机械瓣纤维条索状团块的超声检测与临床意义

Detection of Strandlike Small Masses Attached to Mechanical Prosthetic Valves and its Clinical Significance

目的探讨经食道及经胸超声心动图（ＴＥＥ，ＴＴＥ）对附着于机械瓣瓣环或其附近的细小纤维条索状回声团块（ＳＬＭ）的检测、超声表现及其临床意义。方法应用ＴＥＥ及ＴＴＥ随访检查１６８例机械瓣置换术后病例，检出１２例患者有ＳＬＭ现象；比较ＳＬＭ组与对照组机械瓣瓣口血流动力学指标及临床资料。结果在１２例患者中，ＳＬＭ的宽度和长度分别为０．１５±０．０３和１．１２±０．４３ｃｍ，７例ＳＬＭ呈细长纤维条索状、５例呈细小点状，６例ＳＬＭ呈单个、６例呈多个，７例ＳＬＭ有一定的活动度、５例活动度小，１０例ＳＬＭ附着于机械瓣瓣环、２例附着于瓣环附近。机械瓣瓣口的有效开放面积、最大及平均跨办压差以及返流束的宽度和长度在ＳＬＭ组与对照组中均无显著差异（Ｐ均＞０．０５）。ＳＬＭ组无血栓栓塞、发热、贫血史，凝血酶原时间控制良好。结论附着于机械瓣瓣环或其附近的ＳＬＭ易被ＴＥＥ检出且具有一定的声学特征，ＳＬＭ似乎不增加血栓栓塞的危险性。

Objective\ This study was designed to detect strandlike small masses(SLMs) attached to mechanical prosthetic valves by transesophageal and transthoracic echocardiography(TEE,TTE),and to evaluate its clinical significance.\ Methods\ TEE and TTE were performed on 168 patients with mechanical prosthetic valves,SLMs were detected in 12 patients by TEE and in these patients only one by TTE.Eleven patients without SLMs and with the same type,size and position of prosthetic valves were selected as controls. The clinical data including histories of thromboembolic events,fever,anemia and PT in the patients with SLMs were documented.\ Results\ The average size of SLMs was 0.15±0.03 cm in width and 1.12±0.43 cm in length,the appearance of SLMs in 7 patients was strandlike and 5 dotlike,the number of SLMs in 6 patients was single and in the other 6 multiple,SLMs in 7 patients was movable and 5 immovable,SLMs in 10 patients attached to mechanical prosthetic rings and 2 to the site near mechanical prosthetic rings. The effective orifice of the prostheses,maximal transvalvular gradient,mean travsvalvular gradient,and the width and the length of regurgitant jets between SLM group and control group were insignificantly different(P>0.05,each). Patients with SLMs did not have thromboembolic events,fever,anemia and PT were well controlled.\ Conclusion\ SLMs attached to mechanical prosthetic valves can be detected by TEE and the SLMs do not pose extra risks of thromboembolic events on the patients.