Hirata N, Sakakibara T, Shimazaki Y, Watanabe S, Nomura F, Akamatsu H, Sasaki J, Kodama K, Nakano S, Kawashima Y
Cardiovascular Division, Osaka Police Hospital, Japan.
J Thorac Cardiovasc Surg. 1992 Oct;104(4):1029-34.
To elucidate the effects of mitral valve surgery on right ventricular function in 11 patients with mitral stenosis, pre- and postoperative right ventricular function were quantified using gated equilibrium blood pool radionuclide ventriculography at rest and during exercise. The preoperative right ventricular ejection fraction was 39 +/- 4% at rest and 36 +/- 9% during exercise, which during exercise was lower than control values (51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction was lower during exercise than at rest, postoperative right ventricular ejection fraction during exercise was lower than normal values (42 +/- 3% versus 51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction did not decrease during exercise, the postoperative right ventricular ejection fraction was within normal limits during exercise (54 +/- 5%). In addition, postoperative right ventricular ejection fraction during exercise increased to normal values in patients whose preoperative right ventricular ejection fraction during exercise had been 40% or higher. Preoperative peak ejection rate was -1.81 +/- 0.19 EDV/sec at rest and -1.72 +/- 0.39 EDV/sec during exercise, which during exercise was lower than control values (-2.44 +/- 0.53 EDV/sec) (p < 0.01). Postoperatively, peak ejection rate during exercise (-2.50 +/- 0.37 EDV/sec) increased (p < 0.05) to normal levels. Preoperative peak filling rate was 1.61 +/- 0.47 EDV/sec at rest and 1.88 +/- 0.54 EDV/sec during exercise, which during exercise was lower than control values (2.58 +/- 0.62 EDV/sec) (p < 0.01). Postoperatively, peak filling rate during exercise (2.82 +/- 0.62 EDV/sec) increased (p < 0.05) to normal values in all patients. Preoperative changes in both right ventricular ejection fraction and peak ejection rate from rest to exercise inversely correlated with the preoperative pulmonary vascular resistance at rest (right ventricular ejection fraction, r = -0.79, p < 0.005; and peak ejection rate, r = -0.67, p < 0.05). In conclusion, right ventricular systolic function improved in about half of the patients with mitral stenosis, and diastolic function improved in all patients during exercise following surgery. When the preoperative pulmonary vascular resistance was elevated, the right ventricular systolic dysfunction persisted.
为阐明二尖瓣手术对11例二尖瓣狭窄患者右心室功能的影响，在静息和运动状态下，采用门控平衡心血池放射性核素心室造影术对患者术前和术后的右心室功能进行定量分析。术前右心室静息射血分数为39±4%，运动时为36±9%，运动时低于对照组值（51±5%）（p<0.01）。当术前运动时右心室射血分数低于静息时，术后运动时右心室射血分数低于正常值（42±3%对51±5%）（p<0.01）。当术前运动时右心室射血分数未降低时，术后运动时右心室射血分数在正常范围内（54±5%）。此外，术前运动时右心室射血分数≥40%的患者，术后运动时右心室射血分数升至正常水平。术前静息时峰值射血率为-1.81±0.19EDV/秒，运动时为-1.72±0.39EDV/秒，运动时低于对照组值（-2.44±0.53EDV/秒）（p<0.01）。术后运动时峰值射血率（-2.50±0.37EDV/秒）升高（p<0.05）至正常水平。术前静息时峰值充盈率为1.61±0.47EDV/秒，运动时为1.88±0.54EDV/秒，运动时低于对照组值（2.58±0.62EDV/秒）（p<0.01）。术后所有患者运动时峰值充盈率（2.82±0.62EDV/秒）均升高（p<0.05）至正常水平。术前右心室射血分数和峰值射血率从静息到运动的变化与术前静息时肺血管阻力呈负相关（右心室射血分数，r=-0.79，p<0.005；峰值射血率，r=-0.67，p<0.05）。总之，约半数二尖瓣狭窄患者右心室收缩功能改善，术后所有患者运动时舒张功能均改善。术前肺血管阻力升高时，右心室收缩功能障碍持续存在。
