Pibarot P, Dumesnil J G, Cartier P C, Métras J, Lemieux M D
Quebec Heart Institute, Laval Hospital, Laval University, Sainte-Foy, Canada.
Ann Thorac Surg. 2001 May;71(5 Suppl):S265-8. doi: 10.1016/s0003-4975(01)02509-7.
Patient-prosthesis mismatch is a frequent cause of high postoperative gradients in normally functioning prostheses. The objective of this study was to determine whether mismatch can be predicted at the time of operation.
Indices used to predict mismatch were valve size, indexed internal geometric area, and projected indexed effective orifice area (EOA) calculated at the time of operation, and results were compared with indexed EOA and mean gradients measured by Doppler echocardiography after operation in 396 patients.
The sensitivity and specificity of these indices to detect mismatch, defined as a postoperative indexed EOA of 0.85 cm2/m2 or less, were respectively: 35% and 84% for valve size, 46% and 85% for indexed internal geometric area, and 73% and 80% for projected indexed EOA. Projected indexed EOA also correlated best with resting (r = 0.67) and exercise (r = 0.77) postoperative gradients.
The projected indexed EOA calculated at the time of operation accurately predicts mismatch as well as resting and exercise postoperative gradients, whereas valve size and indexed internal geometric area cannot be used for this purpose.
人工瓣膜-患者不匹配是正常功能人工瓣膜术后出现高跨瓣压差的常见原因。本研究的目的是确定在手术时能否预测不匹配情况。
用于预测不匹配的指标包括手术时计算的瓣膜大小、体表面积校正后的内部几何面积以及预计的体表面积校正有效瓣口面积（EOA），并将结果与396例患者术后通过多普勒超声心动图测量的体表面积校正EOA和平均压差进行比较。
这些指标检测不匹配（定义为术后体表面积校正EOA≤0.85 cm2/m2）的敏感性和特异性分别为：瓣膜大小的敏感性和特异性分别为35%和84%，体表面积校正后的内部几何面积为46%和85%，预计的体表面积校正EOA为73%和80%。预计的体表面积校正EOA与术后静息状态（r = 0.67）和运动状态（r = 0.77）下的压差也具有最佳相关性。
手术时计算的预计体表面积校正EOA能够准确预测不匹配情况以及术后静息和运动状态下的压差，而瓣膜大小和体表面积校正后的内部几何面积不能用于此目的。
