García-Fernández M A, Torrecilla E, San Román D, Hernández J M, Esturau R, Moreno M, Jiménez J, Bueno H, Echevarría T, Acevedo J
Servicio de Cardiología no Invasiva, Hospital General Gregorio Marañón, Madrid.
Rev Esp Cardiol. 1993 May;46(5):267-74.
This study was performed to test the usefulness of transesophageal echocardiography in the diagnosis and assessment of pathological mitral regurgitation in patients with mitral valve prostheses. Doppler color flow imaging by transesophageal echocardiography was compared to the transthoracic echocardiography and angiographic and surgical assessment. We analyzed the influence of the spatial configuration of the jet on the semiquantitative assessment of mitral regurgitation. We studied 71 patients with prostheses in mitral position which were submitted for transesophageal echocardiography examination. 51 of these patients were found to have a pathological prosthetic regurgitation that was confirmed in 21 cases by left ventriculography and in 4 during cardiac surgery. Transesophageal echocardiography Doppler color flow imaging identified a regurgitant jet in 31 patients (60.7%). There was complete agreement with the quantitative assessment of regurgitation by angiography or surgery in 36% of the cases. All patients with prosthetic insufficiency observed by angiography or during cardiac surgery were confirmed by transesophageal echocardiography. Complete agreement in grade of severity by transthoracic echocardiography was found in 84% of cases. There was a difference in grade of severity of mitral regurgitation in only 4 patients. Regurgitant jets were classified by transesophageal echocardiography color Doppler in two groups: free jets and impinging wall jets. 21 cases presented a free jet and 31 excentrically directed impinging wall jet of mitral regurgitation. There was complete agreement with hemodynamic assessment of severity in all patients with regurgitant free jets (11/11). In presence of jet wall there was understimation of mitral regurgitation in 28.5% (4/13).(ABSTRACT TRUNCATED AT 250 WORDS)
本研究旨在测试经食管超声心动图在人工二尖瓣患者病理性二尖瓣反流的诊断和评估中的实用性。将经食管超声心动图的多普勒彩色血流成像与经胸超声心动图、血管造影和手术评估进行比较。我们分析了反流束空间形态对二尖瓣反流半定量评估的影响。我们研究了71例二尖瓣位有人工瓣膜的患者，这些患者接受了经食管超声心动图检查。其中51例患者被发现存在病理性人工瓣膜反流，21例经左心室造影证实，4例在心脏手术中证实。经食管超声心动图多普勒彩色血流成像在31例患者（60.7%）中发现了反流束。36%的病例与血管造影或手术对反流的定量评估完全一致。血管造影或心脏手术中观察到的所有人工瓣膜功能不全患者均经食管超声心动图证实。经胸超声心动图在84%的病例中发现严重程度分级完全一致。仅4例患者二尖瓣反流严重程度分级存在差异。经食管超声心动图彩色多普勒将反流束分为两组：自由反流束和撞击壁反流束。21例出现自由反流束，31例出现二尖瓣反流的偏心撞击壁反流束。所有自由反流束患者（11/11）的严重程度血流动力学评估完全一致。存在反流束撞击壁时，二尖瓣反流被低估的比例为28.5%（4/13）。（摘要截短于250字）
