超声心动图技术评价人工瓣机能的临床研究

Assessing the function of prosthetic heart valve using echocardiography

目的 应用经胸(TTE)和经食管超声心动图(TEE)评价二尖瓣(MV)或/和主动脉瓣(AV)置换术后人工机械瓣机能。方法 对201例MV或/和AV置换者频谱测量血流峰值速度和跨瓣压差,评估人工瓣反流及瓣周漏程度;二维超声观察人工瓣,测量手术前后左心房、左心室内径和左心室射血分数(LVEF)。结果 (1)相同瓣位StJude、G-K、On-x人工瓣前向峰值血流速度(Vmax)和跨瓣压差(△P)之间无显著差异。(2)164枚人工MV出现0级反流131例(79.88%),I级反流29例(17.68%);Ⅱ级2例(1.22%);瓣周漏2例(1.22%)。81枚人工AV69例(85.18%)无反流,12例(14.82%)轻度反流。(3)术后左心房、左心室较术前明显缩小,LVEF较术前减低。结论TTE对人工瓣活动、瓣周异常和血流动力学的评判简便易行,TEE具有进一步评价病变部位、程度及术中即刻评价手术效果的优点。

Objective To assess the function of mechanical prosthetic heart valve(MPHV)in the mitral valve(MV) and aortic valve (AV)position using transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE). Methods Two hundred and one patients with MPHV were evaluated by two dimensional echocardiography and Doppler blood flow. The diameter of left atrium (LA) and left ventricle (LV) , LVEF, peak velocities (Vmax) and pressure gradients(△P) of blood flow in the prosthetic valves were measured at same views. Results (1) The Vmax and AP of blood flow in the prosthetic valves were not significantly different at same portion in St Jude ,G-K and On-x. (2)Among 164 patients underwent mitral valve replacement revealed 29 cases with mitral re-gurgitation (MR) grade I, 2 cases with grade Ⅱ and 2 cases with severe paravalvular leakage. Among 81 patients underwent aortic valve(AV) replacement revealed 12 cases with slight AVR. (3) The post-operative diameters of LA and LV were lower than those of pre-operation. Post-operative LVEF were lower than those of pre-operation. Conclusions TTE was a reliable tool for detecting the function and blood flow dynamics of MPHV and TEE can more accurately detect the abnormal location and extent of MPHV.