以前當(dāng)我看資料碰到“tether”，“tethering”，“l(fā)eaflet tethering”的時候，我不知道這是什么意思。在“菲根鮑姆超聲心動圖學(xué)”中文譯本中，“tethering”被譯為“圈合效應(yīng)”，但我并不能形象地理解這是一個什么樣的效應(yīng)。通過翻閱原版?“Feigenbaum’s Echocardiography” 書，才有了較為合適的理解。

字典對“tether”的釋義為：to tie an animal to a post so that it cannot move very far，簡單理解就是“牽住或拴住物體以影響、限制其運(yùn)動”。在心臟活動中就可以理解為“結(jié)構(gòu)之間的牽拉或阻礙，以限制或影響結(jié)構(gòu)的活動”。這種影響可以是雙向的。例如：冠心病梗死范圍較大時，運(yùn)動減弱或消失的心肌節(jié)段牽拉鄰近正常的心肌，使其收縮活動也減弱，導(dǎo)致心超下觀察到的異常運(yùn)動范圍大于實(shí)際梗死范圍。而當(dāng)心梗范圍很小時，鄰近正常的心肌運(yùn)動牽拉梗死處心肌，導(dǎo)致心超下觀察不到微小的梗死區(qū)異?；顒印?/span>從原版 “Feigenbaum’s Echocardiography” 書中取幾個例子如下：

1.Complicating any of the quantitative analyses of regional wall motion in ischemic disease is the phenomenon of?tethering. This can occur on either a horizontal orvertical basis and occurs because the motion of a segment with intrinsically normal function may be altered by its proximity to an abnormal segment which “tethers” the adjacent normal segment and reduces its apparent function.? ?

“牽拉現(xiàn)象”增加了對缺血性心肌病局部室壁運(yùn)動進(jìn)行定量分析的難度。這一現(xiàn)象可發(fā)生于水平方向或垂直方向，是由于異常運(yùn)動的心肌節(jié)段牽拉鄰近的正常心肌，使得正常心肌活動受限，功能測值減低。

2.functional tricuspid regurgitation may occur in any disease causing right ventricular dilation including volume overload related to shunt or primary disease of right ventricular myocardium. The severity of functional tricuspid regurgitation isrelated to the degree?of apical?tethering of the tricuspid leaflets.

任何引起右室擴(kuò)張的疾病，如異常分流或原發(fā)性心肌病引起的容量超負(fù)荷，均可導(dǎo)致功能性三尖瓣反流。反流程度與擴(kuò)張的心尖對三尖瓣葉的牽拉程度有關(guān)。

3. Apical four-chamber view recorded in a patient with a dilated cardiomyopathy and arecently implanted pacemaker/implantable defibrillator. The pacing wires can benoted in (A) (arrow), in (B) note the centrally originating but subsequently eccentric moderate tricuspid regurgitation jet. The initial convergence zone (downward-pointing arrow) corresponds?to a location of?leaflet tethering?by the pacemaker wire.”??

A圖箭頭示心尖四腔心切面示擴(kuò)心病患者右心的起搏器和除顫儀導(dǎo)線。B圖中心性起源的反流，跨三尖瓣后變?yōu)槠男苑戳?。箭頭所示的血流會聚區(qū)對應(yīng)于被導(dǎo)線阻礙了閉合活動的三尖瓣葉所在位置。