Egeblad H, Wennevold A
Medical Department B, Rigshospitalet, Copenhagen, Denmark.
Br Heart J. 1990 Jan;63(1):32-6. doi: 10.1136/hrt.63.1.32.
Subcostal echocardiography of the left ventricle was continuously recorded during balloon dilatation of the aortic valve in ten consecutive elderly patients. Left ventricular wall motion decreased gradually during a minute of maintained complete balloon inflation. Blind analysis of M mode echocardiograms showed a significant reduction in fractional shortening. Deflation of the balloon resulted in global left ventricular hyperkinesia. There was a transient overshoot in fractional shortening, wall thickness, and blood pressure approximately 40 s after deflation of the balloon. The myocardial reaction was similar to that known to occur regionally with brief coronary artery obstruction, whereas the timing of the events seemed to be dissociated from the timing of changes in left ventricular load. Thus it is likely that the left ventricular response during valve dilatation reflects not only changes in load but also an ischaemia-reperfusion effect on the myocardium. The systolic thickening of the hypertrophied interventricular septum was slightly reduced after balloon dilatation. This finding might be a result of repeated episodes of ischaemia and reperfusion. However, the potential for myocardial injury seemed to be unimportant clinically.
对连续10例老年患者在主动脉瓣球囊扩张过程中持续记录左心室肋下超声心动图。在球囊完全充盈并维持1分钟期间，左心室壁运动逐渐减弱。对M型超声心动图进行盲法分析显示，缩短分数显著降低。球囊放气导致左心室整体运动增强。球囊放气后约40秒，缩短分数、室壁厚度和血压出现短暂的超调。心肌反应类似于已知的短暂冠状动脉阻塞时局部发生的反应，而这些事件的发生时间似乎与左心室负荷变化的时间无关。因此，瓣膜扩张期间的左心室反应可能不仅反映负荷变化，还反映对心肌的缺血-再灌注效应。球囊扩张后，肥厚的室间隔的收缩期增厚略有降低。这一发现可能是反复缺血和再灌注发作的结果。然而，心肌损伤的可能性在临床上似乎并不重要。
