Mele D, Vandervoort P, Palacios I, Rivera J M, Dinsmore R E, Schwammenthal E, Marshall J E, Weyman A E, Levine R A
Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Boston 02114.
Circulation. 1995 Feb 1;91(3):746-54. doi: 10.1161/01.cir.91.3.746.
Recent studies have shown that many instrument and physiological factors limit the ability of color Doppler total jet area within the receiving chamber to predict the severity of valvular regurgitation. In contrast, the proximal or initial dimensions of the jet as it emerges from the orifice have been shown to increase directly with orifice size and to correlate well with the severity of aortic insufficiency. Only limited data, however, are available regarding the value of proximal jet size in mitral regurgitation, and it has not been examined in short-axis or transthoracic views. The purpose of the present study, therefore, was to evaluate the relation between proximal jet size and other measures of the severity of mitral regurgitation.
In 49 patients, the anteroposterior height of the proximal jet as it emerges from the mitral valve was measured in the parasternal long-axis view; proximal jet width and area were measured in the short-axis view at the same level. Results were compared with regurgitant volume and fraction by pulsed Doppler subtraction of aortic and mitral flows in 47 patients without more than trace aortic insufficiency; with angiographic grade determined within 24 hours in 33 catheterized patients; and with angiographic regurgitant fraction in 13 patients who were in normal sinus rhythm and had no significant aortic and tricuspid insufficiency. Proximal jet height, width, and area correlated well with Doppler regurgitant volume and fraction (r = .86 to .95; SEE = 7.7 to 9.0 mL; 5.9% to 7.3%). Proximal jet size could also be used to distinguish angiographic grades of mitral regurgitation with minimal overlap (P < .0001) and correlated well with angiographic regurgitant fraction (r = .85 to .91; SEE = 4.1% to 5.1%).
Proximal jet size correlates well with established measures of the severity of mitral regurgitation. It is conveniently available with transthoracic clinical scanning and should be useful in the routine evaluation of patients with mitral regurgitation.
近期研究表明，许多仪器和生理因素限制了利用接收心腔内彩色多普勒总射流面积来预测瓣膜反流严重程度的能力。相比之下，射流从瓣口射出时的近端或起始尺寸已被证明与瓣口大小直接相关，且与主动脉瓣关闭不全的严重程度密切相关。然而，关于二尖瓣反流中近端射流大小的价值仅有有限的数据，并且尚未在短轴或经胸视图中进行研究。因此，本研究的目的是评估近端射流大小与二尖瓣反流严重程度的其他指标之间的关系。
对49例患者，在胸骨旁长轴视图中测量二尖瓣射出的近端射流的前后径；在同一水平的短轴视图中测量近端射流宽度和面积。将结果与47例主动脉瓣反流不超过微量的患者通过脉冲多普勒减去主动脉和二尖瓣血流得到的反流量和反流分数进行比较；与33例导管检查患者在24小时内确定的血管造影分级进行比较；与13例窦性心律正常且无明显主动脉瓣和三尖瓣反流的患者的血管造影反流分数进行比较。近端射流高度、宽度和面积与多普勒反流量和反流分数密切相关（r = 0.86至0.95；标准误 = 7.7至9.0 mL；5.9%至7.3%）。近端射流大小也可用于区分二尖瓣反流的血管造影分级，重叠最小（P < 0.0001），且与血管造影反流分数密切相关（r = 0.85至0.91；标准误 = 4.1%至5.1%）。
近端射流大小与二尖瓣反流严重程度的既定指标密切相关。经胸临床扫描可方便地获得该指标，应有助于二尖瓣反流患者的常规评估。
