心臟超音波報告解讀：二尖瓣修復手術前後的心臟狀況比較-心臟血管專科

心臟超音波報告解讀？

敬愛的吳醫師您好：在下因為曾患感染性心內膜炎造成二尖瓣逆流嚴重，於2021年12月初進行了二尖瓣修補手術，以下是手術前二次及手術後二次的心臟超音波報告，想請您幫忙解讀，
1、今年8/25的追綜檢查報告是否樂觀？
2、心臟變大的情形？
3、平常生活上有沒有需注意的事項？
4、可以進行慢跑運動來保養身體嗎？謝謝您。
一、2021/07/30(手術前)
2 BSA: 1.9 m Interpretation Summary Eccentric LVH Aortic root dilatation.39mm Left ventricular systolic function is preserved (cutoff 60% is normal in severe MR) Ruptured mitral valve chordae P2 leaflet.(Hx of prior IE? )？ Mitral regurgitation severe with pulmonary vein reversal. EROA 0.91cm2？ LVESD 36mm ESDi 19mm/m2 No resting pulmonary HTN. consider surgery if LVESD progresses rapidly or over 40mm MMode/2D Measurements ＆ Calculations IVSd: 1.0 cm LVIDd: 6.0 cm FS: 40.2 % LV mass(C)d: 256.4 grams 2 LVIDs: 3.6 cm EDV(Teich): 180.9 ml LV mass(C)dI: 134.6 grams/m LVPWd: 1.0 cm ESV(Teich): 54.2 ml LVIDs Index: 1.9 cm EF(Teich): 70.0 % RWT_: 0.34 2 2 Ao root diam: 3.9 cm LVOT diam: 2.1 cm LVAd ap4: 42.9 cm LVAd ap2: 38.9 cm 2 LVOT area: 3.5 cm LVLd ap4: 9.3 cm LVLd ap2: 8.8 cm EDV(MOD-sp4): 167.0 ml EDV(MOD-sp2): 145.0 ml EDV(sp4-el): 169.0 ml EDV(sp2-el): 145.9 ml 2 2 LVAs ap4: 25.2 cm LVAs ap2: 19.7 cm LVLs ap4: 7.4 cm LVLs ap2: 7.1 cm ESV(MOD-sp4): 70.1 ml ESV(MOD-sp2): 45.9 ml ESV(sp4-el): 72.2 ml ESV(sp2-el): 46.7 ml EF(MOD-sp4): 58.0 % EF(MOD-sp2): 68.3 % EF(sp4-el): 57.3 % EF(sp2-el): 68.0 % SV(MOD-sp4): 96.9 ml SV(sp4-el): 96.8 ml EDV(MOD-bp): 175.5 ml SV(MOD-sp4) Index: 26.7 ml ESV(MOD-bp): 54.9 ml EF(MOD-bp): 68.7 % Doppler Measurements ＆ Calculations MV E max vel: 97.7 cm/sec MV dec time: 0.18 sec Ao V2 max: 119.4 cm/sec LV V1 max PG: 4.3 mmHg MV A max vel: 63.7 cm/sec Ao max PG: 5.7 mmHg LV V1 mean PG: 2.0 mmHg 2 MV E/A: 1.5 AVA(VD): 3.0 cm LV V1 max: 104.1 cm/sec LV V1 mean: 64.6 cm/sec LV V1 VTI: 16.8 cm 2 MR max vel: 240.0 cm/sec MR PISA: 5.7 cm SV(LVOT): 58.5 ml PA V2 max: 79.5 cm/sec 3 MR max PG: 43.3 mmHg SV(LVOT) index: 30.7 ml PA max PG: 2.5 mmHg MR flow rate: 219.1 cm /sec 2 2 MR mean vel: 364.5 cm/sec PA acc slope: 579.2 cm/sec MR ERO: 0.91 cm MR mean PG: 59.5 mmHg PA acc time: 0.13 sec MR volume: 117.2 ml MR VTI: 128.3 cm MR PISA radius: 0.95 cm MR alias vel: 38.5 cm/sec TR max vel: 239.0 cm/sec TR max PG: 23.7 mmHg Page 1 of 2 Left Ventricle Eccentric LVH. Left ventricular systolic function is borderline reduced. Mitral Valve Ruptured mitral valve chordae posterior leaflet. Mitral regurgitation severe. Great Vessel Aortic root dilatation. Mode 2D+ Color.

二、2021/11/1(手術前)
2 BSA: 1.9 m Interpretation Summary Eccentric LVH Left ventricular systolic function is preserved Ruptured mitral valve chordae P2 leaflet.(Hx of prior IE )？ Eccentric Mitral regurgitation moderate-severe The LV systolic function is normal The left atrium is borderline dilated. Tricuspid regurgitation mild Pulmonic regurgitation mild MMode/2D Measurements ＆ Calculations IVSd: 0.75 cm LVIDd: 6.4 cm FS: 36.3 % LV mass(C)d: 188.0 grams 2 LVIDs: 4.1 cm EDV(Teich): 209.1 ml LV mass(C)dI: 98.4 grams/m LVPWd: 0.72 cm ESV(Teich): 73.4 ml LVIDs Index: 2.1 cm EF(Teich): 64.9 % RWT_: 0.22 Ao root diam: 3.4 cm ACS: 1.9 cm LA dimension: 4.3 cm Doppler Measurements ＆ Calculations MV E max vel: 103.0 cm/sec MV dec time: 0.19 sec Ao V2 max: 97.0 cm/sec PA V2 max: 55.8 cm/sec MV A max vel: 89.7 cm/sec Ao max PG: 3.8 mmHg PA max PG: 1.2 mmHg MV E/A: 1.1 Ao V2 mean: 62.5 cm/sec PA acc time: 0.20 sec Ao mean PG: 1.9 mmHg Ao V2 VTI: 19.6 cm TR max vel: 165.6 cm/sec TR max PG: 11.0 mmHg Left Ventricle Eccentric LVH. The LV systolic function is normal. No regional wall motion abnormality was noted. Left Atrium The left atrium is borderline dilated. Mitral Valve Ruptured mitral valve chordae posterior leaflet. Mitral regurgitation moderate to severe. Right Heart The right ventricle is normal in size and function. Normal right atrial size. Tricuspid regurgitation mild. Pulmonic regurgitation mild. Page 1 of 2 Great Vessel Aortic root dilatation. PE There is no pericardial effusion. Mode 2D+ Color.

三、2022/10/06(手術後)
2 BSA: 1.9 m Interpretation Summary The left ventricle is grossly normal in size and shape. No regional wall motion abnormalities noted. The LV systolic function is normal. s/p Mitral valve repair with artificial chordae and annuloplasty ring Moderate mitral regurgitation. Mild tricuspid regurgitation. MMode/2D Measurements ＆ Calculations IVSd: 0.83 cm LVIDd: 5.1 cm FS: 44.9 % LV mass(C)d: 149.8 grams 2 LVIDd Index(2.2-3.0): 2.6 EDV(Teich): 126.2 ml LV mass(C)dI: 77.1 grams/m LVIDs: 2.8 cm ESV(Teich): 30.5 ml LVIDs Index(1.3-2.1): 1.5 EF(M52%F54%): 75.8 % LVPWd: 0.83 cm RWT_: 0.32 Ao root diam: 4.0 cm asc Aorta Diam: 3.3 cm 2 Ao root area: 12.3 cm ACS: 2.0 cm LA dimension: 4.0 cm Doppler Measurements ＆ Calculations MV V2 max: 159.9 cm/sec Ao V2 max: 92.8 cm/sec LV V1 max PG: 2.5 mmHg PA V2 max: 57.8 cm/sec MV max PG: 10.2 mmHg Ao max PG: 3.4 mmHg LV V1 mean PG: 1.4 mmHg PA max PG: 1.3 mmHg 2 MV V2 mean: 101.8 cm/sec LV V1 max: 79.5 cm/sec PA acc slope: 383.8 cm/sec MV mean PG: 4.7 mmHg LV V1 mean: 54.7 cm/sec PA acc time: 0.15 sec MV V2 VTI: 43.4 cm LV V1 VTI: 16.6 cm TR max vel: 232.3 cm/sec TR max PG: 21.6 mmHg Left Ventricle The left ventricle is grossly normal in size and shape. The LV systolic function is normal. No regional wall motion abnormalities noted. Left Atrium The left atrial size is normal. Right Heart The right ventricle is normal in size and function. Right atrial size is normal. Mitral Valve s/p Mitral valve repair with artificial chordae. An annuloplasty ring is noted in the mitral position. Page 1 of 2 CFM_Doppler There is moderate mitral regurgitation. There is mild tricuspid regurgitation. Mode 2D+ Color.

四、2023/8/25(手術後)
2 BSA: 1.9 m Interpretation Summary The left ventricle is borderline dilated. The LV systolic function is normal The left atrium is mildly dilated. Prior mitral valvuloplasty annuloplasty ring Mitral regurgitation moderate Tricuspid regurgitation mild-moderate MMode/2D Measurements ＆ Calculations IVSd: 1.0 cm LVIDd: 5.3 cm FS: 38.6 % LV mass(C)d: 213.6 grams 2 LVIDd Index(2.2-3.0): 2.8 EDV(Teich): 136.3 ml LV mass(C)dI: 112.3 grams/m LVIDs: 3.3 cm ESV(Teich): 42.9 ml LVIDs Index(1.3-2.1): 1.7 EF(M52%F54%): 68.5 % LVPWd: 1.1 cm RWT_: 0.40 Ao root diam: 3.2 cm asc Aorta Diam: 3.1 cm 2 Ao root area: 8.2 cm ACS: 2.1 cm LA dimension: 4.3 cm Doppler Measurements ＆ Calculations MV E max vel: 180.3 cm/sec MV V2 max: 198.2 cm/sec MV dec time: 0.20 sec Ao V2 max: 121.4 cm/sec MV A max vel: 159.1 cm/sec MV max PG: 15.7 mmHg Ao max PG: 5.9 mmHg MV E/A: 1.1 MV V2 mean: 118.8 cm/sec MV mean PG: 6.5 mmHg MV V2 VTI: 49.0 cm LV V1 max PG: 2.8 mmHg PA V2 max: 58.7 cm/sec TR max vel: 260.6 cm/sec LV V1 mean PG: 1.0 mmHg PA max PG: 1.4 mmHg TR max PG: 27.2 mmHg 2 LV V1 max: 83.9 cm/sec PA acc slope: 394.0 cm/sec LV V1 mean: 53.9 cm/sec PA acc time: 0.15 sec LV V1 VTI: 16.5 cm Left Ventricle The left ventricle is borderline dilated. The LV systolic function is normal. No regional wall motion abnormality was noted. Left Atrium The left atrium is mildly dilated. Mitral Valve Prior mitral valvuloplasty annuloplasty ring. Mitral regurgitation moderate. Page 1 of 2 Right Heart Tricuspid regurgitation mild-moderate. Mode 2D+ Color.

阿d，50~59歲男性，詢問日期：2023/09/02

吳學明醫師回覆-心臟血管專科

醫事人員經歷：衛生福利部桃園醫院心臟內科主任、臨床技能中心主任

術後仍有中度的二尖瓣膜逆流，請定期回門診追蹤規則服藥並規律運動。

回覆日期：2023/09/02
資料來源：台灣e院 - 心臟超音波報告解讀

彙整補充說明

根據您提供的心臟超音波報告，以下是對於您問題的解讀與建議：
1. 追蹤檢查報告的樂觀性：
您在2023年8月25日的檢查報告顯示，左心室的大小邊緣擴大，但心臟的收縮功能仍然正常（LVEF約68.5%），這是相對樂觀的結果。
雖然左心房輕度擴大和中度的二尖瓣逆流仍然存在，但整體心臟功能的保持是值得肯定的。
這意味著手術後的心臟功能尚未顯著惡化，且仍需定期追蹤。

2. 心臟變大的情形：
根據報告，左心室的大小被描述為“邊緣擴大”，這可能是由於二尖瓣逆流造成的血液回流，導致心臟需要更努力地工作以維持正常的血液循環。
左心房的輕度擴大也可能是由於二尖瓣逆流的影響。
這些變化需要密切監控，特別是如果左心室的擴大持續進行，可能會影響心臟的長期健康。

3. 生活上的注意事項：
- 定期回診：建議您定期回診，尤其是在心臟功能或症狀有變化的情況下。
醫生可能會根據您的狀況調整治療計畫。

- 藥物遵從性：遵循醫生的指示，按時服用任何處方藥物，這對於控制心臟病的進展非常重要。

- 監測症狀：注意任何新的症狀，如胸痛、呼吸困難或心悸，並及時告知醫生。

4. 運動建議：
您可以進行慢跑等有氧運動，但建議在開始之前先諮詢您的主治醫師。
運動有助於增強心臟功能和整體健康，但需根據您的具體情況進行調整。
醫生可能會建議您從低強度的運動開始，並逐漸增加強度，以避免過度負荷心臟。

總結來說，您的心臟超音波檢查結果顯示出手術後的心臟功能保持良好，雖然存在中度的二尖瓣逆流和輕度的心臟擴大，但這些情況是可以透過定期的醫療監控和適當的生活方式管理來控制的。
請務必與您的醫療團隊保持良好的溝通，並根據他們的建議進行相應的生活調整。
希望您能夠保持健康，並在日常生活中注意心臟的保健。