Unger-Graeber B, Lee R T, Sutton M S, Plappert M, Collins J J, Cohn L H
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Am J Cardiol. 1991 Mar 1;67(6):517-9. doi: 10.1016/0002-9149(91)90014-c.
To compare the hemodynamic results of different anuloplasty techniques of primary valve repair for mitral regurgitation, 122 patients were prospectively studied with Doppler echocardiograms 5 to 10 days after operation. Seventy-seven patients had mitral valve prolapse, 27 had coronary artery disease, 13 patients had rheumatic mitral valve lesions and 5 patients had infective endocarditis. Forty-eight patients received the flexible Duran ring, 46 received the more rigid Carpentier ring and 28 patients received no ring. Doppler echocardiography demonstrated a significant decrease in mitral valve area estimated by the pressure half-time method in patients who received either a Carpentier (2.6 +/- 0.8 cm2) or Duran ring (2.8 +/- 0.8 cm2) when compared with patients who received no ring (3.2 +/- 0.7 cm2) (p = 0.01). No significant differences were observed for peak transmitral diastolic velocity, peak transmitral diastolic gradient, or the grade of mitral regurgitation by color flow Doppler mapping between patients with and without rings. The etiology of mitral disease and concomitant surgical procedures accompanying mitral valve repair did not significantly influence mitral valve area, peak velocity or peak gradient. These data suggest that Carpentier and Duran rings decrease the hemodynamic mitral valve area; however, the decrease in valve area is small and not associated with a clinically important increase in transvalvular gradient.
为比较二尖瓣反流初次瓣膜修复不同瓣环成形技术的血流动力学结果，对122例患者术后5至10天进行了前瞻性多普勒超声心动图研究。77例患者有二尖瓣脱垂，27例有冠状动脉疾病，13例有风湿性二尖瓣病变，5例有感染性心内膜炎。48例患者接受了柔性杜兰环，46例接受了更硬的卡彭蒂埃环，28例患者未使用环。多普勒超声心动图显示，与未使用环的患者（3.2±0.7 cm²）相比，接受卡彭蒂埃环（2.6±0.8 cm²）或杜兰环（2.8±0.8 cm²）的患者通过压力减半时间法估算的二尖瓣面积显著减小（p = 0.01）。通过彩色多普勒血流图测量，有环和无环患者之间的二尖瓣舒张期峰值流速、二尖瓣舒张期峰值压差或二尖瓣反流程度均未观察到显著差异。二尖瓣疾病的病因以及二尖瓣修复时伴随的手术操作对二尖瓣面积、峰值流速或峰值压差没有显著影响。这些数据表明，卡彭蒂埃环和杜兰环会减小二尖瓣的血流动力学面积；然而，瓣膜面积的减小很小，且与跨瓣压差临床上的重要增加无关。
