经胸彩色多普勒超声心动图在室间隔缺损合并主动脉瓣脱垂介入封堵术中的应用价值  

Transthoracic Color Doppler Echocardiographic Evaluation on Interventional Occlusion of VSD with Aortic Valvular Prolapse

作　　者：牟楠楠[1] 郑晓舟[2] 张波[2] 梁家立[2] 刘兰芬[1] 晋芳[3] 

机构地区：[1]济南军区总医院超声诊断科 [2]济南军区总医院心外科 [3]72671部队门诊部

出　　处：《中国超声医学杂志》2008年第2期130-133,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨经胸彩色多普勒超声心动图在室间隔缺损(VSD)合并主动脉瓣(AV)脱垂封堵术中的临床价值。方法30例VSD合并不同程度的AV脱垂的患者,全部行介入封堵术,术前我们将AV脱垂的程度分为3度,I度为AV轻度脱垂,舒张期AV窦略大,未超过瓣环连线,彩色血流未见明显反流。II度AV窦明显扩大,舒张期超过瓣环连线脱向左室流出道并瓣膜轻度反流,反流量不超过0.7ml,舒张期未堵塞缺损口。III度AV脱垂,瓣窦明显扩大,有形态改变,舒张期瓣窦大部分脱入VSD口,瓣根与VSD口部分粘连,瓣叶僵硬,活动度差,彩色血流示明显反流,反流量大于1ml。结果30例VSD合并AV脱垂患者,AV右冠瓣脱垂15例,AV无冠瓣脱垂13例,右、无冠瓣同时脱垂2例。15例右冠瓣脱垂I度9例,II度4例,III度2例。13例AV无冠瓣脱垂,I度8例,II度4例,III度1例。2例双瓣(右、无冠瓣)脱垂,均I度脱垂。30例患者行VSD封堵术,28例封堵成功,2例封堵失败(其中1例嵴下型VSD,另1例嵴内型VSD合并AV脱垂),2例VSD均合并III度AV右冠瓣脱垂并瓣膜反流。术中释放封堵伞后超声检查AV反流量明显大于术前,反流量大于1ml。结论经胸彩色多普勒超声心动图在VSD合并AV脱垂术前程度的判断,介入术中封堵器是否加重AV的脱垂,瓣膜反流量是否大于术前,超声检查对VSD介入手术的成功,封堵器的选择起到重要的作用和诊断价值。Objective To evaluate the diagnostic value of transthoracic color Doppler echocardiography on interventional occlusion of ventricular septal defect （VSD） with aortic valvular prolapse （AVP） . Methods Totally 30 patients who bad suffered from VSD with different degree AVP were treated with interventional occlusion. The AVP was classified into 3 grades before treatment. In grade Ⅰ , the aortic sinus dilated mildly and the sinus bottom was not beyond the valvular ring during diastolic phase, without aortic regurgitation detected on color Doppler ; in grade Ⅱ , the aortic sinus dilated moderately and the bottom was beyond the valvular ring and prolapsed into the outflow tract of the left ventricle during diastolic phase and the aortic regurgitation could be detected with jet volume less than 0. 7 ml ; in grade Ⅲ , the aortic sinus dilated severely with morphological changes, lain on the most part of the sinus prolapsed into VSD, with the valvular root adhered with the part of VSD orifice, the leaflet became stiff with decreased activity and the aortic regurgitation was obvious with volume more than 1 ml. Results Among the 30 VSD patients, right coronary cusp prolapse was in 15 patients （grade Ⅰ in 9, grade Ⅱ in 4, and grade Ⅲ in 2）, noncoronary sinus prolapse in 13 patients （grade Ⅰ in 8, grade Ⅱ in 4, and grade Ⅲ in 1）, and both right coronary cusp and noncoronary sinus prolapse in 2 patients （both were grade Ⅰ ） . The VSD was occluded successfully in 28 patients, and failed in 2 patients who were with both grade Ⅲ prolapse of right coronary cusp and aortic regurgitation. In these 2 patients, when the VSD was occluded, the aortic regurgitation volume was augmented obviously. Conclusions Transthoracic color Doppler echocardiography has significant contribution to the judgement of AV prolapse degree, whether aortic regurgitation wounld be increased during interventional occlusion or not, and has achievement of interventional VSD occlusion with aortic valvular prolapse.

关 键 词：经胸彩色超声心动图 室间隔缺损 主动脉瓣脱垂 封堵术 

分 类 号：R541.1[医药卫生—心血管疾病] R654.2[医药卫生—内科学]