Pakrashi B C, Mary D A, Tandon A P, Abid A, Ionescu M I
Eur J Cardiol. 1976 Jun;4(2):151-63.
Sequential hemodynamic studies were performed at mean intervals of 6 and 38 months following mitral valve replacement in 10 patients who had angiographically competent fascia lata valves and in whom preoperative hemodynamic studies were available. The cardiac index did not change significantly during postoperative studies as compared with the preoperative values, and its response in relation to oxygen uptake during exercise remained impaired. The mean pulmonary wedge and pulmonary artery pressures showed significant reduction at the first and the second postoperative studies, both at rest and during exercise. Progressive reduction in the pulmonary vascular resistance occurred in patients with high initial values, although the group mean did not alter significantly. The mean diastolic gradient across the mitral fascial valves averaged 8.1 +/- 1.3 mm Hg at rest rising to 22.5 +/- 2.4 mm Hg during exercise (P less than 0.001), and the calculated mitral valve area was 1.9 +/- 0.22 cm2 at rest and 2.36 +/- 0.3 cm2 during exercise (P less than 0.02). This study indicates that the insertion of stented mitral fascia lata valves results in significant hemodynamic improvement, which is maintained at least for 3 years after surgery, in patients with competent valves. However, a degree of obstruction to the forward flow is apparent especially during exercise, despite the central flow design of the valve.
对10例二尖瓣置换术后的患者进行了序贯血流动力学研究，这些患者的阔筋膜瓣在血管造影检查中功能良好且术前有血流动力学研究数据。平均间隔时间分别为6个月和38个月。与术前值相比，术后研究期间心脏指数无显著变化，其在运动时对氧摄取的反应仍受损。平均肺楔压和肺动脉压在术后首次和第二次研究中，无论静息还是运动时均显著降低。初始值较高的患者肺血管阻力逐渐降低，尽管组均值无显著改变。二尖瓣阔筋膜瓣静息时平均舒张期压差平均为8.1±1.3 mmHg，运动时升至22.5±2.4 mmHg（P<0.001），计算得出的二尖瓣面积静息时为1.9±0.22 cm²，运动时为2.36±0.3 cm²（P<0.02）。本研究表明，对于瓣膜功能良好的患者，植入带支架的二尖瓣阔筋膜瓣可显著改善血流动力学，且术后至少3年维持这种改善。然而，尽管瓣膜采用了中心血流设计，但特别是在运动期间，仍存在一定程度的前向血流梗阻。
