Iskandrian A S, Hakki A H, Kotler M N
Cardiovasc Clin. 1986;17(1):181-200.
Assessment of the severity of valvular regurgitation is possible by nuclear techniques, but overlap with mild, moderate, or severe degrees of valvular regurgitation has been reported. For the individual patient, if a baseline correlation is established between RNA measurements and catheterization derived measurements, RNA may then be used serially to follow the patients. Controversy still persists in defining the optimum time for aortic valve replacement. We do not recommend aortic valve replacement in an asymptomatic patient whose end-systolic dimension is greater than 55 mm and fractional shortening is less than 25 percent. No single measurement at one point in time including a greater than or equal to 5 percent decrease in EF during exercise in the presence of a normal resting EF should be used as an indication for aortic valve replacement. It is our belief that these patients can be followed safely and that aortic valve replacement should be recommended only when symptoms appear or resting LV function deteriorates. Conflicting results have been reported with regard to left ventricular function after aortic valve replacement. In the majority of patients with pure AR, a decrease in left ventricular dimensions and improvement in resting EF and exercise EF does occur. However, the improved exercise EF is still lower than that observed in normal subjects. Regression of left ventricular hypertrophy occurs in the vast majority of patients with aortic stenosis in the late postoperative period following aortic valve replacement. In most patients with pure aortic regurgitation, significant regression of hypertrophy has been reported following aortic valve replacement. However, in some patients with isolated aortic regurgitation or mixed aortic stenosis and aortic regurgitation, the increased left ventricular mass and abnormal left ventricular function persist even after successful aortic valve replacement. With regard to patients with mitral regurgitation undergoing mitral valve replacement, a decrease in LVEF occurs early in the postoperative period and the decrease persists in the late postoperative period. In patients undergoing mitral valve replacement and using intraoperative echocardiographic techniques, patients with significant decreases in ejection fraction can be identified in the operating room. These patients can be treated immediately with drug therapy and/or intraaortic balloon counterpulsation support to ensure maximal opportunity for survival.
通过核技术可以评估瓣膜反流的严重程度，但有报道称其与轻度、中度或重度瓣膜反流存在重叠。对于个体患者，如果在RNA测量值与心导管检查得出的测量值之间建立了基线相关性，那么RNA随后可用于对患者进行连续监测。在确定主动脉瓣置换的最佳时机方面仍存在争议。对于无症状且左室收缩末期内径大于55mm、缩短分数小于25%的患者，我们不建议进行主动脉瓣置换。在静息EF正常的情况下，运动期间EF下降大于或等于5%，不应将这一单一时间点的测量结果作为主动脉瓣置换的指征。我们认为，这些患者可以安全地进行随访，只有在出现症状或静息左室功能恶化时才应建议进行主动脉瓣置换。关于主动脉瓣置换术后左室功能，已有相互矛盾的报道。在大多数单纯主动脉反流患者中，左室尺寸确实会减小，静息EF和运动EF也会改善。然而，改善后的运动EF仍低于正常受试者。在主动脉瓣置换术后的后期，绝大多数主动脉瓣狭窄患者的左室肥厚会消退。在大多数单纯主动脉反流患者中，主动脉瓣置换术后已有显著的肥厚消退报道。然而，在一些孤立性主动脉反流或主动脉狭窄合并主动脉反流的患者中，即使主动脉瓣置换成功，左室质量增加和左室功能异常仍会持续。对于接受二尖瓣置换的二尖瓣反流患者，术后早期LVEF会下降，并在术后后期持续存在。在接受二尖瓣置换并使用术中超声心动图技术的患者中，在手术室中可以识别出射血分数显著下降的患者。这些患者可立即接受药物治疗和 / 或主动脉内球囊反搏支持，以确保最大的生存机会。
