Morehead A J, Firstenberg M S, Shiota T, Qin J, Armstrong G, Cosgrove D M, Thomas J D
Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Ann Thorac Surg. 2000 Jan;69(1):135-9. doi: 10.1016/s0003-4975(99)01080-2.
Paravalvular jets, documented by intraoperative transesophageal echocardiography, have prompted immediate valve explantation by others, yet the significance of these jets is unknown.
Twenty-seven patients had intraoperative transesophageal two-dimensional color Doppler echocardiography, performed to assess the number and area of regurgitant jets after valve replacement, before and after protamine. Patients were grouped by first time versus redo operation, valve position and type.
Before protamine, 55 jets were identified (2.04+/-1.4 per patient) versus 29 jets after (1.07+/-1.2 per patient, p = 0.0002). Total jet area improved from 2.0+/-2.2 cm2 to 0.86+/-1.7 cm2 with protamine (p<0.0001). In all patients jet area decreased (average decrease, 70.7%+/-27.0%). First time and redo operations had similar improvements in jet number and area (both p>0.6). Furthermore, mitral and mechanical valves each had more jets and overall greater jet area when compared to aortic and tissue valves, respectively.
Following valve replacement, multiple jets are detected by intraoperative transesophageal echocardiography. They are more common and larger in the mitral position and with mechanical valves. Improvement occurs with reversal of anticoagulation.
术中经食管超声心动图记录的瓣周漏，已促使其他医生立即进行瓣膜置换，但这些瓣周漏的意义尚不清楚。
27例患者在术中接受经食管二维彩色多普勒超声心动图检查，以评估在使用鱼精蛋白前后瓣膜置换术后反流束的数量和面积。患者按初次手术与再次手术、瓣膜位置和类型分组。
使用鱼精蛋白前，共识别出55个反流束（每位患者2.04±1.4个），而使用后为29个（每位患者1.07±1.2个，p = 0.0002）。使用鱼精蛋白后，反流束总面积从2.0±2.2平方厘米改善至0.86±1.7平方厘米（p<0.0001）。所有患者的反流束面积均减小（平均减小70.7%±27.0%）。初次手术和再次手术在反流束数量和面积方面的改善相似（p均>0.6）。此外，与主动脉瓣和生物瓣膜相比，二尖瓣和机械瓣膜的反流束分别更多且总面积更大。
瓣膜置换术后，术中经食管超声心动图可检测到多个反流束。它们在二尖瓣位置和使用机械瓣膜时更常见且更大。抗凝逆转后情况有所改善。
