不同分型二叶式主动脉瓣间超声与临床特征比较

Comparison of echocardiography and clinical features in different bicuspid aortic valve morphologies

目的比较不同瓣膜融合类型二叶式主动脉瓣(BAV)的临床及超声心动图特征,探讨主动脉瓣膜功能障碍类型和主动脉增宽部位的差异。方法回顾分析230例2011年1月~2017年1月于北京朝阳医院诊断为二叶式主动脉瓣患者的临床资料及超声心动图。结果 230例BAV患者中,右冠瓣与无冠瓣融合(R-N)型127例,左冠瓣与右冠瓣融合(R-L)型89例及左冠瓣与无冠瓣融合(L-N)型14例。R-L型主动脉瓣反流(轻、中或重度)占比均显著高于R-N型,差异有统计学意义(P<0.05);R-N型主动脉瓣狭窄(轻、中或重度)患者占比均较R-L型高,但并无统计学意义(P>0.05)。R-L型主动脉窦部内径较R-N型显著增宽,差异有统计学意义(P<0.05),R-N型升主动脉内径较R-L型更宽,但并无显著差异(P>0.05)。230例患者中以主动脉窦直径(DSTJ)≥升主动脉直径(Dasc)为Type N组(40例),DSTJ<Dasc为Type A组(190例)。R-N、R-L及L-N型患者中,Type A均较Type N更常见(P<0.05),且R-N型Type A组BAV患者占比最多。结论 R-L型BAV较R-N型更易发生主动脉瓣反流和主动脉窦部增宽,R-N型Type A组在BAV中占比最多。

Objective To compare the clinical and echocardiographic features of different bicuspid aortic valve （BAV） morphologies, and to explore the differences between aortic valve dysfunction and aortic broadening location. Methods We performed a retrospective review of clinical and echocardiographic data about who presented with BAV between January 2011 and January 2017 in Beijing Chao-Yang Hospital. Results We identified 230 patients with BAV into three morphologies R-N, right and non-coronary fusion （n=127）; R-L, fusion of right and left coronary cusp （n=89）; and L-N, left and non-coronary fusion （n=14）. R-L type patients had higher proportion of aortic regurgitation （mild, moderate or severe） than that of R-N type patients （P〈0.05）. R-N type patients had higher proportion of aortic stenosis （mild, moderate or severe） than that of R-L type patients, but there was no significant difference （P〉0.05）. R-L type patients had larger aortic sinus dimensions than that of R-N （P〈0.05）. R-N type patients had larger ascending aorta dimensions than that of R-L, but there was no significant difference （P〉0.05）. Two aortic shapes were defined： normal type （n=40） and ascending dilatation （n=190）. Any of the R-N, R-L and L-N, type A was more common than type N. Patients with R-N and type A had the highest proportion. Conclusion R-L type of BAV patients had higher incidence of aortic regurgitation and larger aortic sinus dimensions than that of R-N. BAV patients with R-N and type A had the highest proportion.