CAROTID DUPLEX SONOGRAPHY - BISFERIOUS PULSE CONTOUR IN PATIENTS WITH AORTIC VALVULAR DISEASE
CAROTID DUPLEX SONOGRAPHY - BISFERIOUS PULSE CONTOUR IN PATIENTS WITH AORTIC VALVULAR DISEASE
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DOI：
10.2214/ajr.157.2.1853828
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发表时间：
1991-08-01
影响因子：
5
通讯作者：
GARDNER, DJ
中科院分区：
文献类型：
--
作者：
KALLMAN, CE;GOSINK, BB;GARDNER, DJ
主动脉瓣疾病患者的颈动脉多普勒波形中出现特征性收缩和舒张脉搏轮廓，这在以前关于颈动脉多普勒超声检查的出版物中尚未描述。本研究的目的是评价已知主动脉瓣疾病患者中这些颈动脉双功波形异常的存在和性质，并将这些变化与瓣膜功能障碍的严重程度相关联。研究组包括26例主动脉瓣返流或主动脉瓣返流合并主动脉瓣狭窄患者。由两名放射科医生回顾性审查双功研究中是否存在两个收缩期峰值，以及是否存在舒张期血流方向逆转。主动脉瓣反流的特征是两个收缩期峰值，从拉丁文“两次跳动”中被称为bisferious。“心脏病专家通过超声心动图将主动脉瓣返流分级为轻度、中度或重度。一组20例年龄匹配的无主动脉瓣疾病的患者进行了类似的评估。26例患者中13例（50%）表现为双辉型。26例患者中有5例（19%）舒张期血流明显逆转。4例患者在主动脉瓣置换术前后均进行了研究。3例患者术前有bisferious波形，其中2例还出现舒张期血流逆转。第四例患者有逆行性血流，但无收缩期轮廓异常。术后，所有颈动脉波形均正常。对照组的双功波形均无收缩期或舒张期特征性异常，双频谱和舒张期逆行血流是与主动脉瓣病变相关的多普勒模式。这些模式在主动脉瓣置换术后是可逆的。虽然超声心动图仍然是评价疑似瓣膜功能障碍的首选研究，但多达三分之一的主动脉瓣返流患者可能没有可检测到的杂音。因此，在颈动脉多普勒检查中识别这些模式可能提供临床有用的信息，并作为以前未被怀疑的心血管疾病的线索。
Characteristic systolic and diastolic pulse contours occur in the carotid Doppler waveforms of patients with aortic valvular disease that have not previously been described in publications concerning carotid duplex sonography. The purpose of this study was to evaluate the presence and characterize the nature of these carotid duplex waveform abnormalities in patients with known aortic valve disease and to correlate these changes with the severity of valve dysfunction. The study group consisted of 26 patients with aortic regurgitation or combined aortic regurgitation and aortic stenosis. Duplex studies were retrospectively reviewed by two radiologists for the presence of two systolic peaks, and for the presence of diastolic reversal of flow direction. This pattern of two systolic peaks, characteristic of aortic regurgitation, is called bisferious from the Latin "twice beating." Aortic regurgitation was graded by echocardiography as mild, moderate, or severe by the cardiologists reviewing the examination. A group of 20 age-matched patients without aortic valvular disease were similarly assessed. The bisferious pattern was demonstrated in 13 (50%) of 26 patients. Five (19%) of 26 patients had significant reversal of diastolic flow. Four patients were studied both before and after aortic valve replacement. Three had bisferious wave contours preoperatively; two of these also had diastolic reversal of flow. The fourth patient had retrograde flow in diastole without systolic contour abnormality. Postoperatively, all carotid waveforms were normal. None of the duplex waveforms in the control group demonstrated characteristic systolic or diastolic abnormalities.The bisferious waveform and retrograde diastolic flow are Doppler patterns associated with aortic valvular disease. These patterns are reversible after aortic valve replacement. While echocardiography remains the study of choice in the evaluation of suspected valvular dysfunction, up to one third of patients with aortic regurgitation may not have a detectable murmur. Therefore, identifying these patterns on carotid duplex examinations may provide clinically useful information and serve as a clue to previously unsuspected cardiovascular disease.