Romero Cárdenas A, Valdez Tiburcio O, Gutiérrez Fajardo P, Lamarche Mondragón S, Espinola Zavaleta N, Rijlaarsdam M, Vargas Barrón J
Departamento de Ecocardiografía, Instituto Nacional de Cardiología Ignacio Chávez, México, DF.
Arch Inst Cardiol Mex. 1996 Mar-Apr;66(2):116-21.
Severe mitral regurgitation is accompanied by increment of left atrial pressure. The objective of this work was to compare Doppler parameters related to transvalvular peak-pressure gradient in patients with normally functioning and patients with malfunctioning mitral prosthetic valve, secondary to insufficiency, in order to analyze if the presence of high protodiastolic pressure gradient and normal prosthetic valve area could correlate with severe mitral regurgitation (MR). Fourty-two patients were studied. Group I: twenty-two normally functioning prosthesis (15 mechanical, 7 biological). Group II: twenty malfunctioning mitral prosthetic valves secondary to severe insufficiency (11 mechanical and 9 biological), 12 patients with acute MR and 8 with chronic MR. All of the patients were evaluated though transthoracic (TTE) and transesophageal (TEE) Doppler-echocardiography. Diastolic peak velocity prosthetic flow (DVP), protodiastolic gradient (PDG), mean gradient (MG) and prosthetic area (PA) by pressure halftime (PHT) were measured. DVP in Group I was 1.56 +/- 0.29 m/s and 2.49 +/- 0.30 m/s in Group II (p = 0.001). PGD measured 10.36 +/- 3.79 mmHg in Group I and 15.95 +/- 7.48 mmHg in Group II (p = 0.001). MG 4.86 +/- 1.90 mmHg in Group I and 10.38 +/- 4.8 mmHg in Group II (p = 0.001). PA was 2.01 +/- 0.54 cm2 in Group I and 2.10 +/- 0.43 cm2 in Group II (NS). PHT was 115.59 +/- 31.99 mseg in Group I and 108.3 +/- 19.1 mseg in Group II (NS).
In patients with high PDG (greater than 20 mmHg) and normal prosthetic mitral area assessed by TTE could be suspicious of malfunctioning prosthesis secondary to severe insufficiency. Due to the higher sensitivity and specificity in the diagnosis of malfunctioning mitral prosthesis and the ability to determine the magnitude and severity of prosthetic regurgitation assessment should be completed with TTE.
严重二尖瓣反流伴有左心房压力升高。本研究的目的是比较二尖瓣人工瓣膜功能正常和功能异常（继发于瓣膜关闭不全）患者中与跨瓣峰值压力梯度相关的多普勒参数，以分析舒张早期高压梯度和正常人工瓣膜面积的存在是否与严重二尖瓣反流（MR）相关。研究了42例患者。第一组：22例人工瓣膜功能正常（15例机械瓣，7例生物瓣）。第二组：20例因严重关闭不全导致人工二尖瓣功能异常（11例机械瓣和9例生物瓣），12例急性MR患者和8例慢性MR患者。所有患者均通过经胸（TTE）和经食管（TEE）多普勒超声心动图进行评估。测量人工瓣血流舒张期峰值速度（DVP）、舒张早期梯度（PDG）、平均梯度（MG）以及通过压力减半时间（PHT）计算的人工瓣膜面积（PA）。第一组的DVP为1.56±0.29m/s，第二组为2.49±0.30m/s（p = 0.001）。第一组的PGD为10.36±3.79mmHg，第二组为15.95±7.48mmHg（p = 0.001）。第一组的MG为4.86±1.90mmHg，第二组为|0.38±4.8mmHg（p = 0.001）。第一组的PA为2.01±0.54cm²，第二组为2.10±0.43cm²（无统计学差异）。第一组的PHT为115.59±31.99msec，第二组为108.3±19.1msec（无统计学差异）。
对于TTE评估显示PDG高（大于20mmHg）且人工二尖瓣面积正常的患者，可能提示继发于严重关闭不全的人工瓣膜功能异常。由于TTE在诊断人工二尖瓣功能异常方面具有更高的敏感性和特异性以及确定人工瓣膜反流的程度和严重性的能力，评估应通过TTE完成。
