Hata T, Namba H, Sone Y, Imamaki M, Kuinose M, Taniguchi G
Department of Cardiovascular Surgery, Cardiovascular Center Sakakibara Hospital, Okayama, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Mar;38(3):518-22.
A 17 mm diameter Björk-Shiley Monostrut prosthesis was implanted in a 64-year-old female for aortic valve replacement in a semi-emergency. This valve was one of the smallest valves which were available in Japan. The patient was admitted because of severe hemolytic anemia and heart failure. Echocardiography showed regurgitation and calcification of Ionescu-Shiley tissue valve which was implanted 5 years ago. The patient's body surface area was 1.2 m2. Because of narrow aortic annulus, we could barely implant a 17 mm diameter Björk-Shiley Monostrut prosthesis. The valve function was examined by Brockenbrough method. During catheterization, the heart rate was 85 b/min and cardiac index was 3.00 l/min/m2. In these hemodynamic conditions, simultaneous measurements of aortic and left ventricular pressures revealed only 9 mmHg mean systolic pressure gradient. Similarly, 20 mmHg of pressure gradient across the implanted valve was obtained by Gorlin's formula. We could calculate that the effective orifice area of a 17 mm diameter Björk-Shiley Monostrut prosthesis was 1.0 cm2. Postoperative echocardiography demonstrated 42 mmHg systolic pressure gradient across this prosthesis by Doppler techniques, and left ventricular wall thickness was not decreased. To best our knowledges, this was the first case in which post-operative evaluation such a small prosthesis was measured.
一枚直径17毫米的 Björk-Shiley 单支柱人工心脏瓣膜在一名64岁女性患者身上进行了半紧急主动脉瓣置换植入。该瓣膜是当时日本市面上最小尺寸的瓣膜之一。患者因严重溶血性贫血和心力衰竭入院。超声心动图显示，5年前植入的 Ionescu-Shiley 组织瓣膜存在反流和钙化。患者的体表面积为1.2平方米。由于主动脉瓣环狭窄，我们勉强植入了一枚直径17毫米的 Björk-Shiley 单支柱人工心脏瓣膜。采用 Brockenbrough 方法对瓣膜功能进行了检查。在导管插入过程中，心率为85次/分钟，心脏指数为3.00升/分钟/平方米。在这些血流动力学条件下，同步测量主动脉和左心室压力显示平均收缩压梯度仅为9毫米汞柱。同样，根据 Gorlin 公式得出植入瓣膜两端的压力梯度为20毫米汞柱。由此我们可以计算出，直径17毫米的 Björk-Shiley 单支柱人工心脏瓣膜的有效开口面积为1.0平方厘米。术后超声心动图通过多普勒技术显示该瓣膜两端的收缩压梯度为42毫米汞柱，且左心室壁厚度未减小。据我们所知，这是首例对如此小尺寸人工心脏瓣膜进行术后评估的病例。
