Ben-Ismail M, Descaves C, Ziza J M, Bousnina A
Arch Mal Coeur Vaiss. 1980 Jul;73(7):841-50.
A series of 24 cases of paraprosthetic valvular regurgitation, 10 mitral and 14 aortic, in 19 out of a group of 634 operated patients with a total of 822 prosthetic heart valves is reported. The presenting features are dominated by auscultatory changes, though inconstant episodes of heart failure, and, in aortic prostheses, the high incidence of infective endocarditis. Paraclinical investigations are of variable value; cineradiography in aortic valves and phonocardiography in mitral valves are useful; catheterisation with ventriculography or aortic angiography according to the case under study are the investigations of choice, especially in mitral regurgitation where it is essential. Typical clinical settings for these problems are valve ring dilatation calcification, and previous or active infective endocarditis. The indications for urgent surgery depend on the clinical signs, the presence of heart failure, haemolysis, active endocarditis and deterioration despite medical treatment. The series compares the data in mitral paraprosthetic regurgitation, difficult to diagnose but with a reasonably good prognosis, and aortic paraprosthetic regurgitation, easier to diagnose but associated with a poor prognosis due to the high incidence of associated endocarditis.
在一组634例接受手术且共植入822枚人工心脏瓣膜的患者中，报告了24例人工瓣膜反流病例，其中二尖瓣反流10例，主动脉瓣反流14例。临床表现以听诊变化为主，伴有不连续的心力衰竭发作，在主动脉瓣人工瓣膜中，感染性心内膜炎的发生率较高。辅助检查价值不一；主动脉瓣的电影造影和二尖瓣的心音图检查有用；根据具体病例进行心室造影或主动脉造影的导管检查是首选检查，尤其是在二尖瓣反流时，这是必不可少的。这些问题的典型临床情况是瓣环扩张、钙化以及既往或活动性感染性心内膜炎。紧急手术的指征取决于临床体征、心力衰竭的存在、溶血、活动性心内膜炎以及尽管进行了药物治疗仍出现病情恶化。该系列比较了二尖瓣人工瓣膜反流（难以诊断但预后相对较好）和主动脉瓣人工瓣膜反流（易于诊断但由于相关心内膜炎的高发生率而预后较差）的数据。
