Girard S E, Miller F A, Orszulak T A, Mullany C J, Montgomery S, Edwards W D, Tazelaar H D, Malouf J F, Tajik A J
Division of Cardiovascular Disease, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
J Am Coll Cardiol. 2001 Feb;37(2):579-84. doi: 10.1016/s0735-1097(00)01113-x.
We sought to: 1) identify trends in the diagnostic testing of patients with prosthetic aortic valve (AVR) obstruction who undergo reoperation and 2) compare diagnostic test results with pathologic findings at surgery.
It is unclear whether Doppler transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have reduced hemodynamic catheterization rates.
We reviewed 92 consecutive cases ofAVR reoperation at a single center from 1989 to 1998, comparing 49 cases of mechanical AVR obstruction (group A) to 43 cases of bioprosthetic obstruction (group B). Preoperative Doppler TTE was performed in all cases.
In group A cases, there was a marginally significant trend towards lower catheterization rates for the Gorlin AVR area, from 36% in 1989 to 1990 to 10% in 1997 to 1998 (p = 0.07), but diagnostic TEE utilization (47% of cases) did not vary. The cause of mechanical AVR obstruction was pannus in 26 cases (53%), mismatch (P-PM) in 19 (39%) and thrombosis in 4 (8%). The mechanism (pannus/thrombus vs. mismatch) was identified in 10% by TTE and 49% by TEE (p < 0.001). In group B cases, hemodynamic catheterization rates (21%) and diagnostic TEE utilization (21%) did not vary with time. Obstruction was caused by structural degeneration in 37 cases (86%), thrombosis in 3 (7%), mismatch in 2 (5%) and pannus in 1 (2%). The mechanism was correctly identified in 63% by TTE and in 81% by TEE (p = 0.18).
Doppler TTE is the primary means to diagnose AVR obstruction; hemodynamic catheterization is not routinely needed. In unselected patients with mechanical AVR obstruction, TEE differentiation of pannus or thrombus from mismatch is challenging.
我们试图：1）确定接受再次手术的人工主动脉瓣（AVR）梗阻患者诊断性检查的趋势，以及2）将诊断性检查结果与手术时的病理结果进行比较。
尚不清楚经胸多普勒超声心动图（TTE）和经食管超声心动图（TEE）是否降低了血流动力学导管检查率。
我们回顾了1989年至1998年在单一中心连续进行的92例AVR再次手术病例，将49例机械性AVR梗阻病例（A组）与43例生物瓣梗阻病例（B组）进行比较。所有病例均在术前进行了多普勒TTE检查。
在A组病例中，对于戈林AVR面积，导管检查率有略微显著的下降趋势，从1989年至1990年的36%降至1997年至1998年的10%（p = 0.07），但诊断性TEE的使用率（47%的病例）没有变化。26例（53%）机械性AVR梗阻的原因是瓣周漏，19例（39%）是不匹配（P-PM），4例（8%）是血栓形成。通过TTE确定机制（瓣周漏/血栓与不匹配）的比例为10%，通过TEE为49%（p < 0.001）。在B组病例中，血流动力学导管检查率（21%）和诊断性TEE的使用率（21%）没有随时间变化。梗阻由结构退变引起的有37例（86%），血栓形成3例（7%），不匹配2例（5%），瓣周漏1例（2%）。通过TTE正确识别机制的比例为63%，通过TEE为81%（p = 0.18）。
多普勒TTE是诊断AVR梗阻的主要手段；通常不需要进行血流动力学导管检查。在未经选择的机械性AVR梗阻患者中，TEE区分瓣周漏或血栓与不匹配具有挑战性。
