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首页> 外文期刊>Circulation journal >Mechanism of Early-Diastolic Mitral Regurgitation
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Mechanism of Early-Diastolic Mitral Regurgitation

机译：早期舒张二尖瓣反流的机制

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Ahemodynamically stable 64-year-old man withischemic cardiomyopathy was referred for echocardiographicevaluation before catheter ablationof ventricular arrhythmias. Echocardiography showed aseverely enlarged left ventricle with extended akineticregions at the apical level and mild functional mitral regurgitation(MR). Pulmonary arterial diastolic pressure estimatedfrom the pulmonary regurgitation velocity was10mmHg. Surprisingly, the MR occurred not only in systolebut also in early diastole (Figure A, Supplementary Figure;Supplementary Movie). Vector flow mapping (VFM) imagesrevealed that a clockwise vortex under the anterior mitralleaflet existed during the cardiac cycle (Figure B, whitearrows) and a counterclockwise vortex occurred just underthe aortic valve in the isovolumic relaxation period (IVR)(Figure B4, red arrow), generating blood flow towards theanterior mitral leaflet from the boundary of these vortices,which caused the occurrence of early-diastolic MR(Figure B5, circle). The pressure difference from the leftventricular (LV) outflow tract to the apex at IVR wasseverely reduced and the early-diastolic pressure was slightlyhigher in the apex compared with the base (Figure C,D),suggesting loss of LV suction. These findings suggestedthat boundary friction from sustained clockwise vortex,together with loss of driving pressure from the left atriumto the LV apex due to low left atrial pressure and loss ofLV suction, caused the counterclockwise vortex in the LV outflow tract and subsequent early-diastolic MR.Although the presence and physiological significance oflate-diastolic MR has previously been recognized, that ofearly-diastolic MR has not been reported. VFM providednovel information on the mechanism of early-diastolic MRgeneration.
机译：在心间心律失常的导管烧蚀前，厌氧上稳定的64岁的64岁男性在后脑曝气前提到了超声心动图。超声心动图显示Aseyeverelly扩大左心室，在顶端水平和温和的功能二尖瓣重新门（MR）处于延长的apeteCetegions。肺动脉舒张压估计肺反射速度为10mmHg。令人惊讶的是，MR不仅发生在SystoleBut的早期舒张中（图A，补充图;补充电影）。向量流程图（VFM）易于释放在心脏周期期间存在的前麦纳利拉拉内特下的顺时针涡流（图B，Whitearrows）和逆时针涡流发生在内脏弛豫期间（IVR）中的主动脉瓣（图B4，红色箭头） ，从这些涡流的边界产生朝向Theanterior二尖瓣宣传叶的血流，这导致早期舒张MR的发生（图B5，圆圈）。与IVR在IVR胰蛋白酶上的左侧（LV）流出的压力差异降低的压力差异，并且与碱（图C，D）相比，顶点中的早期舒张压略微高，表明LV吸入的损失。这些发现提出了从持续顺时针涡旋的界限摩擦，并且由于低心房压力和损失的左心房压力和损失吸入而导致从左荨麻疹的驱动压力损失，导致LV流出道和随后的早期舒张MR中的逆时针涡旋。尽管先前已经认识到了舒适的MR的存在和生理意义，但尚未报告舒张的先生。 VFM提供有关早期舒张性MRGERATION机制的信息。

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