Madu E C, D'Cruz I A
Echocardiography Laboratory, University of Tennessee, Memphis 38163, USA.
Clin Cardiol. 1997 Feb;20(2):93-8. doi: 10.1002/clc.4960200203.
The two left ventricular (LV) papillary muscles are small structures but are vital to mitral valve competence. Partial or complete rupture, complicating acute myocardial infarction, causes severe or even catastrophic mitral regurgitation, potentially correctable by surgery. Papillary muscle dysfunction is a controversial topic in that the role of the papillary muscle itself, in causing mitral regurgitation post infarction, has been seriously questioned; it is less confusing if this syndrome is attributed not only to papillary muscle but also to adjacent LV wall ischemia or infarction. Papillary muscle calcification is easily and frequently detected on echocardiography, but its clinical significance remains uncertain. Papillary muscle hypertrophy accompanies LV hypertrophy of varied etiology and may have a significant role in producing dynamic late-systolic intra-LV obstruction in hypertrophic cardiomyopathy and other hyperdynamic hypertrophied LV chambers. All the above abnormalities can be adequately assessed by 2-D echocardiography and the Doppler modalities. In selected cases, transesophageal echocardiography can provide additional valuable data by improving visualization of papillary muscles and mitral apparatus.
左心室（LV）的两块乳头肌虽结构较小，但对二尖瓣功能正常至关重要。急性心肌梗死并发的部分或完全断裂，会导致严重甚至灾难性的二尖瓣反流，手术有可能矫正。乳头肌功能障碍是一个有争议的话题，因为乳头肌本身在心肌梗死后引起二尖瓣反流中的作用受到了严重质疑；如果将此综合征不仅归因于乳头肌，还归因于相邻左心室壁缺血或梗死，就不那么令人困惑了。乳头肌钙化在超声心动图上很容易且经常被检测到，但其临床意义仍不确定。乳头肌肥大伴随各种病因引起的左心室肥大，在肥厚型心肌病和其他高动力性肥厚左心室腔中，可能在产生动态晚期收缩期左心室内梗阻方面起重要作用。上述所有异常情况均可通过二维超声心动图和多普勒检查方法进行充分评估。在某些病例中，经食管超声心动图可通过改善乳头肌和二尖瓣装置的可视化提供额外有价值的数据。
