二尖瓣反流
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• A short-axis view is useful in defining the exact location of pathology because it allows imaging of both leaflets [ˈli:flət] and the commissures['kɒmɪsjʊəZ] . The fourchamber view can cut through the leaflets at different locations.
3. Mixed Etiology.
• Occasionally, patients may来自百度文库present with mixed etiologies of MR that include both primary and secondary MR.
LOREM IPSUM DOLOR
• For example, a patient with long-standing ischemic [ɪs'ki:mɪk] or nonischemic cardiomyopathy and secondary MR may rupture a chord and develop a flail leaflet. • Conversely, a patient with mild or moderate MR from primary leaflet pathology may have a myocardial infarction and develop worse MR from tethering of the already abnormal leaflets.
1. Primary MR.
• In primary MR, an intrinsic [ɪnˈtrɪnsɪk] abnormality of the leaflets causes the MR, whereas secondary MR results from distortion [dɪ'stɔ:ʃn] of the MV apparatus [ˌæpəˈreɪtəs] due to LV and/or LA remodeling. • The most common cause of primary MR is myxomatous ['mɪksəmətəs] degeneration [dɪˌdʒenəˈreɪʃn] • Fibroelastic deficiency refers to focal segmental pathology with thin leaflets, while Barlow’s disease refers to diffuse thickening and redundancy [rɪˈdʌndənsi] , typically affecting multiple segments of both leaflets and chordae.
• Includes the anterior and posterior mitral leaflets, • The mitral annulus, chordae ['kɔ:di:] tendinae, papillary[pə'pɪlərɪ] muscles, and the underlying LV myocardium（左室下壁心肌）. • Echocardiographic views and their relation to mitral anatomy [əˈnætəmi] and the three scallops ['skɒləp] of each leaflet have been reviewed in detail.
Barlow’s disease
Barlow病在我国较为常见，主要表现为瓣叶纤维弹性组织缺失、黏液样变性， 致使在形态上表现为瓣叶增厚、增宽，约为正常瓣叶的两倍并呈胶冻样改变， 瓣叶强度减低。Barlow病二尖瓣强度减低的最重要原因在于腱索的横截面较 正常腱索的异常纤维组织增多(可达2～3倍)，围绕正常形态上，表现为瓣膜变 薄透明，胶原卷曲降低，脆性增加，腱索冗长或断裂，前后瓣叶对合点后移， 造成二尖瓣关闭不全，瓣环扩大，左室容积增大。超声心动图术前依据这些 特征性表现对此病诊断率很高。从各切面观察，瓣叶明显增厚、卷曲，类似 风心病瓣膜增厚表现，但瓣叶交界无明显粘连，开放尚可，且瓣叶运动松散， 腱索冗长或收缩期见细小断裂腱索随血流摆动，对合点后移，彩色多普勒于 收缩期可见大量偏心血流信号。因长期大量反流，M型及二维超声表现瓣环扩 大，左室容积增大。
Carpentier classification
• Type I leaflet motion is normal but can be associated with MR if there is annular dilation (secondary MR) or a leaflet perforation [ˌpɜ:fəˈreɪʃn] . • Type II leaflet motion is excessive [ɪkˈsesɪv] and is most commonly due to MVP or flail leaflet. • Type III leaflet motion is restrictive, commonly seen in the presence of LV dilation (secondary MR) or rheumatic [rʊ'mætɪk] MV disease or other postinflammatory [pəʊstɪnf'læmətrɪ] conditions such as collagen [ˈkɔlədʒən] vascular disease胶原血管病, radiation injury, carcinoid syndrome, or drug-induced inflammatory changes.
2. Secondary MR.
• The leaflets are intrinsically normal in secondary MR, although minor leaflet thickening and annular calcification can be present. Most secondary MR is a disease of the LV. With adverse [ˈædvɜ:s] LV remodeling, one or both of the mitral leaflets are pulled apically into the LV as a result of the outward displacement of the papillary[pə'pɪlərɪ] muscles and annular dilated, This results in incomplete mitral leaflet closure. • Severe LA dilatation [ˌdaɪləˈteɪʃn] .
Three-dimensional echocardiography can provide detailed views of the complex structure of the MV apparatus
• A cross-commissural view (typically by TEE but approximated[əˈprɒksɪmət] by the transthoracic [trænzθɔ:'ræsɪk] apical two-chamber view) is good at identifying the lateral (P1) and medial (P3) scallops ['skɒləp] of the posterior leaflet and the middle (A2) anterior leaflet.
Typically, a 2D longaxis view runs through the middle portion of the anterior leaflet (A2) and the middle scallop of the posterior leaflet (P2).
LOREM IPSUM DOLOR
Three-dimensional echocardiographic frames of MVs from the LA view
Identifying the Mechanism of MR: Primary and Secondary MR
The mechanism of MR can be divided broadly into two categories, based on whether the mitral leaflets exhibit significant pathological abnormality or not (Table 5).
Etiology Of Mitral Regurgirtation
LOREM IPSUM DOLOR
New words
• chordae ['kɔ:di:],腱索 • Regurgirtation[rɪˌɡɜ:dʒɪ'teɪʃn] ，反流 • intrinsic [ɪnˈtrɪnsɪk]，内在的。 • distortion [dɪ'stɔ:ʃn]，扭曲 • apparatus [ˌæpəˈreɪtəs] 装置，器械 • myxomatous ['mɪksəmətəs] degeneration [dɪˌdʒenəˈreɪʃn]粘液变性。
New words
• Fibroelastic deficiency弹力纤维缺乏 • redundancy [rɪˈdʌndənsi]冗余 • adverse [ˈædvɜ:s]不良 • perforation [ˌpɜ:fəˈreɪʃn]，穿孔
MV apparatus [ˌæpəˈreɪtəs]
3. Mixed Etiology.
• Occasionally, patients may来自百度文库present with mixed etiologies of MR that include both primary and secondary MR.
LOREM IPSUM DOLOR
• For example, a patient with long-standing ischemic [ɪs'ki:mɪk] or nonischemic cardiomyopathy and secondary MR may rupture a chord and develop a flail leaflet. • Conversely, a patient with mild or moderate MR from primary leaflet pathology may have a myocardial infarction and develop worse MR from tethering of the already abnormal leaflets.
1. Primary MR.
• In primary MR, an intrinsic [ɪnˈtrɪnsɪk] abnormality of the leaflets causes the MR, whereas secondary MR results from distortion [dɪ'stɔ:ʃn] of the MV apparatus [ˌæpəˈreɪtəs] due to LV and/or LA remodeling. • The most common cause of primary MR is myxomatous ['mɪksəmətəs] degeneration [dɪˌdʒenəˈreɪʃn] • Fibroelastic deficiency refers to focal segmental pathology with thin leaflets, while Barlow’s disease refers to diffuse thickening and redundancy [rɪˈdʌndənsi] , typically affecting multiple segments of both leaflets and chordae.
• Includes the anterior and posterior mitral leaflets, • The mitral annulus, chordae ['kɔ:di:] tendinae, papillary[pə'pɪlərɪ] muscles, and the underlying LV myocardium（左室下壁心肌）. • Echocardiographic views and their relation to mitral anatomy [əˈnætəmi] and the three scallops ['skɒləp] of each leaflet have been reviewed in detail.
Barlow’s disease
Barlow病在我国较为常见，主要表现为瓣叶纤维弹性组织缺失、黏液样变性， 致使在形态上表现为瓣叶增厚、增宽，约为正常瓣叶的两倍并呈胶冻样改变， 瓣叶强度减低。Barlow病二尖瓣强度减低的最重要原因在于腱索的横截面较 正常腱索的异常纤维组织增多(可达2～3倍)，围绕正常形态上，表现为瓣膜变 薄透明，胶原卷曲降低，脆性增加，腱索冗长或断裂，前后瓣叶对合点后移， 造成二尖瓣关闭不全，瓣环扩大，左室容积增大。超声心动图术前依据这些 特征性表现对此病诊断率很高。从各切面观察，瓣叶明显增厚、卷曲，类似 风心病瓣膜增厚表现，但瓣叶交界无明显粘连，开放尚可，且瓣叶运动松散， 腱索冗长或收缩期见细小断裂腱索随血流摆动，对合点后移，彩色多普勒于 收缩期可见大量偏心血流信号。因长期大量反流，M型及二维超声表现瓣环扩 大，左室容积增大。
Carpentier classification
• Type I leaflet motion is normal but can be associated with MR if there is annular dilation (secondary MR) or a leaflet perforation [ˌpɜ:fəˈreɪʃn] . • Type II leaflet motion is excessive [ɪkˈsesɪv] and is most commonly due to MVP or flail leaflet. • Type III leaflet motion is restrictive, commonly seen in the presence of LV dilation (secondary MR) or rheumatic [rʊ'mætɪk] MV disease or other postinflammatory [pəʊstɪnf'læmətrɪ] conditions such as collagen [ˈkɔlədʒən] vascular disease胶原血管病, radiation injury, carcinoid syndrome, or drug-induced inflammatory changes.
2. Secondary MR.
• The leaflets are intrinsically normal in secondary MR, although minor leaflet thickening and annular calcification can be present. Most secondary MR is a disease of the LV. With adverse [ˈædvɜ:s] LV remodeling, one or both of the mitral leaflets are pulled apically into the LV as a result of the outward displacement of the papillary[pə'pɪlərɪ] muscles and annular dilated, This results in incomplete mitral leaflet closure. • Severe LA dilatation [ˌdaɪləˈteɪʃn] .
Three-dimensional echocardiography can provide detailed views of the complex structure of the MV apparatus
• A cross-commissural view (typically by TEE but approximated[əˈprɒksɪmət] by the transthoracic [trænzθɔ:'ræsɪk] apical two-chamber view) is good at identifying the lateral (P1) and medial (P3) scallops ['skɒləp] of the posterior leaflet and the middle (A2) anterior leaflet.
Typically, a 2D longaxis view runs through the middle portion of the anterior leaflet (A2) and the middle scallop of the posterior leaflet (P2).
LOREM IPSUM DOLOR
Three-dimensional echocardiographic frames of MVs from the LA view
Identifying the Mechanism of MR: Primary and Secondary MR
The mechanism of MR can be divided broadly into two categories, based on whether the mitral leaflets exhibit significant pathological abnormality or not (Table 5).
Etiology Of Mitral Regurgirtation
LOREM IPSUM DOLOR
New words
• chordae ['kɔ:di:],腱索 • Regurgirtation[rɪˌɡɜ:dʒɪ'teɪʃn] ，反流 • intrinsic [ɪnˈtrɪnsɪk]，内在的。 • distortion [dɪ'stɔ:ʃn]，扭曲 • apparatus [ˌæpəˈreɪtəs] 装置，器械 • myxomatous ['mɪksəmətəs] degeneration [dɪˌdʒenəˈreɪʃn]粘液变性。
New words
• Fibroelastic deficiency弹力纤维缺乏 • redundancy [rɪˈdʌndənsi]冗余 • adverse [ˈædvɜ:s]不良 • perforation [ˌpɜ:fəˈreɪʃn]，穿孔
MV apparatus [ˌæpəˈreɪtəs]