MioAtlas
G3: 人工瓣膜

主动脉瓣生物瓣

外科置换为功能正常的主动脉瓣生物瓣（牛心包或猪生物组织安装在硬质三支架瓣架上或无支架瓣膜）。

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定义

外科置换为功能正常的主动脉瓣生物瓣（牛心包或猪生物组织安装在硬质三支架瓣架上或无支架瓣膜），特征为无金属喀喇音的柔和生物性开启和关闭，以及人工瓣孔固有的生理性收缩期跨瓣压差 [V1] [V5] [G23-05] [G23-06]。

严重程度标准

  • 严重程度分级：单一功能正常级别（单一）。
  • 根据 ASE 2024 指南 [V5, Tabla 5] 及 ASE 2009 [G23-05, Tabla 6] 的建议：
    • 峰值流速（Vmax）< 3.0 m/s（取决于型号和瓣膜尺寸，通常为 2.0–2.6 m/s）[V5] [G23-05]。
    • 平均跨主动脉瓣人工瓣压差 < 20 mmHg（常为 10–18 mmHg）[V5] [G23-05]。
    • 多普勒速度指数（DVI = VTI lvot / VTIpr）≥ 0.30 [V5] [G23-05]。
    • 正常有效瓣口面积（EOA）（通常 > 1.2 cm²）[V5] [G23-05]。
    • 无显著生物瓣反流或瓣周漏 [V5]。

分层表现

血流动力学

  • 基线平均收缩期跨瓣压差 < 20 mmHg [V5] [G23-05]。
  • 左心室后负荷正常化及收缩功能保留 [V1] [V5]。

心律

  • 正常窦性心律 [V1]。

ECG

  • 正常窦性心律图型或既往左心室肥厚进行性消退 [E1]。

心音与杂音

  • 无金属喀喇音：天然低沉的生物性开启和关闭（无机械金属人工瓣开启或关闭喀喇音）[G23-06] [G23-07]。
  • 第二心音（S2）：存在由组织瓣叶对合产生的清脆生物音质主动脉瓣成分（A2）[G23-06] [G1-11]。
  • 收缩期喷射 / 血流杂音：在胸骨右缘第 2 肋间（主动脉瓣区）闻及的正常人工瓣血流的柔和收缩中期喷射性杂音（1–2/6级），呈菱形 [G23-06] [G1-14]。
  • 正常第一心音（S1）[G1-10]。

动脉脉搏

  • 颈动脉脉搏正常，上升支良好 [B4]。

颈静脉搏动

  • 正常颈静脉搏动 [B3]。

负荷试验

  • 血流动力学负荷动作（Valsalva动作 / 下蹲位）：生理性正常反应，心输出量和喷射性杂音呈协调变异 [B1]。

模拟器严重程度分级

模拟器严重程度分级: 单一级别
基线心律: 正常窦性心律

亦称为： 主动脉瓣生物瓣 · 生物主动脉瓣 · 生物性主动脉人工瓣 · 组织性主动脉瓣置换 · 主动脉生物瓣

该组中的其他病变

文献来源

  1. [B1] Bedside diagnosis of systolic murmurs . N Engl J Med (1988) . DOI: 10.1056/NEJM198806163182404 PubMed: 2897627
  2. [B3] The jugular venous pressure revisited . Cleve Clin J Med (2013) . DOI: 10.3949/ccjm.80a.13039 PubMed: 24085809
  3. [B4] The Carotid Pulse . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250154
  4. [E1] AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology . Circulation (2009) . DOI: 10.1161/CIRCULATIONAHA.108.191097 PubMed: 19228820
  5. [G1-10] The First Heart Sound . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250175
  6. [G1-11] The Second Heart Sound . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250183
  7. [G1-14] Systolic Murmurs . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250186
  8. [G23-05] Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography . J Am Soc Echocardiogr (2009) . DOI: 10.1016/j.echo.2009.07.013 PubMed: 19733789
  9. [G23-06] Auscultation of the normally functioning prosthetic valve . Ann Intern Med (1981) . DOI: 10.7326/0003-4819-95-5-594 PubMed: 7294551
  10. [G23-07] Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research . J Am Coll Cardiol (2021) . DOI: 10.1016/j.jacc.2021.02.038 PubMed: 33888385
  11. [V1] 2025 ESC/EACTS Guidelines for the management of valvular heart disease . Eur Heart J (2025) . DOI: 10.1093/eurheartj/ehaf194 PubMed: 40878295
  12. [V5] Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography . J Am Soc Echocardiogr (2024) . DOI: 10.1016/j.echo.2023.10.004 PubMed: 38182282