Bernardes L, Abreu J, Soares R, Matos P, Ramos J S, Salomão S
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa.
Rev Port Cardiol. 1990 Dec;9(12):973-9.
To evaluate the flow characteristics of normal and abnormal functioning mechanical and bioprosthetic (B) mitral valves.
Prospective study in patients submitted to mitral valve replacement.
Laboratory of Echocardiography at Santa Marta Hospital.
61 consecutive and asymptomatic patients with normally functioning mitral prosthesis (prt)--37 Bjork-Shiley (B-S), 11 Carpentier-Edwards (C-E), 5 Hancok (HAN), 7 Ionescu-Shiley (I-S) and 1 Wessex--and 15 pts with abnormal prosthetic function (6 B-S, 5 Hall-Kaster, 2 C-E, 1 I-S and 1 HAN).
Prosthetic mitral flow record, using 2D-Doppler echocardiography, to analyse: peak velocity (PV), peak gradient (PG), mean gradient (MG), pressure half time (PHT), area (A) and presence of regurgitation (R).
Normally functioning prosthetic valves--PV ranged from 88 to 186 cm/s (134.6 +/- 24.3) in B-S prt and 133 to 198 cm/s (157.4 +/- 18.8) in B, p less than 0.0001. The prt B-S showed a greater PG (10.3 +/- 2.5 vs 7.6 +/- 2.6 mmHg), MG (3.1 +/- 1.1 vs 2.6 +/- 1 mmHg) and smaller area (2.3 +/- 0.4 vs 2.5 +/- 0.4 cm2) then Bioprosthetic ones, p less than 0.0001, p = 0.003, p = 0.003 respectively. There was a significant correlation between PG and MG: r = 0.84, r = 0.87, r = 0.84 respectively in B-S prt, Bioprosthesis and both, p less than 0.001. Mild regurgitation was present in 8 pts with prt B-S and 4 with B. Malfunctioning prosthetic valves--The mean of PV was 238.5 +/- 29.2 cm/s in prt B-S compared to 265.48.2 +/- 48.2 cm/s in B. Significant regurgitation, was detected by Doppler technic in 100% of B and 72% of mechanical prt. PV greater than 2 m/s has a 100% sensitivity and specificity to separate normal from abnormal prosthesis function.
These data may be useful as reference values to the follow-up of pts with these types of prt. The prt B-S seems to have more optimal hemodynamics profile than B ones. Protodiastolic transprosthetic PV greater than 2 m/s suggest abnormal functioning valve. PG is a significant determinant of MG.
评估正常及异常功能的机械二尖瓣和生物瓣的血流特性。
对接受二尖瓣置换术的患者进行前瞻性研究。
圣玛尔塔医院超声心动图实验室。
61例连续且无症状的二尖瓣人工瓣膜功能正常的患者（假体）——37例 Bjork-Shiley（B-S）型、11例Carpentier-Edwards（C-E）型、5例Hancok（HAN）型、7例Ionescu-Shiley（I-S）型和1例Wessex型，以及15例人工瓣膜功能异常的患者（6例B-S型、5例Hall-Kaster型、2例C-E型、1例I-S型和1例HAN型）。
采用二维多普勒超声心动图记录人工二尖瓣血流，以分析：峰值速度（PV）、峰值压差（PG）、平均压差（MG）、压力减半时间（PHT）、面积（A）及反流情况（R）。
人工瓣膜功能正常者——B-S型假体的PV范围为88至186cm/s（134.6±24.3），生物瓣为133至198cm/s（157.4±18.8），p<0.0001。B-S型假体的PG（10.3±2.5对7.6±2.6mmHg）、MG（3.1±1.1对2.6±1mmHg）更高，面积（2.3±0.4对2.5±0.4cm²）更小，与生物瓣相比，p分别为<0.0001、p = 0.003、p = 0.003。PG与MG之间存在显著相关性：B-S型假体、生物瓣及两者总体的r分别为0.84、0.87、0.84，p<0.001。8例B-S型假体和4例生物瓣患者存在轻度反流。人工瓣膜功能异常者——B-S型假体的PV平均值为238.5±29.2cm/s，生物瓣为265.4±48.2cm/s。通过多普勒技术检测，100%的生物瓣和72%的机械假体存在显著反流。PV大于2m/s对区分正常与异常假体功能具有100%的敏感性和特异性。
这些数据可作为这类假体患者随访的参考值。B-S型假体似乎比生物瓣具有更优的血流动力学特征。舒张前期经人工瓣膜PV大于2m/s提示瓣膜功能异常。PG是MG的重要决定因素。
