Freeman W K, Schaff H V, Orszulak T A, Tajik A J
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1990 Sep;16(3):623-30. doi: 10.1016/0735-1097(90)90352-p.
Serial two-dimensional and Doppler echocardiography was performed on 61 patients who had surgical ultrasonic aortic valve decalcification for calcific aortic stenosis. The mean patient age at the time of operation was 77.4 +/- 7.0 years; 93% had moderate to severe preoperative symptomatic limitation. Compared with preoperative studies, Doppler echocardiographic evaluation before hospital discharge revealed a significant reduction in the mean aortic valve pressure gradient (45.3 +/- 16.2 to 14.4 +/- 6.5 mm Hg, p less than 0.0001) and improvement in aortic valve area (0.62 +/- 0.17 to 1.33 +/- 0.33 cm2, p less than 0.0001). There was no initial change in aortic regurgitation grade. Follow-up Doppler echocardiographic evaluation was possible in 43 patients alive at 9.3 +/- 3.9 months. A small but statistically significant trend toward aortic restenosis was found; only one patient had severe restenosis. Severe aortic regurgitation had developed in 26% of patients and moderate aortic regurgitation in 37%. Aortic valve replacement was performed in six patients (14%) with severe symptomatic aortic regurgitation. Significant deficiency in central coaptation as a result of cusp scarification and retraction appeared to be the mechanism of postdecalcification regurgitation. Attempted salvage of the native aortic valve in severe calcific stenosis by ultrasonic decalcification adequately relieves stenosis but leads to an unacceptable incidence of significant aortic regurgitation at follow-up study.
对61例行外科超声主动脉瓣钙化灶清除术治疗钙化性主动脉瓣狭窄的患者进行了系列二维和多普勒超声心动图检查。手术时患者的平均年龄为77.4±7.0岁；93%的患者术前有中度至重度症状性限制。与术前检查相比，出院前的多普勒超声心动图评估显示平均主动脉瓣压力阶差显著降低（从45.3±16.2降至14.4±6.5 mmHg，p<0.0001），主动脉瓣面积有所改善（从0.62±0.17增至1.33±0.33 cm²，p<0.0001）。主动脉瓣反流分级最初无变化。43例存活9.3±3.9个月的患者接受了随访多普勒超声心动图评估。发现有主动脉再狭窄的轻微但具有统计学意义的趋势；只有1例患者有严重再狭窄。26%的患者出现了严重主动脉瓣反流，37%的患者出现了中度主动脉瓣反流。6例（14%）有严重症状性主动脉瓣反流的患者接受了主动脉瓣置换术。瓣叶瘢痕化和回缩导致的中央对合明显不足似乎是脱钙后反流的机制。通过超声脱钙试图挽救严重钙化性狭窄的天然主动脉瓣可充分缓解狭窄，但在随访研究中导致了不可接受的显著主动脉瓣反流发生率。
