Dodić S, Stojsić D, Stajnic M, Dodić B, Srdić S, Gnip S
Institut za kardiovaskularne bolesti, Klinika za kardiologiju, Sremska Kamenica.
Med Pregl. 1998 Sep-Oct;51(9-10):427-30.
Mitral annulus and valves form the mitral orifice area with the size between 4.0-6.0 cm2. Every area which is smaller than this, represents mitral stenosis. As a consequence of mitral stenosis hemodynamic gradients occur over the mitral orifice with circulation disturbances below and above the stenotic mitral valve. The size of transmitral gradient is important in the evaluation of functional or/and structural changes in the blood vessels of pulmonary circulation. This investigation included 40 patients with mitral stenosis (or accompanying minimal mitral regurgitation). All patients underwent echocardiographic examination: area of the mitral orifice was determined and hemodynamic procedure with the left and right heart catheterization was performed. The following hemodynamic parameters were measured: mean capillary wedge pressure, left ventricular filling pressure, left ventricular mean diastolic pressure, mean pulmonary artery pressure. According to these parameters resistance in the pulmonary circulation was measured. The size of the mitral orifice was determined according to oximetry blood analyses and hemodynamic parameters. All patients were divided into 4 groups: minimal (2.5-4.0 cm2), mild (1.5-2.5 cm2), moderate (1.0-1.5 cm2) and severe mitral stenosis (1.0 cm2). The comparison of echocardiographic and hemodynamic parameters revealed a high and positive correlation between the area of mitral orifice. There was also a negative and moderate correlation between the values of stenotic mitral orifice area and total pulmonary resistance, i.e. in all patients with severe mitral stenosis there was an increased pulmonary arteriolar resistance.
Noninvasive echocardiographic method is valid in the evaluation of stenotic mitral valve area. In the evaluation of hemodynamic parameters in the pulmonary circulation the index of arteriolar pulmonary systemic vascular resistance is very important. In all patients with the area of stenotic mitral orifice 1.0 cm2, there are functional or pathomorphologic changes in the pulmonary circulation of the blood vessel wall.
二尖瓣环和瓣膜形成二尖瓣口面积，大小在4.0 - 6.0平方厘米之间。任何小于此面积的区域均表示二尖瓣狭窄。二尖瓣狭窄会导致二尖瓣口出现血流动力学梯度，狭窄二尖瓣瓣膜下方和上方出现循环紊乱。跨二尖瓣梯度的大小在评估肺循环血管的功能或/和结构变化中很重要。本研究纳入了40例二尖瓣狭窄（或伴有轻度二尖瓣反流）患者。所有患者均接受了超声心动图检查：测定二尖瓣口面积，并进行了左右心导管检查的血流动力学检查。测量了以下血流动力学参数：平均毛细血管楔压、左心室充盈压、左心室平均舒张压、平均肺动脉压。根据这些参数测量肺循环阻力。根据血氧分析和血流动力学参数确定二尖瓣口大小。所有患者分为4组：轻度（2.5 - 4.0平方厘米）、中度（1.5 - 2.5平方厘米）、重度（1.0 - 1.5平方厘米）和极重度二尖瓣狭窄（<1.0平方厘米）。超声心动图和血流动力学参数的比较显示二尖瓣口面积之间存在高度正相关。狭窄二尖瓣口面积值与总肺阻力之间也存在中度负相关，即所有极重度二尖瓣狭窄患者的肺小动脉阻力均增加。
无创超声心动图方法在评估狭窄二尖瓣瓣膜面积方面是有效的。在评估肺循环血流动力学参数时，肺小动脉系统血管阻力指数非常重要。在所有二尖瓣狭窄口面积<1.0平方厘米的患者中，肺循环血管壁存在功能或病理形态学改变。
