经胸超声心动图诊断机械瓣膜功能障碍

Transthoracic echocardiography for diagnosing mechanical valve dysfunction

目的观察经胸超声心动图诊断机械瓣膜功能障碍的价值。方法回顾性分析60例接受二次手术治疗的机械瓣膜功能障碍患者,观察本次术前经胸超声心动图、手术、术后病理及随访资料,分析超声的诊断及评估效能。结果超声心动图检查共于60例患者中检出67枚机械瓣膜功能障碍,包括二尖瓣23枚、主动脉瓣43枚及三尖瓣1枚;主要表现为瓣周漏、瓣膜狭窄及关闭不全、血栓、瓣环脱位、感染性心内膜炎(IE)及窦部夹层等。手术及病理结果显示,60例67枚机械瓣膜功能障碍分布与超声检查所见一致,表现为瓣周漏16枚、瓣周纤维组织增生50枚、血栓19枚、瓣环脱位5枚、IE 12枚、退行性变6枚。随访期间59例未见明显人工瓣膜功能障碍;1例于二次术后第9年出现瓣周漏,经手术封堵后情况良好。结论经胸超声心动图对于诊断机械瓣膜功能障碍具有一定价值,有助于判断是否需要进行再次手术治疗。

Objective The observe the value of transthoracic echocardiography for diagnosing mechanical valve dysfunction.Methods Data of 60 patients with mechanical valve dysfunction who underwent secondary surgery were retrospective analyzed.The preoperative transthoracic echocardiography,surgery,postoperative pathology and follow-up data were observed to explore the diagnostic and evaluation efficacy of ultrasound for mechanical valve dysfunction.Results Echocardiography showed 67 mechanical valves dysfunction in 60 patients,including 23 mitral valves,43 aortic valves and 1 tricuspid valve.The main manifestations of mechanical valve dysfunction included perivalvular leakage,valvular stenosis and insufficiency,thrombus,annular dislocation,infective endocarditis(IE)and sinus dissection.Then surgery and pathology proved 67 mechanical valves dysfunction in 60 patients,and the distribution was consistent with that showed with ultrasound.Perivalvular leakage was found in 16 valves,perivalvular fibrous hyperplasia in 50 valves,thrombosis was detected in 19 valves,while annular dislocation,IE and degenerative changes was noticed in 5,12 and 6 valves,respectively.During the follow-up period,no significant prosthetic valve dysfunction occurred in 59 cases,while 1 patient developed perivalvular leakage 9 years after the secondary surgery and recovered after surgical closure of perivalvular leakage.Conclusion Transthoracic echocardiography was valuable for diagnosing mechanical valve dysfunction,hence being helpful for judging the need of the secondary surgery.