超声心动图在二尖瓣关闭不全外科修复中应用2013年.pdfVIP

当我们遇到一个二尖瓣反流的病人 …… Guidelines and Recommendations on MITRAL REGURGITATION 1. 2D Echocardiography * Valvular structure： Calcifications钙化, tethering活动受限, flail motion连枷样运动, vegetations赘生物 * Impact of the volume overload on the cardiac chambers 2. Doppler Methods a. Color Doppler  the origin of the regurgitation jet and its width (vena contracta) 反流束起源和宽度  the spatial orientation of the regurgitant jet area in the receiving chamber 反流束的空间分布  in cases of significant regurgitation, flow convergence into the regurgitant orifice 血流汇 聚 a. Color Doppler  The size of the regurgitation jet by color Doppler and its temporal resolution时间分辨率 are significantly affected by transducer frequency and instrument settings （gain, output power, Nyquist limit, size and depth of the image sector ） a. Color Doppler © Jet area / VC/ PISA 1. presence and direction of the regurgitant jet 2. semi-quantitative assessment of its severity a. Color Doppler © Jet area  the sole reliance on this parameter can be quite misleading  Jet size is affected by instrument factors, especially pulse repetition frequency (PRF) and color gain  Nyquist limit (aliasing velocity) of 50-60 cm/sec, a color gain that just eliminates消除 random color speckle from non-moving regions. a. Color Doppler © Jet area  eccentric偏心反流, wall-impinging jets 贴壁血流束appear significantly smaller than centrally directed jets of similar hemodynamic severity  structural abnormalities of the valve ( prolapse, flail, or perforation穿孔) a. Color Doppler © Jet area  influenced by flow momentum动力因素 -- the product of flow rate and velocity. A jet may appear larger by increasing the driving pressure across the valve. [ measuring BP for left heart lesions ] 2. Doppler Methods b.