Gentles Thomas L, Finucane A Kirsten, Remenyi Bo, Kerr Alan R, Wilson Nigel J
Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand.
Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand.
Ann Thorac Surg. 2015 Oct;100(4):1383-9. doi: 10.1016/j.athoracsur.2015.06.009. Epub 2015 Aug 14.
Chronic mitral and aortic regurgitation (MR and AR) are associated with progressive contractile dysfunction. In the young, the risk of left ventricle (LV) dysfunction after operation for isolated and combined AR and MR is poorly defined. We aimed to compare LV mechanics in children and young adults with isolated and combined AR and MR, and identify risk factors for LV dysfunction after valve surgery.
Echocardiograms from children and young adults undergoing surgery for isolated severe AR (group I, n = 14), MR (group II, n = 21), or combined AR and MR (group III, n = 13), before and up to 18 months after surgery were compared with a normal population (n = 89). Normalized measures of LV geometry and mechanics were expressed as z scores.
Before surgery all groups had LV dilatation, while groups I and III had afterload elevation and LV dysfunction. After operation LV dysfunction was more common in group III than in groups I and II (11 [84.5%] vs 5 [35.7%] vs 12 [57.1%], p = 0.04). The preoperative end-systolic volume z score predicted LV dysfunction after surgery in group I and II patients (p = 0.047, area under the curve = 0.75) but not in group III, where moderate LV dysfunction was related to the preoperative stress velocity index (-2.6 with vs -1.1 without, p = 0.04).
Left ventricular mechanics in combined AR and MR closely resemble those of AR. End-systolic volume predicts postoperative LV dysfunction in patients with isolated valve regurgitation, while those with combined disease were at high risk of postoperative LV dysfunction.
慢性二尖瓣反流和主动脉瓣反流（MR和AR）与进行性收缩功能障碍相关。在年轻人中，单纯性和合并性AR和MR手术后左心室（LV）功能障碍的风险尚不明确。我们旨在比较单纯性和合并性AR和MR的儿童及年轻成人的左心室力学，并确定瓣膜手术后左心室功能障碍的危险因素。
将接受单纯严重AR手术（I组，n = 14）、MR手术（II组，n = 21）或AR与MR联合手术（III组，n = 13）的儿童及年轻成人术前及术后长达18个月的超声心动图与正常人群（n = 89）进行比较。左心室几何形状和力学的标准化测量值以z评分表示。
术前所有组均有左心室扩张，而I组和III组有后负荷升高和左心室功能障碍。术后III组左心室功能障碍比I组和II组更常见（11例[84.5%] vs 5例[35.7%] vs 12例[57.1%]，p = 0.04）。术前收缩末期容积z评分可预测I组和II组患者术后左心室功能障碍（p = 0.047，曲线下面积 = 0.75），但不能预测III组，III组中度左心室功能障碍与术前应激速度指数有关（有功能障碍者为 -2.6，无功能障碍者为 -1.1，p = 0.04）。
AR与MR合并时的左心室力学与AR非常相似。收缩末期容积可预测单纯瓣膜反流患者术后左心室功能障碍，而合并疾病患者术后左心室功能障碍风险较高。
