Akins C W, Kirklin J K, Block P C, Buckley M J, Austen W G
Circulation. 1979 Aug;60(2 Pt 2):71-6. doi: 10.1161/01.cir.60.2.71.
To assess the degree of mitral subvalvular fibrosis (SVF) in patients with mitral stenosis, left ventriculograms were reviewed, and a mitral subvalvular distance ratio (DR) was determined by dividing the distance from the papillary muscle tips to the closed mitral leaflets in systole by the distance from the aortic valve to the left ventricular apex in diastole. In 15 patients with normal ventricles, the mean DR was 0.244 +/- 0.017. In nine patients with minimal SVF, the mean DR was 0.181 +/- 0.025. In 10 patients with moderate SVF, the mean DR was 0.148 +/- 0.033. In 5 patients with severe SVF, the mean DR was 0.087 +/- 0.009. All mean DRs were mutually distinguishable at p less than 0.01. The clinical results and preoperative DR of 28 patients who had mitral commissurotomy were reviewed. A DR of less than 0.140 precluded a good longterm result from mitral commissurotomy alone. The DR reliably predicts the degree of SVF preoperatively and identifies patients with mitral stenosis who require valve replacement or a direct surgical attack on the subvalvular mechanism.
为评估二尖瓣狭窄患者二尖瓣瓣下纤维化（SVF）的程度，对左心室造影片进行了回顾，并通过将收缩期乳头肌尖端至闭合二尖瓣叶的距离除以舒张期主动脉瓣至左心室心尖的距离来确定二尖瓣瓣下距离比（DR）。15例心室正常的患者，平均DR为0.244±0.017。9例轻度SVF患者，平均DR为0.181±0.025。10例中度SVF患者，平均DR为0.148±0.033。5例重度SVF患者，平均DR为0.087±0.009。所有平均DR在p<0.01时相互有显著差异。回顾了28例行二尖瓣交界切开术患者的临床结果和术前DR。DR小于0.140排除了单纯二尖瓣交界切开术获得良好长期效果的可能。DR可可靠地术前预测SVF的程度，并识别需要瓣膜置换或直接手术处理瓣下结构的二尖瓣狭窄患者。
