Porte J M, Cormier B, Iung B, Dadez E, Starkman C, Nallet O, Michel P L, Acar J, Vahanian A
Cardiac Unit, Tenon Hospital, Paris, France.
Am J Cardiol. 1996 Jan 1;77(1):72-6. doi: 10.1016/s0002-9149(97)89137-0.
Thirty-seven consecutively admitted patients with severe mitral stenosis underwent percutaneous mitral commissurotomy with a transthoracic and biplane or multiplane transesophageal echocardiographic examination before and between 24 and 48 hours after percutaneous mitral commissurotomy. Thirty patients (81%) were in sinus rhythm and 7 were in atrial fibrillation. Left atrial appendage (LAA) function was evaluated in both the transverse and the longitudinal planes by planimetry and pulsed Doppler echocardiographic interrogation at the LAA outlet. Percutaneous mitral commissurotomy resulted in a twofold increase in mitral valve area, and no severe mitral regurgitation occurred. With use of the planimetry method, there was no significant improvement in LAA ejection fraction, except in the transverse plane for patients in sinus rhythm (p = 0.03). With use of Doppler method, 3 distinct flow patterns were observed before the procedure: a "sinus pattern" in patients in sinus rhythm, and a "fibrillatory pattern" (n = 3) or a "no-flow pattern" (n = 4) in patients in atrial fibrillation. After commissurotomy, there was a marked increase in LAA peak Doppler velocity (+62%) and in LAA velocity time integral (+31%). Of the 4 patients in atrial fibrillation with a no-flow pattern, 2 had recovery of a typical effective fibrillatory flow pattern after the procedure. The increase in peak Doppler velocity after commissurotomy was related to the decrease or regression in left atrial spontaneous echo contrast, and correlated with the increase in mitral valve area, the decrease in tranmitral pressure gradient, and the increase in cardiac index; improvement in valve function after successful percutaneous mitral commissurotomy is associated with early improvement in LAA function.
37例连续收治的重度二尖瓣狭窄患者在经皮二尖瓣交界切开术前以及术后24至48小时之间接受了经胸及双平面或多平面经食管超声心动图检查。30例患者（81%）为窦性心律，7例为心房颤动。通过在左心耳（LAA）出口处进行平面测量和脉冲多普勒超声心动图检查，在横向和纵向平面评估LAA功能。经皮二尖瓣交界切开术使二尖瓣瓣口面积增加了两倍，且未发生严重二尖瓣反流。使用平面测量法时，除窦性心律患者的横向平面外，LAA射血分数无显著改善（p = 0.03）。使用多普勒法时，术前观察到3种不同的血流模式：窦性心律患者为“窦性模式”，心房颤动患者为“颤动模式”（n = 3）或“无血流模式”（n = 4）。交界切开术后，LAA多普勒峰值速度显著增加（+62%），LAA速度时间积分增加（+31%）。4例心房颤动且为无血流模式的患者中，2例术后恢复了典型的有效颤动血流模式。交界切开术后多普勒峰值速度的增加与左心房自发回声增强的减少或消退有关，并与二尖瓣瓣口面积的增加、跨二尖瓣压力梯度的降低以及心指数的增加相关；成功的经皮二尖瓣交界切开术后瓣膜功能的改善与LAA功能的早期改善相关。
