Roudaut R, Sermon F, Billes M A, Dallocchio M
Arch Mal Coeur Vaiss. 1984 Sep;77(9):983-92.
The aim of this study was to assess whether, as previously reported series have suggested, aortic valve replacement is too late when echocardiography shows a left ventricular end systolic diameter (LVS) greater than or equal to 55 mm, a left ventricular fractional shortening (FS) less than or equal to 25%, and a ratio of left ventricular radius to wall thickness (R/H) greater than or equal to 4. Sixty-seven patients with pure chronic aortic regurgitation were operated in the period between 1979 and June 1981. All had at least one good quality preoperative M mode recording. Using the above mentioned parameters, the patients were divided into two groups: Group I (n = 41) "good surgical candidates" with LVS less than or equal to 55 mm, FS greater than 25%, and/or R/H less than 4; and Group II (n = 26) "high risk candidates" with LVS greater than 55 mm, FS less than or equal to 25% and/or R/H greater than or equal to 4. The clinical improvement was spectacular in both groups after surgery (mean follow-up 28 +/- 8 months). There were no operative deaths but 5 patients out of each group died secondarily. An echocardiogram was recorded in the immediate post-operative period in 55 cases; there was a significant reduction in LV diameters in both groups but the values in Group II remained higher. A control echocardiogram was recorded 17,5 +/- 8,9 months later 46 cases. The LV diameters had returned to normal in Group I but remained at the upper limit of normal in Group II. We conclude that patients with echocardiographic indices of " high risk " usually have a favourable postoperative course. However, although the echocardiographic parameters to improve, they do not return completely to normal.
本研究的目的是评估，正如先前报道的系列研究所示，当超声心动图显示左心室收缩末期直径（LVS）大于或等于55mm、左心室缩短分数（FS）小于或等于25%、以及左心室半径与壁厚之比（R/H）大于或等于4时，主动脉瓣置换术是否为时已晚。1979年至1981年6月期间，对67例单纯慢性主动脉瓣反流患者进行了手术。所有患者术前均至少有一份质量良好的M型记录。根据上述参数，将患者分为两组：第一组（n = 41）为“良好手术候选者”，LVS小于或等于55mm，FS大于25%，和/或R/H小于4；第二组（n = 26）为“高风险候选者”，LVS大于55mm，FS小于或等于25%和/或R/H大于或等于4。两组患者术后临床改善都很显著（平均随访28±8个月）。无手术死亡，但每组各有5例患者继发死亡。55例患者术后即刻进行了超声心动图检查；两组左心室直径均显著减小，但第二组的值仍较高。46例患者在17.5±8.9个月后进行了对照超声心动图检查。第一组左心室直径已恢复正常，但第二组仍处于正常上限。我们得出结论，具有“高风险”超声心动图指标的患者术后通常有良好的病程。然而，尽管超声心动图参数有所改善，但并未完全恢复正常。
