双平面经食道彩色多普勒对机械二尖瓣返流的评价

Evaluation of the Regurgitation of Mechanical Mitral Prostheses Using Biplane Transesophageal Color Doppler Echocardiography

目的评价机械二尖瓣的返流特征。方法采用双平面经食道彩色多普勒（ＢＴＥＥ）对７２例机械二尖瓣进行了详细观察。结果所有二尖瓣位机械瓣，无论患者心功能状态如何，都存在一定程度的返流，不同类型的瓣膜其返流方式、返流束的形态及空间分布不同。ＧＫ瓣的返流以中央型为主，伴有较小的周边型返流；双叶瓣的返流以周边型为主，伴有轻微的中央型返流。扫查切面不同，所见返流束的形态及空间分布不同，主要取决于声束平面与瓣叶轴向的相对位置及瓣口的朝向。伴有瓣周漏，返流具有明显不同的特点。结论ＢＴＥＥ可以清晰敏感地检测机械二尖瓣返流，并可将“生理性”返流与瓣周漏明显地加以区别。

Objective\ To observe the characteristics of regurgitation of mechanical mitral prostheses.\ Methods\ Biplane transesophageal color Doppler echocardiography(BTEE) was performed in 72 patients with different types of mechanical mitral prostheses,including 36 single tilting disk valves(GK valve),36 bileaflet valves(30 CarboMedics and 6 St Jude valves).\ Results\ All normally functioning valves in mitral position generated regurgitation more or less despite the patient′s cardiac function.\ There were different regurgitant patterns,shapes and spatial distribution in different types of prostheses.\ A dominant central jet existed in all GK valves,accompanied by a minor peripheral jet,while prominent peripheral jets were found in all patients with bileaflet valves,accompanied by a small central jet.\ The shape and the spatial distribution of regurgitant jets depended on the relative position of imaging planes and dise axes.\ Perivalvular leakage was found in 4 patients,which was remarkedly different from the regurgitation mentioned above.\ Conclusion\ BTEE can be used to detect the regurgitation of mechanical mitral prostheses clearly and sensitively,and to differentiate the “physiological”from pathological one,i.e.the perivalvular leakage.