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患者,男性,7岁。临床表现:自幼常感冒,发热,发育稍差,心尖区中度舒张期杂音,胸骨左缘3、4肋间Ⅲ级收缩期杂音,伴有震颤,多次检查抗O、血沉等,均正常。用HP新500型诊断仪,扇形相控阵探头,频率2.5MHz,取左侧卧位,胸骨旁左室长短轴,心尖四腔心等切面。(1)二维:各切面均未发现后内侧乳头肌,仅见左室后外侧壁的单个乳头肌,且二尖瓣前后叶的腱索均汇集于此,腱索增粗、缩短,呈降落伞型,左房增大。彩色血流显象(DFI):舒张期血流经过腱索间隙后形成多彩镶嵌的射流束。脉冲多普勒(PDE):取样容积(SV)置于二尖瓣口及腱索水平下发现舒张期射流信号起自于腱索水平,且采用压力降半时间法测得二尖瓣开放的最大面积2.12cm~2。(2)室间隔上段见回声中断且见经此缺损口收缩期左向右分流束,缺损口0.4mm,连续多普勒(CDE)测得峰速3.5m/s。本病例诊断伞型二尖瓣畸形合并室间隔缺损(VSD)。 讨论 二尖瓣伞型畸形是先天性二尖瓣狭窄的主要类型。其病理变化为左室内仅有单个乳头肌,二尖瓣前后叶的腱索均集中于此,致使瓣叶不能充分开放,而左房内的血流经过腱索之间的空隙才能进入左
Patient, male, 7 years old. Clinical manifestations: since childhood, often cold, fever, slightly worse, moderate diastolic murmur in the apex, sternal left intercostal 3,4 intercostal Ⅲ systolic murmur, accompanied by tremor, multiple checks of anti-O, ESR, etc. normal. With HP new 500 diagnostic apparatus, fan-shaped phased array probe, frequency 2.5MHz, left lateral decubitus, parasternal left ventricular long axis, apical four-chamber heart and other sections. (1) two-dimensional: no posterior medial papillary muscle was found in all sections, only a single papillary muscle of the posterior lateral ventricular wall was found, and the anterior and posterior mitral leaf chordae tendons were collected here, the tendons thicken and shorten, Type, left atrial enlargement. Color flow imaging (DFI): diastolic blood flow through the chordae after the formation of colorful mosaic jets. Pulsed Doppler (PDE): Sampling volume (SV) placed at the level of mitral valve and tendon revealed diastolic jet signal from the level of chordae, and the pressure drop half-time method measured mitral valve open The largest area of 2.12cm ~ 2. (2) See the echo in the upper septal segment interrupted and see the defect systolic left to right shunt, defect 0.4mm mouth, continuous Doppler (CDE) measured peak speed 3.5m / s. This case is diagnosed as umbrella mitral valve malformation combined with ventricular septal defect (VSD). Discussed mitral valve umbrella deformity is the main type of congenital mitral stenosis. The pathological changes of the left ventricle is only a single papillary muscles, anterior and posterior mitral leaf chordae are concentrated in this, resulting in leaflets can not be fully open, while the left atrial blood flow through the gaps between the tendons to enter the left