Itzkoff J M, Curtiss E I, Reddy P S, Uretsky B F, Shaver J A
Am J Cardiol. 1984 Apr 1;53(8):1071-4. doi: 10.1016/0002-9149(84)90639-8.
A unique hemodynamic event was noted in long-term survivors of mitral valve replacement with the Beall prosthesis. The event was a result of intermittent valve dysfunction and transvalvular mitral regurgitation (MR). At cycle lengths longer than 0.9 second that were preceded by shorter cycle lengths, 8 of 13 patients with Beall valve prostheses who had chronic atrial fibrillation (AF) intermittently had a marked unexpected decrease in peak left ventricular systolic pressure and a simultaneous increase in left atrial or pulmonary artery wedge "v" wave pressure. This event, which is a result of intermittent, severe MR, occurred more frequently at longer cycle lengths. In all 8 patients with the finding, severe valve disc wear was found at operation; however, 5 of these patients had only trace or 1+ MR on left ventricular angiography. In contrast, the event did not occur in 11 patients in chronic AF with organic MR or non-Beall valve MR, despite an appropriate number of sufficiently long cycles. The absence of the event in 5 Beall valve patients with significantly faster heart rates than in those with the event may in part be a result of its dependence on cycle length. This hemodynamic event, when present in a Beall valve recipient in AF, is an indication for valve replacement, even in the absence of angiographic evidence of severe MR.
在接受比尔人工心脏瓣膜置换术的长期存活者中，观察到一种独特的血流动力学事件。该事件是间歇性瓣膜功能障碍和二尖瓣反流（MR）的结果。在周期长度大于0.9秒且之前周期长度较短的情况下，13例患有慢性心房颤动（AF）的比尔人工心脏瓣膜置换患者中有8例间歇性出现左心室收缩压峰值明显意外下降，同时左心房或肺动脉楔压“v”波压力升高。这一事件是间歇性严重MR的结果，在较长周期长度时更频繁发生。在所有8例出现该现象的患者中，术中发现瓣膜盘严重磨损；然而，其中5例患者在左心室血管造影中仅有微量或1+级MR。相比之下，11例患有器质性MR或非比尔瓣膜MR的慢性AF患者，尽管有足够数量的足够长周期，但该事件并未发生。5例心率明显快于出现该事件患者的比尔瓣膜患者未出现该事件，部分原因可能是该事件依赖于周期长度。这种血流动力学事件，当出现在AF的比尔瓣膜接受者中时，即使没有严重MR的血管造影证据，也是瓣膜置换的指征。
