MioAtlas
G3: 人工瓣膜

二尖瓣机械瓣

二尖瓣置换为功能正常的机械瓣（热解碳双叶瓣），具有特征性金属关闭喀喇音及生理范围内的跨瓣舒张期压差。

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定义

二尖瓣置换为功能正常的机械瓣（热解碳双叶瓣），特征为响亮、金属质感的机械第一心音（关闭喀喇音）、紧随第二心音之后的金属开启喀喇音，以及处于生理限度内的层流跨瓣舒张期平均压差 [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 6] 及 ASE 2009 [G23-05, Tabla 8] 的建议：
    • 峰值流速（Vmax）< 1.9–2.0 m/s [V5] [G23-05]。
    • 平均跨二尖瓣人工瓣压差 ≤ 5–6 mmHg（正常基线心率下常为 3–5 mmHg）[V5] [G23-05]。
    • 多普勒速度指数比值（DVI = VTIpr / VTI lvot）< 2.2 [V5] [G23-05]。
    • 压力半降时间（PHT）< 130 ms [V5] [G23-05]。
    • 正常有效瓣口面积（EOA）（通常 ≥ 1.7–2.0 cm²）[V5] [G23-05]。
    • 无病理性跨瓣反流或瓣周漏 [V5]。

分层表现

血流动力学

  • 平均舒张期跨瓣压差 ≤ 5 mmHg [V5] [G23-05]。
  • 平均肺毛细血管楔压及左心腔压力正常，若既往心房僵硬持续存在则轻度升高 [V5] [G23-05]。

心律

  • 正常窦性心律，或作为既往左心房重构后遗症频发心房颤动 [V1] [G23-05]。

ECG

  • 窦性心律或心房颤动；可见残留左心房扩大的体征 [E1]。

心音与杂音

  • 机械关闭喀喇音（S1）：第一心音被在心尖部最响并传导至全心前区的极响亮、清脆、高频金属喀喇音所替代 [G23-06] [G23-07]。
  • 机械开启喀喇音：在第二心音A2成分之后立即闻及的高频金属开启喀喇音（在热解碳瓣叶倾斜开启进入LV心腔的瞬间）[G23-06] [G23-07]。
  • 舒张期血流杂音 / 隆隆样杂音：人工瓣孔层流产生的可能存在的微弱、柔和舒张期隆隆样杂音（1/6级）[G23-06] [G1-15]。
  • 第二心音（S2）：保留自身天然生物性A2和P2成分 [G1-11]。

动脉脉搏

  • 正常外周动脉脉搏 [B4]。

颈静脉搏动

  • 正常颈静脉搏动 [B3]。

负荷试验

  • 运动 / 心率增快：因舒张充盈时间缩短使平均跨瓣压差中度增加，而喀喇音保持清脆 [G23-05]。

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： 二尖瓣机械瓣 · 机械二尖瓣 · 二尖瓣机械瓣置换 · 双叶二尖瓣机械瓣 · 二尖瓣机械假体

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. [G1-15] Diastolic Murmurs . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250187
  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