Offstad Jon, Andersen Kai, Paulsson Per, Andreasson Jesper, Kjellman Ulf, Lundblad Oluf, Engstrøm Karl Gunnar, Haaverstad Rune, Svennevig Jan L
Oslo University Hospital, Rikshospitalet, PO box 4950, Nydalen, NO 0424 Oslo, Norway.
J Cardiothorac Surg. 2011 Dec 19;6:163. doi: 10.1186/1749-8090-6-163.
112 patients who received small and medium sized St. Jude Regent heart valves (19-25 mm) at 7 Scandinavian centers were studied between January 2003 and February 2005 to obtain non-invasive data regarding the hemodynamic performance at rest and during Dobutamine stress echocardiography (DSE) testing one year after surgery.
46 woman and 66 men, aged 61.8 ± 9.7 (18-75) years, were operated on for aortic regurgitation (17), stenosis (65), or mixed dysfunction (30). Valve sizes were 19 mm (6), 21 mm (33), 23 mm (41), 25 mm (30). Two patients receiving size 27 valves were excluded from the hemodynamic evaluation. Pledgets were used in 100 patients, everted mattress in 66 and simple interrupted sutures in 21. Valve orientation varied and was dependent on the surgeons' choice. 34 patients (30.4%) underwent concomitant coronary artery surgery.
There were two early deaths (1.8%) and three late deaths, one because of pancreatic cancer. Late events during follow-up were: non structural dysfunction (1), bleeding (2), thromboembolism (2). At one year follow up 93% of the patients were in NYHA classes 1-2 versus 47.8% preoperatively. Dobutamine stress echocardiography (DSE) was performed in a total of 66 and maximal peak stress was reached in 61 patients. During DSE testing, the following statistically significant changes took place: Heart rate increased by 73.0%, cardiac output by 85.5%, left ventriclular ejection fraction by 19.6%, and maximal mean prosthetic transvalvular gradient by 133.8%, whereas the effective orifice area index did not change. Left ventricular mass fell during one year from 215 ± 63 to 197 ± 62 g (p < 0.05).
The Dobutamine test induces a substantial stress, well suitable for echocardiographic assessment of prosthesis valve function and can be performed in the majority of the patients. The changes in pressure gradients add to the hemodynamic characteristics of the various valve sizes. In our patients the St. Jude Regent valve performed satisfactory at rest and under pharmacological stress situation.
2003年1月至2005年2月期间，对7家斯堪的纳维亚中心的112例接受中小型圣犹大Regent心脏瓣膜（19 - 25毫米）的患者进行了研究，以获取术后一年静息状态及多巴酚丁胺负荷超声心动图（DSE）检查时血流动力学性能的非侵入性数据。
46名女性和66名男性，年龄61.8±9.7（18 - 75）岁，因主动脉瓣关闭不全（17例）、狭窄（65例）或混合功能障碍（30例）接受手术。瓣膜尺寸为19毫米（6例）、21毫米（33例）、23毫米（41例）、25毫米（30例）。两名接受27毫米瓣膜的患者被排除在血流动力学评估之外。100例患者使用了 pledgets，66例使用了外翻褥式缝合，21例使用了单纯间断缝合。瓣膜方向各不相同，取决于外科医生的选择。34例患者（30.4%）同时接受了冠状动脉手术。
有2例早期死亡（1.8%）和3例晚期死亡，其中1例死于胰腺癌。随访期间的晚期事件包括：非结构性功能障碍（1例）、出血（2例）、血栓栓塞（2例）。在一年随访时，93%的患者纽约心脏协会（NYHA）心功能分级为1 - 2级，而术前为47.8%。总共66例患者进行了多巴酚丁胺负荷超声心动图（DSE）检查，61例患者达到了最大峰值负荷。在DSE检查期间，发生了以下具有统计学意义的变化：心率增加73.0%，心输出量增加85.5%，左心室射血分数增加19.6%，最大平均人工瓣膜跨瓣压差增加133.8%，而有效瓣口面积指数未改变。左心室质量在一年内从215±63克降至197±62克（p < 0.05）。
多巴酚丁胺试验可诱发显著负荷，非常适合超声心动图评估人工瓣膜功能，且大多数患者均可进行。压力梯度的变化增加了各种瓣膜尺寸的血流动力学特征。在我们的患者中，圣犹大Regent瓣膜在静息状态和药物负荷情况下表现令人满意。
