原发性心脏瓣膜粘液变性的诊断:超声心动图与手术和病理的对照  

Comparison Study of Two-dimensional Echocardiography with Surgery and Pathology in Diagnosing the Primary Myxomatous Degeneration of Cardiac Valves

作　　者：沈学东[1,2] 万亚红[1,2] 蒋振斌[1,2] 洪涛[1,2] 黄士通[1,2] 施纯敏[1,2] 施月芳[1,2] 朱慧君[1,2] 陈灏珠[1,2] 

机构地区：[1]上海医科大学中山医院,200032 [2]上海市心血管病研究所

出　　处：《中国超声医学杂志》1997年第1期18-20,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：本文回顾性分析46例经手术和病理证实为原发性心脏瓣膜粘液变性患者的超声检查结果，发现37例粘液变性的二尖瓣中，21例（56．8％）被二维超声显像正确诊断为原发性二尖瓣脱垂。19例二尖瓣可在胸骨旁长轴切面和心尖四腔心切面观察到脱垂，2例二尖瓣仅在四腔心切面观察到脱垂。超声显像示瓣时不增厚，瓣际交界不粘连。另16例（43．2％）粘液变性的二尖瓣效超声误认为风湿性。二维超声显像示二尖瓣尖均有不同程度增厚，但均无钙化。舒张期二尖瓣前叶在胸骨旁长轴切面可呈现圆隆状。13例二尖瓣收缩期能够超过瓣环水平向左房脱垂。5例瓣膜仅在心尖四腔心切面发现脱垂。另外3例瓣膜无论在胸骨旁长轴切面还是在心尖四腔心切面均不能发现脱垂迹象。病理检查示二尖瓣心房面的关闭线附近有不规则的纤维化。9例粘液变性的主动脉瓣中，二维超声显像发现8例（88．9％）脱垂。另外1例（11．1％）粘液变性的主动脉瓣无任何脱垂迹象，主动脉瓣返流的原因不能明确。In order to evaluate two-dimensional echocardiography (2D) in diagnosis of primary myxomatousdegeneration (PMD) of cardiac valves, 46 patients with PMD of mitral and aortic valves confirmed by surgery and pathologywere retrospectively analyzed. Results: Twenty-one of thirty-seven patients with mitral PMD associated with severe mitralregurgitation were diagnosed as primary mitral valve prolapse by 2D. Nineteen patients with mitral valve prolapse can beareu in parasternal long axis view, two patients were presented only in apical four chamber views. The mean mitral valvearea was 9. 37±2. 67cm2. Sixteen (43. 2% ) patients with mitral PMD were incorrectively diagnosed as rheumatic valvulardisease by 2D, because of the mild leaflet thickening and subvalvular changes. Thirteen of them were found mitral valveprolape, 5 of 13 were presented only in apical four chamber view. The mean mitral valve area was 5. 54±2. 85cm2. Themitral valve prolapse was not detected neither in parasternal long axis view nor in apical four chamber view in another 3patients with mitral PMD. Eight of nine patients with aortic valvular PMD were diagnosed as primary aortic prolapse by2D. The cause of aortic valve regurgitation could not be determined in 1 patient. Conclusion: The mitral PMD were oftendiagnosed as rheuznatic valvular disease by 2D, because of the mild leaflet thickening and subvalvular changes. The mitralproapse wes no always detected in patients with mitral PMD by 2D. In patients with prominent mitral regurgitation, themitral PMD must be considered to prevent incorrect diagnosis.

关 键 词：心脏瓣膜 粘液变性 超声心动图 

分 类 号：R542.504[医药卫生—心血管疾病] R540.45[医药卫生—内科学]