Krayenbühl H P, Hess O M, Schneider J, Turina M
Medizinische Poliklinik, Universitätsspital, Zürich.
Schweiz Med Wochenschr. 1988 Apr 9;118(14):517-21.
In patients with aortic valve disease successful valve replacement leads to a significant decrease in left ventricular angiographic mass, which 14-15 months postoperatively ranges between 31 and 37% of the preoperative value. Postoperative normalization of angiographic mass occurs in 2/3 of the patients with aortic stenosis and in 1/3 of the patients with aortic insufficiency. The degree of preoperative hypertrophy determines whether angiographic mass does or does not normalize after valve replacement. In patients with aortic stenosis and combined lesions, left ventricular end-diastolic wall thickness decreases postoperatively and remains unchanged in the patients with aortic insufficiency. Muscle fiber diameter decreases significantly in the first two years after valve replacement and thereafter remains unchanged. The upper limit of normal (20 mu) is not reached. Relative interstitial fibrosis increases early after surgery whereas left ventricular fibrous content remains unchanged during the first two years after valve replacement. Five years postoperatively there was a significant decrease in left ventricular fibrous content both in patients with aortic stenosis and with aortic insufficiency. Hence there appears to be no longer any validity in the earlier concept that a once established interstitial fibrosis in patients with concentric and eccentric hypertrophy is irreversible after removal of the abnormal hemodynamic burden.
在主动脉瓣疾病患者中，成功的瓣膜置换可使左心室造影质量显著降低，术后14 - 15个月时该质量在术前值的31%至37%之间。造影质量术后恢复正常的情况在三分之二的主动脉瓣狭窄患者和三分之一的主动脉瓣关闭不全患者中出现。术前肥厚程度决定了瓣膜置换后造影质量是否恢复正常。在主动脉瓣狭窄及合并病变的患者中，左心室舒张末期壁厚术后减小，而在主动脉瓣关闭不全患者中保持不变。瓣膜置换后的头两年，肌纤维直径显著减小，此后保持不变，未达到正常上限（20μm）。术后早期相对间质纤维化增加，而瓣膜置换后的头两年左心室纤维含量保持不变。术后五年，主动脉瓣狭窄和主动脉瓣关闭不全患者的左心室纤维含量均显著降低。因此，早期认为在向心性和离心性肥厚患者中一旦形成间质纤维化，在去除异常血流动力学负荷后就不可逆转的观点似乎不再成立。
