Weyman A E, Feigenbaum H, Hurwitz R A, Girod D A, Dillon J C, Chang S
Am J Med. 1976 Jan;60(1):33-8. doi: 10.1016/0002-9343(76)90530-1.
Cross-sectional echocardiographic studies were performed using a high resolution real time mechanical sector scanner in 70 patients with left ventricular outflow obstruction. Seven separate obstructive patterns were recorded in these patients. An area of aortic narrowing just distal to the aortic valve at the superior border of the left atrium was noted with supravalvular aortic stenosis. With congenital valvular aortic stenosis there was an increase in echo production by the thickened aortic leaflets. During systole these prominent leaflet echoes curved inward toward the center of the aortic root reflecting the systolic doming of the valve. With calcific aortic stenosis, the calcification produced an area of dense linear echoes attached in varying degrees to either the anterior or posterior border of the aortic root. At the subvalvular level three obstructive patterns were recorded; with a discrete subvalvular obstructive membrane two linear echoes apparently produced by the inner margins of the obstructing membrane were recorded in the outflow tract. With more extensive fibromuscular narrowing of the subvalvular area, there was inward bowing of the echoes from both the anterior and posterior walls of the outflow tract. In one case this was a dense shelf-like mass of echoes extending downward from the basal portion of the interventricular septum toward the mid-portion of the anterior mitral leaflet with corresponding systolic anterior motion of the mitral leaflet. In patients with idiopathic hypertrophic subaortic stenosis there was systolic anterior motion of the anterior mitral leaflet beginning just distal to the point of coaptation of the mitral leaflets and extending distally toward the papillary muscles. This report suggests that the enlarged field of vision and spatial orientation provided by the cross-sectional echocardiographic technic should improve our ability to record and characterize areas of obstruction to left ventricular outflow.
采用高分辨率实时机械扇形扫描仪对70例左心室流出道梗阻患者进行了横断面超声心动图研究。在这些患者中记录到7种不同的梗阻模式。在左心房上缘的主动脉瓣远端可见主动脉缩窄区域，提示为瓣上主动脉狭窄。先天性瓣膜性主动脉狭窄时，增厚的主动脉瓣叶回声增强。收缩期，这些突出的瓣叶回声向主动脉根部中心向内弯曲，反映瓣膜的收缩期圆顶状改变。钙化性主动脉狭窄时，钙化产生一个致密的线性回声区域，不同程度地附着于主动脉根部的前缘或后缘。在瓣下水平记录到3种梗阻模式；对于离散的瓣下梗阻膜，在流出道记录到两条明显由梗阻膜内缘产生的线性回声。当瓣下区域出现更广泛的纤维肌性狭窄时，流出道前壁和后壁的回声向内弯曲。在1例患者中，这是一个致密的架状回声团，从室间隔基部向下延伸至二尖瓣前叶中部，二尖瓣叶相应地出现收缩期前向运动。在特发性肥厚性主动脉瓣下狭窄患者中，二尖瓣前叶的收缩期前向运动始于二尖瓣叶合拢点的远端，并向乳头肌远端延伸。本报告提示，横断面超声心动图技术提供的扩大视野和空间定位应能提高我们记录和描述左心室流出道梗阻区域的能力。
