超声心动图评价偏心性主动脉瓣反流所致室壁冲击伤  

Echocardiographic evaluation of myocardial impact injury caused by eccentric aortic regurgitation

作　　者：孙佳英[1] 黄云洲[1] 王翠华[1] 李冬蓓[1] 任书堂[1] 龙进[1] 王勇[1] 周建华[1] 李婷[2] 徐冬生[3] SUN Jiaying;HUANG Yunzhou;WANG Cuihua;LI Dongbei;REN Shutang;LONG Jin;WANG Yong;ZHOU Jianhua;LI Ting;XU Dongsheng(Department of Ultrasound,2.Department of Nuclear Medicine,3.Department of Radiology,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院超声科,天津300457 [2]泰达国际心血管病医院核医学科,天津300457 [3]泰达国际心血管病医院放射科,天津300457

出　　处：《中国医学影像技术》2020年第4期494-498,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察经胸彩色多普勒超声心动图评价偏心性主动脉瓣反流(AR)所致室壁冲击伤的效果。方法26例经胸彩色多普勒超声显示中量及以上偏心性AR患者反流束已明确冲击至室间隔或左心室游离壁某处并发生变形,分析其影像学资料,观察偏心性AR对室壁造成冲击伤的形态学特点。结果偏心性AR高速射流冲击部位均位于室间隔或左心室游离壁基底段或中上段(26/26,100%)。其中4例(4/26,15.38%)下间隔和下壁均被冲击,5例(5/26,19.23%)仅下壁被冲击,13例(13/26,50.00%)下壁和下侧壁均被冲击,2例(2/26,7.69%)仅下侧壁被冲击,下间隔、下壁和下侧壁均被冲击者2例(2/26,7.69%)。被冲击室壁处均可见局部扩张(26/26,100%);6例(6/26,23.08%)运动幅度明显减低或消失,10例(10/26,38.46%)轻度减低,10例(10/26,38.46%)正常。CMR图像上除可见局部室壁扩张和运动减低外,严重者延迟增强时可见相应受损部位心肌纤维化改变。核素心肌灌注检查中,冲击伤重者可见局部心肌血流灌注和代谢减低均减低,而轻者无局部心肌血流灌注和代谢减低。结论彩色多普勒超声心动图可用于观察中量及以上偏心性AR直接冲击室壁所致损伤部位和程度。Objective To explore the effect of transthoracic color Doppler echocardiography on evaluating myocardial impact injury caused by eccentric aortic regurgitation(AR).Methods Transthoracic color Doppler echocardiographic imaging data were collected in 26 cases with local deformation of some part of the ventricular septum or left ventricular free wall rammed by moderate and above eccentric AR,and the morphological characteristics of ventricular wall impact injury were analyzed.Results Myocardial impact injury caused by eccentric AR located at the basal-mid segment of ventricular septum or left ventricular wall(26/26,100%).Both inferoseptal and inferior wall were impacted in 4 cases(4/26,15.38%),only inferior wall were impacted in 5 cases(5/26,19.23%),both inferior and inferolateral wall in 13 cases(13/26,50.00%),inferolateral wall in 2 cases(2/26,7.69%),while inferoseptal,inferior and inferolateral wall all were impacted in 2 cases(2/26,7.69%).No anterolateral,anterior nor anteroseptal wall was impacted.Local dilatation was observed at the impacted wall in all cases(26/26,100%).Severe hypokinesia was detected in 6 cases(6/26,23.08%),mild hypokinesia in 10 cases(10/26,38.46%),while normal motion was observed in the rest 10 cases(10/26,38.46%).In addition to local wall dilatation and hypokinesia,myocardial fibrosis could be observed from LGE images in one case.Local perfusion and metabolism decreased on radionuclide perfusion images in severe cases,but not in mild cases.Conclusion Moderate and above eccentric AR can cause damage to some part of the wall impacted directly by the eccentric aortic regurgitation,and the location and extent of damage can be evaluated using color Doppler echocardiography.

关 键 词：主动脉瓣关闭不全 超声心动描记术 室壁冲击伤 

分 类 号：R542.52[医药卫生—心血管疾病] R540.45[医药卫生—内科学]