Nakano S, Taniguchi K, Matsuda H, Sakai K, Kawashima Y
First Department of Surgery, Osaka University Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1988 Sep;89(9):1450-3.
This study was consisted of 69 patients undergoing aortic valve replacement for chronic aortic regurgitation (AR) and 29 patients, for aortic stenosis (AS) between 1978 and 1985. There was no operative death. There were 7 late cardiac deaths in AR patients, with preoperative left ventricular end-systolic volume index (LVESVI) greater than 200 ml/m2. None of the 55 patients with an LVESVI less than 200 m/m2 died of cardiac-causes. In AR patients with preoperative LVESVI greater than 200 ml/m2, despite the postoperative reduction of the wall stress, the ejection fraction failed to return to normal, indicating that irreversible myocardial dysfunction was responsible in these patients. There were two cardiac-related deaths in 29 AS patients, who had preoperative LVESVI greater than 100 ml/m2. In postoperative AS patients with LVESVI greater than 100 ml/m2, postoperative contractile function of the left ventricle was poor. In conclusion, minimal preoperative left ventricular function for satisfactory late results and reversal of functional results may be at a lower level was LVESVI 200 ml/m2 in AR patients and 100 ml/m2 in AS patients.
本研究纳入了1978年至1985年间因慢性主动脉瓣反流（AR）接受主动脉瓣置换术的69例患者以及因主动脉瓣狭窄（AS）接受手术的29例患者。无手术死亡病例。AR患者中有7例晚期心脏死亡，术前左心室收缩末期容积指数（LVESVI）大于200 ml/m²。LVESVI小于200 ml/m²的55例患者中无一例死于心脏相关原因。在术前LVESVI大于200 ml/m²的AR患者中，尽管术后壁应力降低，但射血分数未能恢复正常，表明这些患者存在不可逆的心肌功能障碍。29例AS患者中有2例心脏相关死亡，他们术前LVESVI大于100 ml/m²。在术后LVESVI大于100 ml/m²的AS患者中，左心室的术后收缩功能较差。总之，为获得满意的晚期结果和功能结果逆转，术前左心室功能的最低水平在AR患者中可能为LVESVI 200 ml/m²，在AS患者中为100 ml/m²。
