Jegaden O, Rossi R, Delahaye F, Montagna P, Delaye J, Delahaye J P, Mikaeloff P
Hôpital cardiologique, Bron.
Arch Mal Coeur Vaiss. 1991 Sep;84(9):1297-301.
Between 1972 and 1987, 43 patients underwent isolated mitral valve replacement with mean pulmonary arterial pressures greater than 50 mmHg. The valve disease was stenosis in 13 cases, regurgitation in 15 cases and mixed mitral valve disease in 15 cases. Forty-one patients (95 %) had invalidating cardiac failure (Stages III and IV of the NYHA Classification). The hospital mortality was 2.3%. Thirteen patients died during follow-up, 8 of cardiac failure, 3 of sudden death and 2 died of non-cardiac causes. The 8 year actuarial survival was 82 +/- 7% with an average postoperative follow-up of 96 +/- 41 months. No patients were lost to follow-up. Eighty six per cent of survivors (25/29) are asymptomatic or paucisymptomatic. Doppler studies were performed in 22 patients, showing normal prosthetic function in 18 cases and an obstructive prosthesis in 4 cases. Seventeen patients had tricuspid regurgitation showing normal pulmonary artery systolic pressures in 9 cases and less than 55 mmHg in 5 cases. On average, systolic pulmonary artery pressure fell from 88 +/- 11 mmHg before to 33 +/- 9 mmHg after surgery (p = 0.01). These results show that severe pulmonary hypertension is not prohibitive for mitral valve replacement. The long-term results are good with functional improvement and reduction of pulmonary hypertension.
1972年至1987年间，43例平均肺动脉压大于50 mmHg的患者接受了单纯二尖瓣置换术。瓣膜疾病中，狭窄13例，反流15例，二尖瓣混合病变15例。41例（95%）患者存在失代偿性心力衰竭（纽约心脏协会心功能分级III级和IV级）。医院死亡率为2.3%。13例患者在随访期间死亡，8例死于心力衰竭，3例猝死，2例死于非心脏原因。8年精算生存率为82±7%，术后平均随访时间为96±41个月。无患者失访。86%的幸存者（25/29）无症状或症状轻微。对22例患者进行了多普勒检查，18例人工瓣膜功能正常，4例存在人工瓣膜梗阻。17例患者有三尖瓣反流，9例肺动脉收缩压正常，5例低于55 mmHg。平均而言，肺动脉收缩压从术前的88±11 mmHg降至术后的33±9 mmHg（p = 0.01）。这些结果表明，严重肺动脉高压并非二尖瓣置换术的禁忌证。长期效果良好，心功能改善，肺动脉高压减轻。
