Marchandise B, Piette F, Chalant C H, Kremer R
Acta Cardiol. 1975;30(2):111-28.
Among 304 cases of aortic valvulopathies studied for surgical selection, the authors have found a high incidence of conduction disturbances (16% in aortic stenosis and 18,4% in aortic regurgitation). The conduction defects are mostly intraventricular among stenosis isolated or associated to regurgitation and mostly atrio-ventricular among pure aortic insufficiencies. The highest incidence (30%) being found in patients with bacterial endocarditis acute or healed. The incidence of conduction disturbances increases with age, with the presence of valvular calcifications, of left ventricular strain or failure, of coronary insufficiency and angina... practically with the duration and the severity of the valvular disease. Surgical risk is heavier and natural prognosis poorer in valvulopathies with conduction disturbances. But these disturbances never contraindicates surgery : it is sometimes necessary to insert a pacemaker with or without valvular replacement mostly in aortic stenosis with infrahisian conduction defects. During hemodynamic investigation of such cases one must be ready to stimulate the heart, particularly during right heart catheterization of patients with complete left bundle branch block.
在为手术选择而研究的304例主动脉瓣病变病例中，作者发现传导障碍的发生率很高（主动脉狭窄中为16%，主动脉反流中为18.4%）。在孤立的狭窄或合并反流的情况下，传导缺陷大多发生在室内，而在单纯主动脉瓣关闭不全时，大多发生在房室之间。在急性或已愈合的细菌性心内膜炎患者中发生率最高（30%）。传导障碍的发生率随年龄增长、瓣膜钙化、左心室劳损或衰竭、冠状动脉供血不足和心绞痛而增加……实际上与瓣膜疾病的持续时间和严重程度有关。伴有传导障碍的瓣膜病变手术风险更大，自然预后更差。但这些障碍从不构成手术禁忌：在有希氏束下传导缺陷的主动脉狭窄患者中，有时有必要在置换瓣膜的同时或不置换瓣膜的情况下植入起搏器。在对此类病例进行血流动力学检查时，必须随时准备刺激心脏，尤其是在对完全性左束支传导阻滞患者进行右心导管检查时。
