KAVANAGH-GRAY D, GERIEN A
Can Med Assoc J. 1964 Oct 24;91(17):887-92.
Representative case histories are used to discuss the difficulties in preoperative assessment of patients with multiple valve disease and the dangers of correcting one lesion when two or more valves are seriously damaged. Errors fall into three broad categories: existing second valve disease (1) may not be suspected, (2) may be considered insignificant or (3) may be considered a consequence of the first.Recommendations are offered to minimize these errors. The four valves should be studied physiologically, no matter how "normal" the other three may appear to be clinically, whenever open-heart surgery is contemplated. In bivalvular disease angiographic methods are preferable to pressure studies, for data so obtained are not dependent on cardiac output. Mitral and tricuspid regurgitation can never be attributed with certainty to a more distal lesion but require direct examination at time of operation for assessment.
通过典型病例讨论多瓣膜病患者术前评估的困难，以及当两个或更多瓣膜严重受损时纠正一个病变的风险。错误大致分为三类：存在的第二个瓣膜疾病（1）可能未被怀疑，（2）可能被认为无关紧要，或（3）可能被认为是第一个瓣膜疾病的后果。本文提出了将这些错误降至最低的建议。无论其他三个瓣膜在临床上看起来多么“正常”，只要考虑进行心脏直视手术，都应从生理学角度对四个瓣膜进行研究。在双瓣膜病中，血管造影方法优于压力研究，因为这样获得的数据不依赖于心输出量。二尖瓣和三尖瓣反流绝不能肯定地归因于更远处的病变，而需要在手术时进行直接检查以评估。
