探讨主动脉夹层合并主动脉瓣大量返流与主动脉瓣脱垂的超声心动图鉴别诊断。

回顾性分析1例临床初诊为主动脉瓣关闭不全，后经超声及CT血管造影(CTA)明确诊断为主动脉夹层患者的超声心动图影像特征。

患者因临床诊断为"主动脉瓣关闭不全"而就诊。超声心动图检查主动脉瓣可见大量反流，于舒张期可见膜片样结构脱入左室流出道，疑似脱垂的主动脉瓣。进一步检查发现该膜样结构回声起自主动脉根部并向上延伸，随血流大幅度漂动，舒张期部分进入左心室流出道。超声最终诊断结果为主动脉夹层并主动脉瓣大量反流，并随后经大血管CTA及手术所证实。

当超声心动图检查中发现主动脉瓣大量反流并伴有主动脉瓣脱垂时，应当特别注意观察瓣膜上方主动脉结构，尤其是当出现升主动脉扩张时，更应仔细观察是否有内膜剥脱，脱垂的瓣膜与剥脱内膜的关系，以避免将活动的剥脱内膜误诊为主动脉瓣脱垂。

To discuss the echocardiographic differential diagnosis of aortic dissection with severe aortic regurgitation and aortic valve prolapse.

The echocardiographic features of one case who was suspected as aortic valve insufficiency first and was confirmed as aortic dissection at last by echocardiography and computed tomography angiography (CTA) analyzed retrospectively.

A patient who was diagnosed as aortic valve insufficiency was analyzed.Severe aortic regurgitation and a prolapse flap could be found at left ventricular outflow tract in diastole, and the initial impression of this patient was aortic valve prolapse.Then the further imaging revealed that the flap structure originated from the aortic root and extended upward, and shifted into the left ventricular outflow tract with blood flow.So the patient was diagnosed as aortic dissection with severe aortic regurgitation finally, and was confirmed by followed CTA as well as surgery.

The structure of aortic root should be observed carefully when severe aortic regurgitation and aortic valve prolapse are found in echocardiography examination.To avoid misdiagnosis, it should be pay more attention to dissection when ascending aortic dilates.