主动脉瓣感染性心内膜炎并主动脉瓣穿孔的临床特点及超声心动图应用

The clinical characteristics of the aortic valvular perforation in the aortic valvular infective endocarditis detected by transthoracie echocardiography

目的 :探讨主动脉瓣感染性心内膜炎 ( AVIE)并发主动脉瓣穿孔 ( AVP)的临床及超声心动图( UCG)的特点。方法 :对 11例经临床及 UCG诊断的 AVIE并发 AVP患者的资料进行分析 ,并与手术结果进行对照。结果 :临床特点 :基础心脏病以主动脉瓣畸形多见 ;主要表现发热、贫血、心脏杂音、急性左心衰竭 ;UCG特点 :二维超声心动图 ( 2 DE)显示瓣体的回声连续缺失 ,彩色多普勒血流显像 ( CDFI)显示穿瓣偏心血流 ,U CG诊断 AVP特异性为 90 .9% ;术后患者的心脏血流动力学均明显改善。结论 :U CG检查是正确诊断 AVIE并发 AVP及评价其手术治疗效果的首选方法 。

Objective: To study the clinical characteristics of the aortic valvular perforation (AVP) in aortic valvular infective endocarditis (AVIE) and to evaluate the diagnostic value of transthorcic echocardiography. Method: Eleven consecutive patients with AVP and suffered from AVIE diagnosed by clinic and echocardiography were included in this study. The clinical and echocardiograpic features of these patients was analysed. The features of echocardiography were compared with those of surgery.Result: Most basic heart diseases of these patients were aortic valvular deformity. The incidence of fever, anemia, murmur of heart, acute left heart failure was 81.8 %, 100%, 100% and 72.7 % respectively.The echocardiograpic points of AVP in patient with AVIE were an interruption of aortic leaflet tissue continuity in the two dimensional echocardiography and high veloctiy eccentric turbulent jet traversing a valve leaflet tissue in color doppler folw imaging. The accuracy diagnosised by echocardiography was very high with specificity of 90.9 %. The cardiac hemodynamics were improved after operation.Conclusion: It is important that the AVP in AVIE can detected earlier in clinic.Echocardiography is valuable in diagnosing of the AVP in AVIE earlier and assessing the efficacy of this operation.