Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of California, San Diego, Thornton Hospital, La Jolla, CA.
Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of California, San Diego, Thornton Hospital, La Jolla, CA.
J Cardiothorac Vasc Anesth. 2019 Nov;33(11):3204-3210. doi: 10.1053/j.jvca.2019.03.035. Epub 2019 Mar 21.
Evaluation of prosthetic valve function is a challenging task. The clinician has to employ multiple parameters to quantify dysfunction (if present), the results of which can be mutually discrepant. This results from heterogeneity in the design of the valves themselves, implantation techniques, and both intra- and interpatient hemodynamic variability. Specifically, the location and angle of valve implantation can have a profound impact on its flow characteristics that can lead to symptoms despite satisfactory mechanical function. The authors present the case of inverted implantation of a prosthesis designed for the aortic position in the mitral annulus and resultant mitral stenosis. What follows is an examination of how the flow characteristics, such as pressure recovery, energy loss, and vortex formation, create a gradient that could not be explained by valve size alone.
评估人工瓣膜功能是一项具有挑战性的任务。临床医生必须采用多种参数来量化（如果存在的话）功能障碍，其结果可能相互矛盾。这是由于瓣膜本身的设计、植入技术以及患者内和患者间的血液动力学变异性的异质性所致。具体而言，瓣膜植入的位置和角度可以对其流动特性产生深远的影响，尽管机械功能令人满意，但仍可能导致症状。作者介绍了一个将设计用于主动脉瓣位置的假体倒置植入二尖瓣环并导致二尖瓣狭窄的病例。接下来，我们将检查如何通过压力恢复、能量损失和涡流形成等流动特性来产生梯度，而不仅仅是通过瓣膜大小来解释。
