Vilacosta I, San Román J A, Castillo J A, Arganda L, Rollán M J, Peral V, Sánchez-Harguindey L, Zarco P
Hospital Universitario de San Carlos, Madrid, Spain.
Clin Cardiol. 1997 Jan;20(1):35-40. doi: 10.1002/clc.4960200109.
The purpose of this study was the comprehensive evaluation of the changes in pulmonary venous and mitral flow velocities of patients with acute and chronic severe aortic regurgitation. Transmitral flow velocities obtained with pulsed-wave Doppler echocardiography have been used to provide information on left ventricular (LV) filling and diastolic function. Pulmonary venous flow tracings are an important adjunct to LV inflow pattern in assessing LV diastolic function.
Fourteen patients with severe aortic regurgitation (8 chronic and 6 acute) and in sinus rhythm were examined by transthoracic and transesophageal pulsed Doppler echocardiography. Mitral and pulmonary flow velocities were recorded and compared. All patients had ejection fractions > 40%.
Early mitral flow peak velocity was higher in patients with acute regurgitation (p < 0.001). The mitral A wave was absent in five patients with acute regurgitation. In contrast, a prominent reverse atrial pulmonary systolic wave AR was demonstrated in these patients. Peak diastolic velocity of the pulmonary venous flow was greater in patients with acute aortic regurgitation (0.76 +/- 0.13) than in patients with chronic aortic regurgitation (0.40 +/- 0.09) (p < 0.001). Peak systolic velocity did not differ significantly between the two groups. The systolic fraction of pulmonary venous flow in patients with acute aortic regurgitation was lower (0.43 +/- 0.05) than that of patients with chronic regurgitation (0.63 +/- 0.1) (p < 0.01). All patients with acute aortic regurgitation had an S/D ratio < 1, while those with chronic regurgitation had an S/D > 1 (p < 0.001) and an E/A < 1.
Patients with severe acute aortic regurgitation showed a retrograde atrial kick (absence of transmitral A wave with prominent pulmonary AR wave). These patients had an S/D ratio < 1 (restrictive Doppler pattern). Patients with chronic aortic regurgitation exhibited a Doppler pattern of abnormal LV relaxation (E/A < 1, S/D > 1).
本研究的目的是全面评估急慢性重度主动脉瓣关闭不全患者肺静脉和二尖瓣血流速度的变化。经脉冲波多普勒超声心动图获得的二尖瓣血流速度已用于提供有关左心室（LV）充盈和舒张功能的信息。肺静脉血流描记图是评估左心室舒张功能时左心室流入模式的重要辅助手段。
对14例重度主动脉瓣关闭不全（8例慢性和6例急性）且为窦性心律的患者进行经胸和经食管脉冲多普勒超声心动图检查。记录并比较二尖瓣和肺静脉血流速度。所有患者的射血分数均>40%。
急性反流患者的二尖瓣早期血流峰值速度较高（p<0.001）。5例急性反流患者二尖瓣A波消失。相比之下，这些患者出现了明显的逆向心房肺收缩波AR。急性主动脉瓣关闭不全患者的肺静脉血流舒张期峰值速度（0.76±0.13）高于慢性主动脉瓣关闭不全患者（0.40±0.09）（p<0.001）。两组间收缩期峰值速度无显著差异。急性主动脉瓣关闭不全患者的肺静脉血流收缩期分数（0.43±0.05）低于慢性反流患者（0.63±0.1）（p<0.01）。所有急性主动脉瓣关闭不全患者的S/D比值<1，而慢性反流患者的S/D>1（p<0.001）且E/A<1。
重度急性主动脉瓣关闭不全患者表现出逆向心房搏动（二尖瓣A波消失伴明显的肺静脉AR波）。这些患者的S/D比值<1（限制性多普勒模式）。慢性主动脉瓣关闭不全患者表现出左心室舒张异常的多普勒模式（E/A<1，S/D>1）。
