超声心动图评价左室假腱索与收缩期杂音的关系

Echocardiographic Evaluation of Relationship between Left Ventricular False Tendons and Systolic Murmur

为了探讨左室假腱索(LVFT)与心脏收缩期乐性杂音(SM)之间的关系,应用超声心动图对两组健康人进行了前瞻性研究。组Ⅰ为40例有SM者,组Ⅱ为40例无心脏杂音者。LVFT分为A型穿过左室腔和B型与左室壁平行走行。结果:Ⅰ组中有34例(85.0％)存在LVFT,A型32例(80.0％),仅2例(5.0％)为B型。组Ⅱ中有19例(47.5％)存在LVFT,其中3例(7.5％)为A型,16例(40.0％)为B型。组ILVFT总人数和A型LVFT检出率明显高于组Ⅱ(P<0.01)。组ⅡB型LVFT检出率明显高于组Ⅰ(P<0.01)。组Ⅰ中有5例A型LVFT者彩色多普勒血流显像显示左室射血时在LVFT局部产生五色镶嵌状湍流。结果提示:(1)LVFT(尤其A型)是产生良性SM的原因之一。(2)SM的最响部位通常位于胸骨左缘第3～4肋间至心尖部内侧,呈较柔和的乐性,82％响度为Ⅱ/6级,15％可达Ⅲ/6级,在鉴别诊断时应予注意。(3)SM可能是由于左室射血血流冲击LVFT产生湍流引起LVFT振动所致。

In this prospective study, the echocardiography was used to evaluate the relationship between left ventricular false tendons (LVFT) and systolic musical murmurs (SM). Group I included 40 cases with SM, group Ⅱ included 40 cases without any murmur. LVFT was devided into two types: type A crossing the left ventricular cavity and type B paralleling to the left ventricular wall. The results showed that the incidences of LVFT(85% )and type A(80% )in group Ⅰ were both significantly higher than those in group Ⅱ (P<0.01) ,the incidence of LVFT of type B in group Ⅱ was significantly higher than that in group Ⅰ(P <0.01). Five type A LVFT patients in group Ⅰ showed that blood flow became mosaic colour flow when crossing LVFT in systolic period. It was suggested: 1. LVET was responsible for this common innocent SM. 2. the features of this SM were:a. the site of the maximal intensity located in the third or fourth left parasternal intercostal space over the apex of heart,b. the intensity varied from grade 1/6 to 3/6,c. its nature was mild music. 3. the mechanism of the SM was due to the vibration of LVFT causing by the turbulent of left ventricular blood flow interefered by LVFT.