Takai Hideaki, Yamachika Shiro, Hazama Shiro, Ariyoshi Tsuneo, Odate Tomohiro, Matsukuma Seiji, Yanatori Makoto, Onohara Daisuke, Eishi Kiyoyuki
Department of Cardiovascular Surgery, School of Medicine, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
J Artif Organs. 2004;7(4):203-6. doi: 10.1007/s10047-004-0270-z.
The assessment of prosthesis patient mismatch (PPM) for small aortic annulus is important for prognosis after aortic valve replacement (AVR). Recent investigations have demonstrated that PPM occurs in AVR patients with an indexed effective orifice area (iEOA) of less than 0.85 cm2/m2. We investigated hemodynamic performance and left ventricular mass (LVM) regression after AVR. Eighteen patients who underwent AVR using a 19-mm Carpentier-Edwards pericardial (CEP) valve without annular enlargement were studied by echocardiography and Doppler examination 4 months after AVR. Patients were divided into two groups on the basis of their body surface area (BSA); the smaller BSA (group S, 1.14-1.36 m2, nine patients) and the larger BSA (group L, 1.40-1.83 m2, nine patients). Of these 18 patients, ten underwent isolated AVR, and five underwent AVR with coronary artery bypass graft; (i.e., double valvular replacement, AVR with maze procedure, and AVR with mitral valvulophasty. There were no statistically significant differences between the two groups, except for age (group S, 78.3+/-2.5 years; group L, 73.6+/-2.4 years). There was no significant difference for the iEOA during the late phase at rest (group S, 1.10+/-0.26 cm2; group L, 1.02+/-0.28 cm2). However, there was a significant difference for the LVM regression between the preoperative and postoperative values (group S, 243+/-23.6 mg/cm2 [pre], 190+/-16.9 mg/cm2 [post]; group L, 302+/-13.7 mg/cm2 [pre], 199+/-16.7 mg/cm2 [post]). In elderly Japanese patients with a BSA of less than 18 m2, we demonstrated LVM regression and avoidance of PPM after implantation of the aortic 19-mm CEP valve.
评估小主动脉瓣环患者的人工瓣膜-患者不匹配(PPM)对于主动脉瓣置换术(AVR)后的预后很重要。最近的研究表明,PPM发生在指数有效瓣口面积(iEOA)小于0.85 cm²/m²的AVR患者中。我们研究了AVR后的血流动力学性能和左心室质量(LVM)回归情况。对18例使用19毫米Carpentier-Edwards心包(CEP)瓣膜且未进行瓣环扩大的AVR患者在AVR后4个月进行了超声心动图和多普勒检查。根据体表面积(BSA)将患者分为两组;较小的BSA(S组,1.14 - 1.36 m²,9例患者)和较大的BSA(L组,1.40 - 1.83 m²,9例患者)。在这18例患者中,10例接受了单纯AVR,5例接受了AVR联合冠状动脉旁路移植术;(即双瓣膜置换、AVR联合迷宫手术以及AVR联合二尖瓣成形术)。除年龄外(S组,78.3±2.5岁;L组,73.6±2.4岁),两组之间无统计学显著差异。静息晚期iEOA无显著差异(S组,1.10±0.26 cm²;L组,1.02±0.28 cm²)。然而,术前和术后LVM回归有显著差异(S组,243±23.6 mg/cm²[术前],190±16.9 mg/cm²[术后];L组,302±1³.7 mg/cm²[术前],199±16.7 mg/cm²[术后])。在体表面积小于1.8 m²的老年日本患者中,我们证明了植入19毫米主动脉CEP瓣膜后LVM回归且避免了PPM。