Cho In Jeong, Hong Geu Ru, Lee Seung Hyun, Lee Sak, Chang Byung Chul, Shim Chi Young, Chang Hyuk Jae, Ha Jong Won, Chung Namsik
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2016 Mar;57(2):328-36. doi: 10.3349/ymj.2016.57.2.328.
The incidence of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) has been reported to vary. The purpose of the current study was to investigate incidence of PPM according to the different methods of calculating effective orifice area (EOA), including the continuity equation (CE), pressure half time (PHT) method and use of reference EOA, and to compare these with various echocardiographic variables.
We retrospectively reviewed 166 individuals who received isolated MVR due to rheumatic mitral stenosis and had postoperative echocardiography performed between 12 and 60 months after MVR. EOA was determined by CE (EOA(CE)) and PHT using Doppler echocardiography. Reference EOA was determined from the literature or values offered by the manufacturer. Indexed EOA was used to define PPM as present if ≤1.2 cm²/m².
Prevalence of PPM was different depending on the methods used to calculate EOA, ranging from 7% in PHT method to 49% in referred EOA method to 62% in CE methods. The intraclass correlation coefficient was low between the methods. PPM was associated with raised trans-prosthetic pressure, only when calculated by CE (p=0.021). Indexed EOA(CE) was the only predictor of postoperative systolic pulmonary artery (PA) pressure, even after adjusting for age, preoperative systolic PA pressure and postoperative left atrial volume index (p<0.001).
Prevalence of mitral PPM varied according to the methods used to calculate EOA in patients with mitral stenosis after MVR. Among the various methods used to define PPM, EOA(CE) was the only predictor of postoperative hemodynamic parameters.
据报道，二尖瓣置换术（MVR）后人工瓣膜-患者不匹配（PPM）的发生率有所不同。本研究的目的是根据计算有效瓣口面积（EOA）的不同方法，包括连续方程（CE）、压力减半时间（PHT）法和使用参考EOA，来研究PPM的发生率，并将这些方法与各种超声心动图变量进行比较。
我们回顾性分析了166例因风湿性二尖瓣狭窄接受单纯MVR且在MVR后12至60个月进行术后超声心动图检查的患者。使用多普勒超声心动图通过CE（EOA(CE)）和PHT来确定EOA。参考EOA根据文献或制造商提供的值来确定。如果指数化EOA≤1.2 cm²/m²，则将其定义为存在PPM。
PPM的患病率因计算EOA的方法不同而有所差异，从PHT法的7%到参考EOA法的49%再到CE法的62%。这些方法之间的组内相关系数较低。仅在通过CE计算时，PPM与跨人工瓣膜压力升高相关（p=0.021）。即使在调整年龄、术前收缩期肺动脉压力和术后左心房容积指数后，指数化EOA(CE)仍是术后收缩期肺动脉（PA）压力的唯一预测指标（p<0.001）。
MVR后二尖瓣狭窄患者中，二尖瓣PPM的患病率因计算EOA的方法不同而有所变化。在用于定义PPM的各种方法中，EOA(CE)是术后血流动力学参数的唯一预测指标。
