Sathyamurthy I, Jayanthi K
Director and Interventional Cardiologist, Department of Cardiology, Apollo Main Hospitals, 21, Greams Lane, Off Greams Road, Chennai 600026, India.
Consultant Interventional Cardiologist, SRM Institutes for Medical Sciences, Vadapalani, Chennai, India.
Indian Heart J. 2014 Nov-Dec;66(6):672-7. doi: 10.1016/j.ihj.2014.10.423. Epub 2014 Nov 20.
Aortic stenosis patients with severe LV dysfunction and low cardiac output present with relatively low transvalvular gradients. It is difficult to distinguish them from aortic sclerosis and LV dysfunction with low cardiac output. The former condition is severe AS with LV dysfunction and latter is primarily a contractile dysfunction. Dobutamine stress echocardiogram is key to diagnosis. AS with LV dysfunction associated with preserved contractile reserve benefit from valve replacement and those without contractile reserve needs critical evaluation on a case to case basis. Patients of AS with LV dysfunction with associated coronary artery disease need coronary angiograms to decide regarding need for valve replacement with bypass surgery. A subset of AS patients have low flow, low mean gradients with preserved ejection fraction in whom one must evaluate global hemodynamic load to assess ventriculo-arterial impedence. In this review an approach to the clinical pathways for assessment of low flow, low gradient aortic stenosis has been discussed.
患有严重左心室功能障碍和低心输出量的主动脉瓣狭窄患者的跨瓣压差相对较低。很难将他们与主动脉硬化以及伴有低心输出量的左心室功能障碍区分开来。前一种情况是伴有左心室功能障碍的严重主动脉瓣狭窄，而后一种主要是收缩功能障碍。多巴酚丁胺负荷超声心动图是诊断的关键。伴有保留收缩储备的左心室功能障碍的主动脉瓣狭窄患者可从瓣膜置换中获益，而没有收缩储备的患者则需要逐案进行严格评估。伴有左心室功能障碍且合并冠状动脉疾病的主动脉瓣狭窄患者需要进行冠状动脉造影，以决定是否需要进行瓣膜置换及搭桥手术。一部分主动脉瓣狭窄患者存在低流量、低平均压差且射血分数保留的情况，对此必须评估整体血流动力学负荷以评估心室 - 动脉阻抗。在本综述中，已讨论了评估低流量、低梯度主动脉瓣狭窄临床路径的方法。
