Reisner S A, Lichtenberg G S, Shapiro J R, Schwarz K Q, Meltzer R S
Department of Medicine, University of Rochester, NY.
Am Heart J. 1989 Oct;118(4):755-9. doi: 10.1016/0002-8703(89)90589-9.
Submaximal supine exercise was done by 17 patients with mitral prostheses. Eleven had Björk-Shiley (BS) and six had Starr-Edwards (SE) valves. In 15 patients with normally functioning prostheses, valve area at rest was 2.4 +/- 0.25 cm2 in the BS patients and 1.8 +/- 0.35 cm2 in the SE group (p less than 0.01). In the SE group, peak and mean gradients increased from 8 +/- 1 and 5 +/- 1 mm Hg, respectively, at rest to 22 +/- 5 and 13 +/- 4 mm Hg at peak exercise (mean +/- 1 SD). In the BS group, peak and mean gradients increased from 10 +/- 3 and 5 +/- 2 mm Hg, respectively, at rest to 16 +/- 3 and 10 +/- 3 mm Hg at peak exercise. Peak pressure gradient at peak exercise and the increase in peak gradient with exercise (exercise-resting gradient) were significantly higher in the SE group (p less than 0.05). By plotting the heart rate versus the transmitral gradient during the recovery period, a heart rate-gradient curve was obtained for each type of prosthesis. Doppler echocardiography with moderate supine exercise can be performed in most patients with mechanical prosthesis. Hemodynamic properties (the occlusive character of the SE prosthesis) were brought out by exercise. Doppler echocardiographic measurements during exercise can provide important information, particularly in patients with borderline measurements at rest.
17例二尖瓣置换患者进行了次极量仰卧位运动。其中11例使用Björk-Shiley（BS）瓣膜，6例使用Starr-Edwards（SE）瓣膜。15例假体功能正常的患者中，静息时BS组患者的瓣膜面积为2.4±0.25cm²，SE组为1.8±0.35cm²（p<0.01）。在SE组中，峰值梯度和平均梯度分别从静息时的8±1mmHg和5±1mmHg增加到运动峰值时的22±5mmHg和13±4mmHg（均值±1标准差）。在BS组中，峰值梯度和平均梯度分别从静息时的10±3mmHg和5±2mmHg增加到运动峰值时的16±3mmHg和10±3mmHg。运动峰值时的峰值压力梯度以及运动时峰值梯度的增加（运动-静息梯度）在SE组中显著更高（p<0.05）。通过在恢复期绘制心率与二尖瓣梯度的关系图，获得了每种类型假体的心率-梯度曲线。大多数机械瓣膜置换患者可以在中度仰卧位运动时进行多普勒超声心动图检查。运动揭示了血流动力学特性（SE假体的闭塞特性）。运动期间的多普勒超声心动图测量可以提供重要信息，特别是对于静息时测量处于临界值的患者。
