Villari B, Hess O M, Meier C, Pucillo A, Gaglione A, Turina M, Krayenbuehl H P
Department of Internal Medicine, University Hospital, Zurich, Switzerland.
Circulation. 1992 Mar;85(3):972-8. doi: 10.1161/01.cir.85.3.972.
The effect of regression of myocardial hypertrophy on coronary artery dimensions was evaluated in patients with aortic valve disease who underwent valve replacement.
Cross-sectional area (CSA) of the three major coronary arteries (left anterior descending [LAD], left circumflex [LCx], and right coronary artery) was determined by quantitative coronary arteriography in 15 patients with aortic valve disease before and 38 months (range, 14-113 months) after successful aortic valve replacement. Twelve normal subjects served as controls. Left ventricular (LV) angiographic mass was calculated according to the method of Rackley. CSA of the left coronary artery was larger in aortic valve disease than in controls (LAD, 15 versus 8 mm2, p less than 0.001; LCx, 14 versus 6 mm2, p less than 0.001). After valve replacement, CSA of the left coronary artery decreased (LAD, 12 mm2, p less than 0.05 versus before surgery; LCx, 11 mm2, p less than 0.05 versus before surgery) but remained significantly larger than in controls. CSA of the right coronary artery in patients with aortic valve disease was not different from controls. LV muscle mass was significantly increased in aortic valve disease patients before (364 g) and after (250 g) valve replacement compared with controls (135 g). The appropriateness of coronary artery size with respect to muscle mass was evaluated by normalizing CSA of the left coronary artery (LAD + LCx) per 100 g of LV muscle mass (mm2/100 g). This index amounted to 11 mm2/100 g in controls, to 8 mm2/100 g in preoperative patients (p less than 0.05 versus controls), and to 10 mm2/100 g in postoperative patients with aortic valve disease (p = NS versus controls).
In patients with aortic valve disease, CSA of the proximal LAD and LCx is increased, but this increase is not sufficient to keep CSA per 100 g of LV mass within normal limits. The postoperative decrease in muscle mass is associated with a decrease in the size of LAD and LCx, whereas the size of the right coronary artery remains unchanged. In contrast to the preoperative state, the residually hypertrophied LV myocardium after aortic valve replacement is supplied by an enlarged but adequately sized LAD and LCx.
在接受瓣膜置换术的主动脉瓣疾病患者中，评估心肌肥厚消退对冠状动脉尺寸的影响。
通过定量冠状动脉造影术测定了15例主动脉瓣疾病患者在成功进行主动脉瓣置换术前及术后38个月（范围14 - 113个月）时三大冠状动脉（左前降支[LAD]、左旋支[LCx]和右冠状动脉）的横截面积（CSA）。12名正常受试者作为对照。左心室（LV）造影质量根据Rackley方法计算。主动脉瓣疾病患者左冠状动脉的CSA大于对照组（LAD，15对8mm²，p<0.001；LCx，14对6mm²，p<0.001）。瓣膜置换术后，左冠状动脉的CSA减小（LAD，12mm²，与手术前相比p<0.05；LCx，11mm²，与手术前相比p<0.05），但仍显著大于对照组。主动脉瓣疾病患者右冠状动脉的CSA与对照组无差异。与对照组（135g）相比，主动脉瓣疾病患者术前（364g）和术后（250g）的左心室肌肉质量显著增加。通过将左冠状动脉（LAD + LCx）的CSA每100g左心室肌肉质量（mm²/100g）进行标准化，评估冠状动脉大小与肌肉质量的适配性。该指标在对照组中为11mm²/100g，术前患者中为8mm²/100g（与对照组相比p<0.05），主动脉瓣疾病术后患者中为10mm²/100g（与对照组相比p =无显著性差异）。
在主动脉瓣疾病患者中，近端LAD和LCx的CSA增加，但这种增加不足以使每100g左心室质量的CSA保持在正常范围内。术后肌肉质量的减少与LAD和LCx大小的减小相关，而右冠状动脉的大小保持不变。与术前状态相反，主动脉瓣置换术后残留肥厚的左心室心肌由扩大但大小合适的LAD和LCx供血。
