severe mitral annular calcification, with a significant diastolic gradient and unusual echocardiographic manifestations which include a densely calcified mitral valve annulus with anterior mitral valve leaflets consistent with what is seen in patients with mitral stenosis. When recordings were made immediately below the mitral valve annulus at the free edge of the mitral valve, its leaflets were seen departing in opposite directions, certainly not suggestive of outflow obstruction of the left atrium. Although in previous studies it has been suggested that mitral stenosis does not exist in the presence of mitral annulus calcification, our present report indicates that significant diastolic gradients can be found in patients with mitral annular calcifications. Because of the predominance of this condition in the elderly population, it is suggested that a more aggressive approach be taken in those patients in whom it is warranted by clinical circumstance.
在二尖瓣环钙化中，很少有文献记载二尖瓣存在显著的舒张期压力阶差，且仅在伴有左心室腔小和左心室壁肥厚的相关发现时才有记载。我们报告一例严重二尖瓣环钙化患者，存在显著的舒张期压力阶差及不寻常的超声心动图表现，包括二尖瓣环致密钙化，二尖瓣前叶表现与二尖瓣狭窄患者所见一致。当在二尖瓣游离缘紧邻二尖瓣环下方进行记录时，可见其瓣叶向相反方向分开，这肯定不提示左心房流出道梗阻。尽管既往研究提示二尖瓣环钙化时不存在二尖瓣狭窄，但我们目前的报告表明，二尖瓣环钙化患者可出现显著的舒张期压力阶差。鉴于这种情况在老年人群中较为常见，建议对那些临床情况表明有必要的患者采取更积极的治疗方法。
