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目的研究左室不同部位心肌梗死(MI)所致缺血性二尖瓣反流(IMR)与改良Carpentier分类和左室整体重构的关系。方法对65例临床诊断为MI合并中度二尖瓣反流而无器质性瓣膜病变患者行超声心动图检查。测量左室整体重构指标,采用基于超声心动图的改良Carpentier法对二尖瓣反流机制进行分类。结果 (1)左室下壁MI 29例,27例为ⅢC型(93.1%,27/29),表现为二尖瓣后叶运动明显减低,瓣叶对合错位,偏心性反流沿后叶走行;2例为ⅠC型(6.9%,2/29),表现为左室下壁基底段局限性MI,二尖瓣叶运动正常,MR呈中心性。左室前壁MI 36例,31例为ⅢB型(86.1%,31/36),表现为二尖瓣前后叶运动减低,MR呈中心性;5例为ⅠC型(13.9%,5/36)。(2)反映左室整体重构指标LVEDV、LVEF和SID在左室前壁MI组ⅢB型中的改变较左室下壁ⅢC型更为显著,差异有统计学意义(P<0.01)。结论不同部位MI所致IMR机制有所不同,基于超声心动图的改良Carpentier分类有助于判断左室MI部位。
Objective To investigate the relationship between ischemic mitral regurgitation (IMR) induced by myocardial infarction (MI) and modified Carpentier classification and left ventricular remodeling in different regions of the left ventricle. Methods Echocardiography was performed in 65 patients with clinically diagnosed MI with moderate mitral regurgitation without organic valve disease. The left ventricular remodeling index was measured and the mitral valve regurgitation mechanism was classified by modified Carpentier method based on echocardiography. Results (1) There were 29 cases of MI in the inferior wall of the left ventricle and 27 cases of type Ⅲ C in 27 cases (29.1%). The motion of mitral valve was obviously reduced, 2 cases of type Ⅰ C (6.9%, 2/29), the performance of the basal segment of the left ventricular wall limitations MI, mitral valve leaflets normal motion, MR was central. Left anterior chamber MI 36 cases, 31 cases of type Ⅲ B (86.1%, 31/36), showed mitral valve anterior and posterior motion decreased, MR was central; 5 cases of type Ⅰ C (13.9%, 5/36) . (2) The changes of LVEDV, LVEF and SID in the left ventricular anterior MI group were more significant than those in the lower left ventricular IIIC group (P <0.01). Conclusions The IMR mechanism caused by different parts of MI is different. The improved Carpentier classification based on echocardiography is helpful to judge the MI of left ventricle.