风湿性心脏瓣膜病相对性三尖瓣关闭不全程度诊断的探讨

ON DIAGNOSING THE DEGREE OF TRICUSPID INSUFFICIENCY SECONDARY TO RHEUMATIC HEART VALVULAR DISEASE

本文对43例严重风湿性心脏瓣膜病人的三尖瓣关闭不全程度进行了包括体征、胸片、右心导管、右室造影、超声多普勒和手术探查等综合性对比研究。发现17％的重度三尖瓣关闭不全病例无阳性体征,右室造影与手术探查、多普勒与右室造影以及多普勒与手术探查对三尖瓣关闭不全程度的诊断符合率分别为90％、91％和90％。文章分析了三尖瓣关闭不全程度容易误诊的原因,并提出用简便可靠的多普勒指标L_(TR)/L_(RA)替代创伤性检查,诊断三尖瓣关闭不全程度。

The degree of tricuspid insufficiency (TI) in 43 patients with severe rheumatic heart valvular disease was comprehensively studied with physical examination, chest roentgenogram, hemodynamic features, right ventriculography, echocardiography, pulsed Doppler technique and surgical exploration. The physical signs were absent in 17% of patients with severe TI. The rates of diagnostic accordance for the degree of TI between right ventriculography and surgical exploration, between Doppler and right ventriculography, and between Doppler and surgical exploration were 90%, 91% and 90% respectively. The causes of misdiagnosing the degree of TI are discussed. A simple and reliable Doppler criterion L_(TR)/L_(RA) for determining the degree of TI instead of using invasive technique is suggested.