Sutton D C, Kluger R, Ahmed S U, Reimold S C, Mark J B
Department of Anesthesia, Brigham and Women's Hospital, Boston, Mass.
J Thorac Cardiovasc Surg. 1994 Sep;108(3):576-82.
This study assessed the value of biplane transesophageal echocardiographic assessment of diastolic flow reversal in the descending aorta as an alternative to Doppler color flow imaging in determining severity of aortic regurgitation. In 45 patients undergoing cardiac operations, the severity of aortic regurgitation was assessed by semiquantitative grading of the width of the Doppler color flow regurgitant jet relative to the left ventricular outflow tract, and the presence of diastolic flow reversal was assessed with pulsed-wave Doppler measurements at three sites in the descending aorta. In four patients, the diastolic flow reversal method was the only available form of assessment because of inadequate visualization of the left ventricular outflow tract beneath a mitral valve prosthesis. Diastolic flow reversal in the descending aorta was not observed in patients without aortic regurgitation and was always present in patients with severe aortic regurgitation. Aortic valve replacement successfully eliminated descending aortic flow reversal in all 19 patients in whom it was present before valve replacement. Identification of diastolic flow reversal at multiple sites in the descending aorta with biplane transesophageal echocardiography helps to confirm the presence of severe aortic regurgitation and can serve as an alternative method of assessment when visualization of the left ventricular outflow tract is impaired.
本研究评估了双平面经食管超声心动图对降主动脉舒张期血流逆转的评估价值，以此作为多普勒彩色血流成像的替代方法来确定主动脉瓣反流的严重程度。在45例接受心脏手术的患者中，通过对多普勒彩色血流反流束宽度相对于左心室流出道的半定量分级来评估主动脉瓣反流的严重程度，并在降主动脉的三个部位用脉冲波多普勒测量来评估舒张期血流逆转的情况。在4例患者中，由于二尖瓣人工瓣膜下方左心室流出道显示不清，舒张期血流逆转法是唯一可用的评估方式。无主动脉瓣反流的患者未观察到降主动脉舒张期血流逆转，而重度主动脉瓣反流患者总是存在该现象。主动脉瓣置换术成功消除了所有19例术前存在降主动脉血流逆转患者的降主动脉血流逆转。用双平面经食管超声心动图在降主动脉多个部位识别舒张期血流逆转有助于确认重度主动脉瓣反流的存在，并且当左心室流出道显示受损时可作为一种替代评估方法。
