Djavidani Behrus, Schmid Franz X, Keyser Andreas, Butz Bernhard, Seitz Johannes, Luchner Andreas, Debl Kurt, Feuerbach Stefan, Nitz Wolfgang R
Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany.
J Cardiovasc Magn Reson. 2004;6(1):1-8. doi: 10.1081/jcmr-120027799.
The primary objective of our study was to assess the time course of left ventricular remodeling after the Ross procedure with the use of cine magnetic resonance imaging (MRI).
In a prospective study, 10 patients with isolated aortic valve disease were examined prior to aortic valve surgery, as well as at early follow-up (mean 4 weeks) and at late follow-up (mean 8 months) after pulmonary autograft aortic valve replacement (Ross procedure). The heart was imaged with a 1.5 T MR scanner along the short and long axes using a breath-hold, electrocardiogram (ECG)-triggered, cine gradient-echo sequence (FLASH). Myocardial mass and ventricular function were assessed.
After aortic valve replacement, left ventricular myocardial mass (LVM) decreased by 13% (261 +/- 74 g to 230 +/- 65 g, p < 0.05) in the early postoperative period and by a further 16% in the late postoperative period to 192 +/- 31 g (p < 0.05). In addition, left ventricular end-diastolic and end-systolic volumes decreased from preoperative 187 +/- 89 mL (LV EDV) and 73 +/- 59 mL (LV ESV) to 119 +/- 55 mL and 56 +/- 42 mL, respectively, in the early postoperative period. In the late postoperative period, there was a further decrease to 98 +/- 30 (p < 0.05) and 33 +/- 19 mL, respectively. Ejection fraction did not change markedly after surgery (preoperatively 61 +/- 13% vs. 56 +/- 14% postoperatively). Patients with leading aortic stenosis were characterized by predominant regression of LVM and patients with leading aortic regurgitation by predominant regression of LV EDV (each p < 0.05).
Cine MRI allows accurate assessment of left ventricular structure and geometry before and after aortic valve replacement with pulmonary autograft and is very sensitive in detecting relatively small changes of left ventricular myocardial mass and volumes early after hemodynamic relief as well as during serial assessment.
我们研究的主要目的是使用电影磁共振成像（MRI）评估Ross手术后左心室重塑的时间进程。
在一项前瞻性研究中，对10例孤立性主动脉瓣疾病患者在主动脉瓣手术前、肺自体移植主动脉瓣置换术（Ross手术）后的早期随访（平均4周）和晚期随访（平均8个月）时进行检查。使用1.5T MR扫描仪沿短轴和长轴对心脏进行成像，采用屏气、心电图（ECG）触发的电影梯度回波序列（FLASH）。评估心肌质量和心室功能。
主动脉瓣置换术后，术后早期左心室心肌质量（LVM）下降13%（从261±74g降至230±65g，p<0.05），术后晚期进一步下降16%，降至192±31g（p<0.05）。此外，术后早期左心室舒张末期和收缩末期容积分别从术前的187±89mL（左心室舒张末期容积）和73±59mL（左心室收缩末期容积）降至119±55mL和56±42mL。在术后晚期，分别进一步降至98±30（p<0.05）和33±19mL。术后射血分数无明显变化（术前61±13%，术后56±14%）。以主动脉瓣狭窄为主的患者LVM主要消退，以主动脉瓣反流为主的患者左心室舒张末期容积主要消退（均p<0.05）。
电影MRI能够准确评估肺自体移植主动脉瓣置换术前、后的左心室结构和形态，并且在血流动力学改善后早期以及连续评估期间检测左心室心肌质量和容积的相对较小变化时非常敏感。
