先天性二尖瓣狭窄超声心动图特点  

Features of Congenital Mitral Stenosis by Echocardiography

作　　者：李慧[1] 万琳媛[1] 李慕子 王剑鹏[1] 王浩[1] 孟红[1] LI Hui;WAN Lin-yuan;LI Mu-zi;WANG Jian-peng;WANG Hao;MENG Hong(Department of Echocardiographsy,Fuowai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Bejing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声科,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第5期4168-4173,共6页Molecular Cardiology of China

基　　金：中央高校基本科研业务费专项资金(3332018051)。

摘　　要：目的总结先天性二尖瓣狭窄(CMS)超声心动图表现,结合术后超声心动图随访结果探讨其外科治疗评估策略。方法纳入2012年8月至2020年2月收治的CMS患者66例,依据"瓣叶""乳头肌""腱索"结构异常将研究对象分为7组,分析各组病例超声心动图特征及术后中期随访结果,总结超声心动图外科治疗评估策略。结果单纯乳头肌病变CMS发生重度狭窄比例较小,瓣叶及腱索病变发生重度狭窄比例较高。35例外科手术患者术前、出院前及术后6个月左心房收缩末期内径、左心室舒张末期内径及左心室收缩功能差异均无统计学意义(P均>0.05),术前、出院前及术后6个月二尖瓣前向血流速度分别为(2.4±0.4)m/s、(1.6±0.4)m/s、(1.9±0.3)m/s,平均跨瓣压差分别为(11.8±6.5)mmHg、(4.2±2.6)mmHg、(6.1±3.1)mmHg(1 mmHg=0.133 kPa),差异均有统计学意义(P均<0.001)。4例患者围手术期死亡;2例患者复发重度狭窄再次手术干预。结论瓣叶合并瓣器异常的CMS易合并其他畸形且血流动力学异常较严重,超声心动图是评估CMS外科治疗相关解剖及血流动力学的重要工具。Objective To review the patients with congenital mitral stenosis(CMS)and summary echocardiographic features and surgical approaches in these patients.Methods Clinical and echocardiographic data of 66 patients with CMS since August 2012 to February 2020 were reviewed.Patients were divided into seven groups based on the structural abnormalities of"flap","papillary muscle"and"chordae tendineae".The echocardiographic characteristics and mid-term follow-up results were analyzed,and surgical treatment strategies were summarized.Results The incidence of severe stenosis in CMS with simple papillary abnormal was relatively small,while the incidence of severe stenosis in the lesions of valvular flap and chordae tendineae was relatively high.There were no statistically significant differences in left atrial end-systolic diameter,left ventricular end-diastolic diameter and left ventricular systolic function in 35 surgical patients preoperation,discharge and 6 months after surgery(P>0.05).The difference of flow velocity[(2.4±0.4)m/s vs(1.6±0.4)m/s vs(1.9±0.3)m/s]before surgery,discharge and 6 months after surgery,and the difference of mean MS gradient[(11.8±6.5)mmHg vs(4.2±2.6)mmHg vs(6.1±3.1)mmHg,1 mmHg=0.133 kPa]were all statistically significant(P<0.001).Four patients died in perioperative period.Reoperation for 2 patients with recurrent severe stenosis.Conclusion Abnormal flaps combined with apparatus are likely to be associated with other combined malformations and hemodynamics abnormalities.Echocardiography is an important tool to evaluate the anatomy and hemodynamics of CMS surgery.

关 键 词：先天性二尖瓣狭窄 二尖瓣修复 超声心动图描记术 

分 类 号：R542.51[医药卫生—心血管疾病]