Lesbre J P, Chassat C, Lespérance J, Petitclerc R, Bonan R, Dyrda I, Pasternac A, Bourassa M
Arch Mal Coeur Vaiss. 1986 Sep;79(10):1439-48.
The authors have studied by pulsed and continuous Doppler ultrasonography 108 pericardial prostheses in a good functional state implanted for less than five years to patients without any clinical and echographic signs of heart failure. The pulsed Doppler ultrasonography allowed to exclude the possible dysfunction of the prostheses; continuous Doppler ultrasonography allowed the measurement of the maximal transprosthetic velocities and to deduce the corresponding maximal and middle gradients by means of simplified Bernouilli's equation. Using three types of bioprostheses (Carpentier-Edwards, Ionescu and Mitroflow) the following problems were investigated: Normal ranges of maximal transprosthetic velocity and gradients. At the aortic level the maximal velocity ranges from 1.60 to 2.83 +/- 14 m/s and the maximal gradients from 10 for size 27-29 to 32 +/- 3.3 mmHg for size 19. At the mitral level the maximal velocity ranges from 0.80 to 2 m/s and the mean gradients from 1 for size 33 to 7 mmHg for size 25. The mean half-life of decrease is 100 +/- 28 ms. Thus all aortic bioprostheses appear to be stenosing, which is not the case for the mitral ones, size 31 and 33. Factors governing the maximal transprosthetic velocity and the gradients: these determining factors are the size, the type and the age of the bioprosthesis (r = 0.59 for the correlation between maximal velocity and size, r = 0.53 between size and mean aortic gradient). The accessory factors are the age and the functional condition of the myocardium. All these factors have to be considered and neutralized for allowing a valid comparison of various types of prostheses. Comparison of the three pericardial prostheses studied: in patients without signs of myocardial dysfunction of prosthetic origin and with comparable basal conditions, comparison of maximal velocity and of the gradient points to a significant superiority of the Mitroflow at the aortic level and of the Ionescu and Mitroflow at the mitral level. It should be noted in the end that the great similarity of the results obtained in the present study by Doppler ultrasonography with the previously reported hemodynamic data confirms the important role of the Doppler method in the evaluation of valvular bioprostheses.
作者使用脉冲式和连续式多普勒超声心动图对108个功能良好且植入时间少于5年的心包人工瓣膜进行了研究，这些患者没有任何心力衰竭的临床和超声心动图迹象。脉冲式多普勒超声心动图可排除人工瓣膜可能存在的功能障碍；连续式多普勒超声心动图可测量最大跨瓣速度，并通过简化的伯努利方程推导相应的最大和平均压差。使用三种类型的生物瓣膜（卡朋蒂埃 - 爱德华兹、约内斯库和米特罗弗洛）研究了以下问题：最大跨瓣速度和压差的正常范围。在主动脉瓣水平，最大速度范围为1.60至2.83±0.14 m/s，对于27 - 29号尺寸，最大压差为10 mmHg，对于19号尺寸，最大压差为32±3.3 mmHg。在二尖瓣水平，最大速度范围为0.80至2 m/s，对于33号尺寸，平均压差为1 mmHg，对于25号尺寸，平均压差为7 mmHg。下降的平均半衰期为100±28 ms。因此，所有主动脉生物瓣膜似乎都存在狭窄，而对于二尖瓣生物瓣膜（31号和33号尺寸）则并非如此。影响最大跨瓣速度和压差的因素：这些决定因素是生物瓣膜的尺寸、类型和年龄（最大速度与尺寸之间的相关性r = 0.59，尺寸与平均主动脉压差之间的相关性r = 0.53）。辅助因素是心肌的年龄和功能状态。为了对各种类型的人工瓣膜进行有效的比较，必须考虑并抵消所有这些因素。所研究的三种心包人工瓣膜的比较：在没有人工瓣膜源性心肌功能障碍迹象且基础条件可比的患者中，最大速度和压差的比较表明，在主动脉瓣水平米特罗弗洛具有显著优势，在二尖瓣水平约内斯库和米特罗弗洛具有显著优势。最后应该指出的是，本研究通过多普勒超声心动图获得的结果与先前报道的血流动力学数据非常相似，这证实了多普勒方法在评估瓣膜生物瓣膜中的重要作用。
