Fujiwara T, Nogami A, Masaki H, Yamane H, Matsuoka S, Yoshida H, Fukuda H, Katsumura T, Kajiya F
Department of Thoracic Surgery, Kawasaki Medical School, Kurashiki, Japan.
Ann Thorac Surg. 1989 Oct;48(4):518-22. doi: 10.1016/s0003-4975(10)66853-1.
In 6 patients with pure aortic stenosis, the flow velocity waveforms in the left anterior descending coronary artery were studied using an 80-channel 20-MHz pulsed Doppler velocimeter before and immediately after aortic valve replacement. All patients showed normal coronary arteriograms. The left anterior descending coronary artery flow velocity waveform in aortic stenosis was characterized by a reverse flow in the first half of systole and a slowly increasing diastolic inflow. After aortic valve replacement, the reverse flow in the first half of systole disappeared in all patients, but an end-systolic reverse flow was discerned in 5 of 6 patients. The increasing rate of the diastolic inflow was augmented in all patients. After aortic valve replacement, the time from onset of diastole to the diastolic peak velocity was shortened from 176.8 +/- 28.8 to 90.5 +/- 18.8 ms (p less than 0.01), and the diastolic peak velocity increased from 90.5 +/- 28.0 to 122.5 +/- 17.2 cm/s (p less than 0.05). Blood pressure and heart rate, however, did not change significantly before and after valve replacement. These changes in the left coronary artery velocity waveforms after valve replacement suggest the beneficial effects of removal of aortic stenosis on human coronary artery inflow.
在6例单纯主动脉瓣狭窄患者中，于主动脉瓣置换术前及术后即刻，使用80通道20兆赫兹脉冲多普勒流速仪对左前降支冠状动脉内的血流速度波形进行了研究。所有患者冠状动脉造影均正常。主动脉瓣狭窄时左前降支冠状动脉血流速度波形的特征为收缩期前半段出现反向血流以及舒张期血流缓慢增加。主动脉瓣置换术后，所有患者收缩期前半段的反向血流均消失，但6例患者中有5例在收缩期末出现反向血流。所有患者舒张期血流增加速率均增大。主动脉瓣置换术后，舒张期开始至舒张期峰值速度的时间从176.8±28.8毫秒缩短至90.5±18.8毫秒（p<0.01），舒张期峰值速度从90.5±28.0厘米/秒增至122.5±17.2厘米/秒（p<0.05）。然而，瓣膜置换术前、后血压和心率无显著变化。瓣膜置换术后左冠状动脉速度波形的这些变化提示解除主动脉瓣狭窄对人体冠状动脉血流有有益作用。
