超声心动图诊断主动脉瓣四瓣化畸形

Echocardiographic diagnosis of quadricuspid aortic valve

目的观察超声心动图诊断主动脉瓣四瓣化畸形(QAV)的价值。方法纳入63例QAV患者,将其分为轻度主动脉瓣反流(AR)组(n=20)、中度AR组(n=35)及重度AR组(n=8);回顾性分析超声声像图及临床资料,观察临床因素及瓣膜超声征象对于QAV的诊断效能。结果经胸超声心动图(TTE)和/或经食管超声心动图(TEE)示QAV患者主动脉瓣存在4个瓣叶,各瓣叶大小可相等或有所不同;瓣膜形态多增厚、挛缩、卷曲或粘连;回声多增粗、增强,可伴钙化。舒张期主动脉瓣膜呈十字形关闭,伴不同程度AR,未见明显狭窄;收缩期等大型瓣膜呈方形或菱形开放,非等大型瓣膜则呈不规则形。重度AR组2例合并感染性心内膜炎,瓣膜回声异常更为明显,并见条索状或结节状赘生物、心室扩大及心包积液。不同瓣叶大小患者AR程度差异无统计学意义(P>0.05);而不同年龄、高血压及瓣膜不同回声患者AR程度差异均有统计学意义(P均<0.05),且年龄越大,AR程度越重(χ^(2)=9.461,P=0.002)。结论超声心动图可显示QAV患者主动脉瓣瓣膜数目、形态、结构及开闭情况,评估心脏大小和功能,结合临床资料有助于为诊断及治疗QAV提供参考。

Objective To observe the value of echocardiography for diagnosing quadricuspid aortic valve(QAV).Methods Totally 63 patients with QAV were enrolled and divided into mild aortic regurgitation(AR)group(n=20),moderate AR group(n=35)and severe AR group(n=8).The ultrasonic and clinical data were retrospectively analyzed.Then clinical factors and ultrasonic signs of valve for diagnosis of QAV were observed.Results Transthoracic echocardiography(TTE)and/or transesophageal echocardiography(TEE)showed that all aortic valve of QAV with 4 leaflets,and the size of each leaflet was equal or unequal,the valves obviously thickened,curled or adhered with contracture,and the echoes thickened and enhanced,some complicated with calcifications.During diastole,aortic valve closed,presented as cross shaped,with varying degrees of AR,while no obvious stenosis was found.During systole,valves of equal size opened and presented as square or rhombic,while valves of unequal size presented as irregular shape.Two patients of severe AR group complicated with infective endocarditis,the abnormal echoes of valves were more obvious,complicated with striped or nodular vegetations,ventricular enlargement and pericardial effusion.There was no significant difference of AR degree among different sized valves(P>0.05),while there were significant differences of AR degrees in patients with different ages,hypertension and valve echoes(all P<0.05),and AR degree increased with aging(χ^(2)=9.461,P=0.002).Conclusion Echocardiography could identify the number,shape,structure and opening and closing of aortic valves of QAV,and evaluate the size and function of heart,which might provide references for diagnosis and treatment of QAV combined with clinical data.