Krayenbuehl H P, Hess O M, Schneider J, Turina M
Herz. 1984 Oct;9(5):270-8.
47 patients with aortic valve disease were studied by left ventricular micromanometry and cineangiography before and 18 months after successful valve replacement. There were 27 patients (17 with aortic stenosis, ten with aortic insufficiency) with moderate hypertrophy (angiographic mass less than 180 g/m2) and 20 patients (ten with aortic stenosis, ten with aortic insufficiency) with severe hypertrophy (angiographic mass greater than or equal to 180 g/m2). In the patients with moderate hypertrophy ejection fraction was slightly although not significantly smaller than in 14 controls. Peak systolic circumferential wall stress was, however, significantly increased. In the patients with severe hypertrophy ejection fraction was significantly decreased although afterload was similar to that in the patients with moderate hypertrophy. This indicated a depressed contractile state in the patients with mass exceeding 180 g/m2. After surgery peak systolic wall stress returned to normal levels in both groups. Among the patients with severe preoperative hypertrophy only the patients with aortic stenosis showed a normal ejection fraction after surgery, whereas in the patients with aortic insufficiency ejection fraction improved but remained depressed compared to the controls. In a second study, comparison of left ventricular function with myocardial structure (endomyocardial biopsies) was carried out in 30 patients with aortic valve disease (group 1: 18 with aortic stenosis, group 2: twelve with aortic insufficiency). Both groups were restudied 18.8 and 17.4 months, respectively, following successful aortic valve replacement. Preoperative biplane ejection fraction (60 and 57%), angiographic mass (183 and 186 g/m2), muscle fibre diameter (31.1 and 30.8 mu), interstitial fibrosis (17.1 and 17.4%) and left ventricular fibrous content (31.0 and 32.2 g/m2) were similar in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
47例主动脉瓣疾病患者在成功进行瓣膜置换术前及术后18个月接受了左心室微测压和心血管造影检查。其中27例患者（17例主动脉瓣狭窄，10例主动脉瓣关闭不全）为中度肥厚（血管造影显示心肌质量小于180g/m²），20例患者（10例主动脉瓣狭窄，10例主动脉瓣关闭不全）为重度肥厚（血管造影显示心肌质量大于或等于180g/m²）。中度肥厚患者的射血分数虽略低于14例对照组，但差异无统计学意义。然而，收缩期峰值圆周壁应力显著增加。重度肥厚患者的射血分数显著降低，尽管后负荷与中度肥厚患者相似。这表明心肌质量超过180g/m²的患者存在收缩功能抑制。术后两组患者的收缩期峰值壁应力均恢复至正常水平。术前重度肥厚患者中，仅主动脉瓣狭窄患者术后射血分数恢复正常，而主动脉瓣关闭不全患者的射血分数有所改善，但与对照组相比仍较低。在第二项研究中，对30例主动脉瓣疾病患者（第1组：18例主动脉瓣狭窄，第2组：12例主动脉瓣关闭不全）的左心室功能与心肌结构（心内膜活检）进行了比较。两组患者在成功进行主动脉瓣置换术后分别于18.8个月和17.4个月再次接受检查。两组患者术前的双平面射血分数（分别为60%和57%）、血管造影显示的心肌质量（分别为183g/m²和186g/m²）、肌纤维直径（分别为31.1μm和30.8μm）、间质纤维化（分别为17.1%和17.4%）以及左心室纤维含量（分别为31.0g/m²和32.2g/m²）相似。（摘要截取自250字）
