Silver M D, Wilson G J
Circulation. 1977 Oct;56(4 Pt 1):617-22. doi: 10.1161/01.cir.56.4.617.
We examined 13 Beall model 104 prostheses recovered at surgery or autopsy 10 to 84 1/2 months after insertion and observed the pattern of prosthesis wear. We defined wear as "mild" when the disc was notched but neither the metal of the struts was exposed not the cloth seat torn. In "moderate" wear the disc was notched, the Teflon coating of the struts was worn away exposing the underlying metal but the cloth of the set was not torn. The cloth seat was torn in "severe" wear, exposing the metal seat and causing a different pattern of disc erosion. In one case this allowed the disc to tilt into the valve lumen and, later, to escape from its cage. Most of the prostheses studied showed "moderate" or "severe" wear. We believe that some degree of wear is inevitable. Clinical signs and symptoms were not specific but a rough correlation existed between the severity of hemolysis, as indicated by serum LDH levels, and the degree of prosthesis wear. When wear was "severe", the results of cardiac catheterization studies usually mirrored the change, but there were a few exceptions. All patients with the Beall model 104 prosthesis may eventually develop "severe" wear, and we recommend regular reassessment with a view toward prosthesis replacement.
我们检查了13个在植入后10至84.5个月时通过手术或尸检回收的Beall 104型假体，并观察了假体磨损情况。当瓣膜有缺口但支柱金属未暴露且布质座未撕裂时，我们将磨损定义为“轻度”。“中度”磨损时，瓣膜有缺口，支柱的特氟龙涂层磨损，露出下面的金属，但座的布质未撕裂。“重度”磨损时布质座撕裂，露出金属座并导致瓣膜侵蚀模式不同。有一例中，这使得瓣膜倾斜进入瓣膜腔，随后从其笼架中脱出。大多数研究的假体显示为“中度”或“重度”磨损。我们认为一定程度的磨损是不可避免的。临床体征和症状并不特异，但血清乳酸脱氢酶水平所显示的溶血严重程度与假体磨损程度之间存在大致的相关性。当磨损为“重度”时，心导管检查结果通常反映出这种变化，但也有少数例外情况。所有使用Beall 104型假体的患者最终可能都会出现“重度”磨损，我们建议定期重新评估，以便考虑更换假体。
