摘要
本文对30例风湿性心办膜病以CarboMedics(简称CM)机械双叶瓣置换二尖瓣且CM办功能正常的患者术前及术后早期进行超声检查。重点是;病损二尖瓣结构的二维超声观察,病损瓣及CM瓣口的各项多普勒血流参数,术后早期左房容积、左室大小及功能、肺动脉收缩压的改善情况。对切除瓣膜进行病理形态学检查,与超声显像对照,探究其病理组织学基础。结果表明:1.超声所测病损瓣膜的狭窄程度与实测值有很好的相关性,瓣膜的增厚情况两者间有一定相关性,超声对瓣膜明显钙化显像好,但不能提供有无出血、溃疡。风湿性二尖瓣的病理变化属结缔组织的一种特殊炎症。2.CM瓣各项血流参数的正常范围;峰值流(PK):1.51±0.21m/s,最大跨瓣压差(PG):1.27±0.35kPa,平均跨瓣压差(MG):0.64±0.20kPa,压力降半时间(PHT):105±16ms;多普勒估测瓣口面积(MOA):2.12±0.51cm^2。3.术后早期左房客积明显回缩,肺动脉收缩压降低、左室大小及收缩功能无明显变化。提示:1.术前超声能较准确地提供风湿性二尖瓣膜的病损情况,其声像图增厚、狭窄特征的病理基础为慢性炎症反应,2,CM双叶瓣在术后早期功能良好,仅存在轻度血流受阻。3.患者心血管系统血流动力学在术后早期即得到改善。
Echoeardiography was performed in 30 rheumatic cardiac valve patients with normally functioning CarboMedics (CM) bileaflet prostheses in the mitral position at before and immediately after operation. We observed the stenotic mitral valves' structure, the abnormal mitral and CM valves' orifice's Doppler indexes. The following variables were compared:volume of left atrial, dimension and function of left ventricle, pulmonary artery systolic pressure. Pathological studies were engaged in excised valves, and compared with echocardiographic diagnosis. The results showed: 1. The rheumatic valves' thickness derived by ultrasound correlated with those obtained at specimen measurment. For the sonotic deposit, excellent correlation was found. Ultrasound could show valve's calcification, but couldn't provide valve's ulcerate and naemorrhage. The rheumatic valve's pathologic change is a kind of particular inflammation of connective tissue. 2. For the CM prostheses in the mitral position, the Doppler indexes' normal range were:peak velocity 1. 5l±0. 21 m/s, peak gradient 1. 27±0. 35 kPa. Mean gradient 0. 64±0. 20 kPa, pressure half time 105±16ms, mitral effective orifice area 2. 12±0.51cm2. 3. Immediately after operation, left atrial volume was obviously contracted, pulmonary artery systolic pressure was reduced, the dimension and function of left ventricle had few change. These concluded: 1. Echocardiography can provide accurate information about rheumatic mitral valve. The valve image's pathologic base is a particular inflammation. 2. The CarboMedics prosthesis offered relatively little resistance to forward flow. 3. The operation improved patients' hemodynamic state in the immediate postoperative period.
出处
《临床超声医学杂志》
1995年第4期195-202,共8页
Journal of Clinical Ultrasound in Medicine
