Забавный клапан
Модератор: Pyankov Vasily
Забавный клапан
Женщина , 26 лет. ЭхоКГ ей, конечно, не нужно. Но, как говорится, что сделано...
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С уважением, Кира Далгатова.
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Очень похоже на двухотверстный МК или double orifice, вариант врожденного стеноза, очень редкий у нас на 20000 исследований детей всего 2 наблюдения. какой градиент? есть по-моему 3 типа.
Сслылки как Василий не бросаю, их полно хоть гуглем или пабмедом- не проблема, а вот свой опыт...
Сслылки как Василий не бросаю, их полно хоть гуглем или пабмедом- не проблема, а вот свой опыт...
Александр Соколов
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Все-таки не удержался - вот картинка наша+статья про проблему,
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- dblORIFICEvalv.pdf
- а это о проблеме
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Александр Соколов
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Спасибо, именно об этом я и думала.sokolov166 писал(а):Очень похоже на двухотверстный МК
Based on the echocardiographic studies, DOMV has been classified into three types by Trowitzsch et al These are as follows:
1. Complete bridge type: Two separate complete orifices are visible from the leaflet edges all the way through the body of the leaflet. Both the orifices are circular, almost equal in size, and appear like a pair of spectacles.
2. Incomplete bridge type: A connection is seen between the anterior and posterior leaflets only at the leaflet edges. At the mid-basal level, the mitral valve appears normal.
3. Hole type: A single orifice is present at the leaflet level. An additional smaller orifice is visible in one of the two commissures oriented roughly at a right angle to the main orifice.
http://www.ispub.com/journal/the_intern ... eport.html
Александр Анатольевич! Приведенный Вами случай, вероятно, сomplete bridge type. Красивая картинка, настоящие «очки». Можно ли посмотреть другие позиции и клапан в цвете?
В данном случае я вижу некую структуру, будто соединяющую края створок МК. Это хорошо заметно в первом сердечном цикле по длинной оси при покадровом просмотре. По короткой оси МК раскрывается двумя отверстиями только в срезе по кончикам створок, ближе к основанию клапана раскрытие выглядит нормальным. Картина вроде бы соответствует incomplete bridge type DOMV. А стеноза никакого нет. Что, в общем-то не противоречит данным литературы. «Usually this anomaly does not lead to any significant hemodynamic effects, sometimes it is regurgitant and rarely stenotic. Hence most descriptions of this anomaly were casual observations at autopsy or during surgery for other associated cardiac defects. More recently, two dimensional echocardiography has allowed a non-invasive and more frequent detection of this abnormality.»
Вот еще клип по короткой оси на уровне ПМ.
С уважением, Кира Далгатова.
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Ecть и другая классификация Double orifice mitral valve:
Eccentric or hole type
This is the most common type, accounting for about 85%, and was seen in the first case reported by Greenfield in 1876.It is characterized by a larger main orifice and a smaller accessory orifice situated at either the anterolateral or the posteromedial commissure. Other anomalies of the valve apparatus, such as cleft leaflets, accessory papillary muscles, fused papillary muscles, and crossing chordae tendineae, are commonly present. Abnormal chordal rings, with or without subjacent papillary musculature, are a constant finding in this classic type. When the accessory orifice is located at the posteromedial commissure, a common atrioventricular canal is usually present. By comparison, the atrioventricular canal is normally divided if the accessory orifice is located at the anterolateral commissure.
Central or bridge type
In about 15% of patients with double orifice mitral valve, a central bridge of fibrous or abnormal leaflet tissue connects the 2 leaflets of the mitral valve, dividing the orifice into medial and lateral parts. These 2 openings may be equal or unequal, and the papillary muscles are usually normal, with chordae surrounding each orifice inserting into one papillary muscle. In this type of double orifice mitral valve, dilatation of the posteromedial orifice is feasible by means of balloon valvuloplasty.
Duplicate mitral valve type
This condition involves 2 mitral valve annuli and valves, each with its own set of leaflets, commissures, chordae, and papillary muscles.
http://emedicine.medscape.com/article/897322-overview
Eccentric or hole type
This is the most common type, accounting for about 85%, and was seen in the first case reported by Greenfield in 1876.It is characterized by a larger main orifice and a smaller accessory orifice situated at either the anterolateral or the posteromedial commissure. Other anomalies of the valve apparatus, such as cleft leaflets, accessory papillary muscles, fused papillary muscles, and crossing chordae tendineae, are commonly present. Abnormal chordal rings, with or without subjacent papillary musculature, are a constant finding in this classic type. When the accessory orifice is located at the posteromedial commissure, a common atrioventricular canal is usually present. By comparison, the atrioventricular canal is normally divided if the accessory orifice is located at the anterolateral commissure.
Central or bridge type
In about 15% of patients with double orifice mitral valve, a central bridge of fibrous or abnormal leaflet tissue connects the 2 leaflets of the mitral valve, dividing the orifice into medial and lateral parts. These 2 openings may be equal or unequal, and the papillary muscles are usually normal, with chordae surrounding each orifice inserting into one papillary muscle. In this type of double orifice mitral valve, dilatation of the posteromedial orifice is feasible by means of balloon valvuloplasty.
Duplicate mitral valve type
This condition involves 2 mitral valve annuli and valves, each with its own set of leaflets, commissures, chordae, and papillary muscles.
http://emedicine.medscape.com/article/897322-overview
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