Fukushima M, Hiramatsu M, Yoshima H, Yamada M, Ohkubo N, Matsuwaka R, Yoshii Y, Ohgidani N, Hoki N, Hata S
J Cardiogr. 1985 Jun;15(2):483-93.
To determine proper operative procedures for aortic regurgitation (AR), we attempted to evaluate the severity of AR by two-dimensional Doppler echocardiography (TDE), using 15 mongrel dogs with experimentally-induced AR. Furthermore, the left ventricular (LV) suction method was investigated for the significance in estimating the severity of AR, cardiac outputs were measured by the thermodilution technique, TDE, and electromagnetic flowmeter (EMF). The values obtained by each method were compared. In dogs with AR, regurgitant fraction (RF) was calculated from stroke volumes obtained by TDE and EMF, as follows: RF [TDE] = (LVO-RVO)/LVO (LVO: left ventricular output; RVO: right ventricular output) RF [EMF] = [total stroke volume (T)-effective stroke volume (E)]/T The effects of alterations in afterload and pump flow rates on regurgitant fractions and regurgitant volumes measured by the LV suction method were also studied. The following results were obtained: Good correlations were observed between RVO and LVO measured by TDE, and those measured by the thermodilution technique and EMF, respectively. In dogs with AR, regurgitant fractions measured by TDE correlated well with those measured by EMF. These results strongly suggested that the Doppler index (RF) was accurate and useful for estimating the severity of AR clinically. Regurgitant volumes measured by the LV suction method were not influenced by the pump flow rate, and they correlated well with square root values of the mean diastolic pressure in the aorta. In the LV suction method, Bernoulli's theorem held good between the regurgitant volumes and the mean diastolic pressures in the aorta of the dogs with AR. Considering the factors of mean diastolic pressure in the aorta and diastolic time, regurgitant volumes measured by EMF in the beating heart showed excellent agreement with those measured by the LV suction method in ventricular fibrillation. Therefore, to evaluate quantitatively the pathophysiological changes of the aortic valve in patients with AR, we should estimate the severity of AR using regurgitant volumes corrected for the cardiac cycle at the same mean diastolic pressure in the aorta.
为确定主动脉瓣反流（AR）的合适手术方法，我们尝试用二维多普勒超声心动图（TDE）评估15只实验性诱导产生AR的杂种犬的AR严重程度。此外，研究了左心室（LV）抽吸法在评估AR严重程度中的意义，通过热稀释技术、TDE和电磁流量计（EMF）测量心输出量。比较了每种方法获得的值。在患有AR的犬中，反流分数（RF）由TDE和EMF获得的每搏量计算得出，如下：RF [TDE] = (LVO - RVO)/LVO（LVO：左心室输出量；RVO：右心室输出量）RF [EMF] = [总每搏量（T）-有效每搏量（E）]/T还研究了后负荷和泵流量变化对通过LV抽吸法测量的反流分数和反流容积的影响。得到以下结果：TDE测量的RVO与热稀释技术和EMF测量的RVO之间分别观察到良好的相关性。在患有AR的犬中，TDE测量的反流分数与EMF测量的反流分数相关性良好。这些结果强烈表明，多普勒指数（RF）在临床上准确且有助于估计AR的严重程度。通过LV抽吸法测量的反流容积不受泵流量的影响，并且与主动脉平均舒张压的平方根值相关性良好。在LV抽吸法中，患有AR的犬的主动脉反流容积与平均舒张压之间符合伯努利定理。考虑到主动脉平均舒张压和舒张期时间因素，在跳动心脏中通过EMF测量的反流容积与在心室颤动中通过LV抽吸法测量的反流容积显示出极好的一致性。因此，为了定量评估AR患者主动脉瓣的病理生理变化，我们应该使用在主动脉相同平均舒张压下针对心动周期校正的反流容积来估计AR的严重程度。
