Fernandez F, Neveux E, Belfante M, Lelguen C, Gerbaux A
Arch Mal Coeur Vaiss. 1980 Jul;73(7):851-6.
The haemodynamic and angiocardiographic data of 19 patients with Starr-Edwards mitral valve prosthesis were analysed to determine the causes of secondary deterioration observed in 14 of them. This was shown to be due to: 1. Surgical complications or progression of pre-existing valvular lesions which were not, or only partially, corrected (3 cases) (adiastole due to pericardial effusion, aortic valve disease and severe tricuspid incompetence); average diastolic pressure gradient CPW-LV 4.7 +/- 1.5 mmHG, the functional valve surface area (FVA) 1.37 +/- 0.2 cm2, LVEDP 17.7 +/- 4 mmHg, LVEDV 57.5 +/- 11 ml/m2, and EF 73.5 +/- 8 p. 100; 2. Deterioration of left ventricular contractility with LVEDP greater than 13 mmHg, LVEDV greater than 100 ml/m2 and EF less than 45 p. 100 (4 cases); CPW-LV gradient 9.8 +/- 4 mmHG, FVSA 1.30 +/- 0.2 cm2, LVEDP 20.5 +/- 8 mmHG, LVEDV 212 +/- 168 ml and EF 38 +/- 21 p. 100; 3. Significant reduction of left ventricular volume (LVEDV 22 ml/m2 1 case); 4. Left atrial thrombosis (1 case); 5. Prosthetic valve dysfunction (5 cases) one paravalvular leak and 4 thromboses. In these 4 cases, the PCW-LV gradient was 15 +/- 5 mmHg, FVSA 0.95 +/- 0.1 cm2 LVEDP 8 +/- 2 mmHg, LVEDV 132.8 +/- 93 ml/m2 and EF 45 +/- 28 p. 100; these results were different to whose found in the other patients and those investigated systematically (PCW-LV gradient 8.2 +/- 3 mmHg, FVSA 1.38 +/- 0.3 cm2, LVEDP 11 +/- 4 mmHg, LVEDV 66.4 +/- 33 ml/m2, EF 53 +/- 13 p. 100). The significant haemodynamic criteria in favour of thrombosis of the prosthesis were: CPW-LV gradient greater than 12 mmHg under basal conditions or after exercise and a FVSA less than 1.1 cm2.
对19例植入斯塔尔-爱德华兹二尖瓣人工瓣膜的患者的血流动力学和心血管造影数据进行了分析，以确定其中14例出现继发性瓣膜功能恶化的原因。结果表明，原因如下：1. 手术并发症或原有瓣膜病变进展，这些病变未得到纠正或仅部分得到纠正（3例）（心包积液、主动脉瓣疾病和严重三尖瓣关闭不全导致的心舒张期异常）；平均舒张期压力阶差CPW-LV为4.7±1.5 mmHg，功能性瓣膜表面积（FVA）为1.37±0.2 cm²，左心室舒张末期压力（LVEDP）为17.7±4 mmHg，左心室舒张末期容积（LVEDV）为57.5±11 ml/m²，射血分数（EF）为73.5±8%；2. 左心室收缩功能恶化，LVEDP大于13 mmHg，LVEDV大于100 ml/m²，EF小于45%（4例）；CPW-LV阶差为9.8±4 mmHg，FVSA为1.30±0.2 cm²，LVEDP为20.5±8 mmHg，LVEDV为212±168 ml，EF为38±21%；3. 左心室容积显著减少（LVEDV为22 ml/m²，1例）；4. 左心房血栓形成（1例）；5. 人工瓣膜功能障碍（5例），1例瓣周漏和4例血栓形成。在这4例中，PCW-LV阶差为15±5 mmHg，FVSA为0.95±0.1 cm²，LVEDP为8±2 mmHg，LVEDV为132.8±93 ml/m²，EF为45±28%；这些结果与其他患者以及系统研究中的结果不同（PCW-LV阶差为8.2±3 mmHg，FVSA为1.38±0.3 cm²，LVEDP为11±4 mmHg，LVEDV为66.4±33 ml/m²，EF为53±13%）。支持人工瓣膜血栓形成的显著血流动力学标准为：基础状态下或运动后CPW-LV阶差大于12 mmHg，FVSA小于1.1 cm²。
