彩色多普勒超声对心前区来源不明无害杂音的诊断价值

Identifying origins and mechanisms of innocent unknown cardiac murmur by echocardiography

目的:以彩色多普勒超声心动图(CCDE)检查方法研究心前区来源不明,无害杂音的来源及其机制。方法:选择有心前区3/6收缩期杂音的患者54例。应用CCDE结合激发试验观察局部湍流的产生部位、解剖基础及其发生机制。结果:在54例患者中,安静时仅有32例(59.3%)可检出轻度或可疑的局部湍流;激发后有51例(94.4%)可检出明显或确定性局部湍流,仍有3例(5.6%)未能检出湍流。在检出湍流的51例中,其产生部位分别为:左室腔内结构(LVCS),25例;右室流出道(RVOT),19例;主动脉弓降部(AADA),7例。LVCS来源的杂音形成局部湍流的解剖结构分别为:S形室间隔伴或不伴室间隔基底部增厚(12/25),左室假腱索(10/25),二尖瓣腱索、乳头肌(3/25);RVOT来源的杂音形成局部湍流的解剖结构分别为:RVOT轻度狭窄(15/19),异常肌束(4/19);AADA来源的杂音形成局部湍流的解剖基础为主动脉硬化及弓降部变形。结论:通过CCDE结合激发试验发现了三种较少见、功能性、易漏诊的心脏杂音来源及形成机制。

Objective： To identify the origins and the mechanisms of innocent unknown cardiac murmurs by color-coded Doppler echocardiography （CCDE）. Methods： Fifty-four patients with unknown precardial murmurs of grade 3/6 were included in this study. CCDE incorporating with various agility methods was performed to reveal the sites induced local turbulent flow （LTF） and its underlying anatomical structures. Results; Suspected LTF was found only in thirty-two patients （59. 3%） at rest, and significant LTF was identified in 51 patients （94.4%） with 3 patients remaining no LTF after the various agilities. In 51 patients with LTF, the sites of LTF were localized at the left ventricle （n= 25） including sigmoid shaped ventricular septum （12/25）, false tendon （10/25） and mitral tendon （3/25）; at right ventricular outflow tract （n=19） including mild functional outflow tract stenosis （15/19） and anomaly muscular band （4/19） ; and at arch-descending aorta connection due to atherosclerotic deformation or kinking （n= 7）, Conclusion： The origins and the anatomical rationale of three rare functional innocent cardiac murmurs are successfully identified by CCDE incorporating with agilities.