Afridi I, Apostolidou M A, Saad R M, Zoghbi W A
Department of Medicine, Baylor College of Medicine, Methodist Hospital, Houston, Texas 77030.
J Am Coll Cardiol. 1995 Jan;25(1):137-45. doi: 10.1016/0735-1097(94)00326-l.
The aim of this study was to provide a detailed description of echocardiographic and Doppler features of pseudoaneurysms involving the mitral-aortic intervalvular fibrosa and to compare echocardiographic and aortographic findings.
Infection of the aortic valve may spread to the aortic annulus, resulting in ring abscesses or pseudoaneurysms, or both, of the intervalvular fibrosa, which can alter patient management and prognosis.
The echocardiographic and Doppler findings of 20 patients with pseudoaneurysms or ring abscesses, or both, were reviewed and compared with surgical and aortographic results.
A total of 23 lesions were identified, of which 16 were intervalvular pseudoaneurysms, and 7 were ring abscesses. Transthoracic echocardiography detected 43% of the lesions, whereas transesophageal echocardiography identified 90% (p < 0.01). The most distinct feature of the pseudoaneurysms was marked pulsatility, with systolic expansion and diastolic collapse (mean systolic area [+/- SD] 4.1 +/- 3.4 cm2 vs. diastolic mean area 1.8 +/- 2.2 cm2, p < 0.05). Using color Doppler, two types were identified: unruptured pseudoaneurysms (n = 9), which communicated only with the left ventricular outflow tract and had a distinct flow pattern, and ruptured pseudoaneurysms (n = 7), which, in addition, communicated with the left atrium or aorta. Compared with pseudoaneurysms, ring abscesses were smaller and nonpulsatile and showed either no flow or continuous systolic and diastolic flow, the site of paravalvular aortic insufficiency. In 10 patients who underwent aortography, three lesions were identified, and findings were concordant with echocardiography. However, in seven patients aortographic findings were normal, whereas echocardiography identified intervalvular pseudoaneurysms, all of which were documented at operation.
Intervalvular pseudoaneurysms are more frequently detected by transesophageal echocardiography than by aortography or transthoracic examination and exhibit distinct dynamic features and Doppler patterns that can further help characterize cavitary lesions in the aortic root and guide appropriate surgical intervention.
本研究旨在详细描述累及二尖瓣 - 主动脉瓣间纤维的假性动脉瘤的超声心动图和多普勒特征，并比较超声心动图和主动脉造影的结果。
主动脉瓣感染可能蔓延至主动脉瓣环，导致瓣间纤维出现环形脓肿或假性动脉瘤，或两者皆有，这会改变患者的治疗和预后。
回顾了20例患有假性动脉瘤或环形脓肿，或两者皆有的患者的超声心动图和多普勒检查结果，并与手术及主动脉造影结果进行比较。
共识别出23个病变，其中16个为瓣间假性动脉瘤，7个为环形脓肿。经胸超声心动图检测出43%的病变，而经食管超声心动图识别出90%（p < 0.01）。假性动脉瘤最显著的特征是明显的搏动性，收缩期扩张，舒张期塌陷（平均收缩期面积[±标准差]4.1±3.4 cm² vs. 舒张期平均面积1.8±2.2 cm²，p < 0.05）。使用彩色多普勒，识别出两种类型：未破裂的假性动脉瘤（n = 9），仅与左心室流出道相通，具有独特的血流模式；破裂的假性动脉瘤（n = 7），此外还与左心房或主动脉相通。与假性动脉瘤相比，环形脓肿较小且无搏动性，显示无血流或连续性收缩期和舒张期血流，即瓣周主动脉瓣关闭不全的部位。在接受主动脉造影的10例患者中，识别出3个病变，结果与超声心动图一致。然而，在7例患者中，主动脉造影结果正常，而超声心动图识别出瓣间假性动脉瘤，所有这些均在手术中得到证实。
与主动脉造影或经胸检查相比，经食管超声心动图更常检测到瓣间假性动脉瘤，其具有独特的动态特征和多普勒模式，可进一步帮助明确主动脉根部的空洞性病变特征，并指导适当的手术干预。
