Kasper W, Treese N, Kageneck V, Pop T, Meinertz T
Int J Cardiol. 1983 May;3(2):191-202. doi: 10.1016/0167-5273(83)90036-0.
We evaluated 56 consecutive patients echocardiographically 9 days to 104 months after aortic valve replacement by the precordial, subxiphoid and suprasternal approach. In 11 patients, the mitral valve had also been replaced. For comparison, a subjective grading system (score 1 up to 3) was applied to the records obtained from each approach. Disc valves (n = 41) were equally scored from the precordial and suprasternal approach (score 2.6). Ball prostheses (n = 6) were best imaged from the suprasternal approach (score 3.0), whereas bioprostheses (n = 9) were best visualized from the precordial (1.8). Simultaneous imaging of both valves was possible in 6 out of 11 patients with a double prosthesis using the suprasternal approach but not from precordial and subxiphoid approaches. Six patients presented prosthetic valve dysfunction. Five patients had paravalvular insufficiency; 4 of these patients had a Björk-Shiley valve and one patient a Lillehei-Kaster valve. The echograms of 4 out of 5 patients with a paravalvular leak were normal from each approach. In another patient an obstructed Björk-Shiley prosthesis was found. The pre- and postoperative echograms demonstrated that the suprasternal approach was best to visualize the obstructed valve. The study shows that the suprasternal technique is superior for evaluation of most patients with aortic valve prostheses.
我们通过心前区、剑突下和胸骨上途径，对56例主动脉瓣置换术后9天至104个月的连续患者进行了超声心动图评估。其中11例患者还进行了二尖瓣置换。为作比较，我们对从每种途径获得的记录应用了一种主观分级系统（分数从1到3）。碟瓣（n = 41）从心前区和胸骨上途径获得的评分相同（分数为2.6）。球瓣人工瓣膜（n = 6）从胸骨上途径成像最佳（分数为3.0），而生物瓣（n = 9）从心前区成像最佳（分数为1.8）。在11例使用双瓣人工瓣膜的患者中，有6例通过胸骨上途径可以同时对两个瓣膜进行成像，但通过心前区和剑突下途径则无法做到。6例患者出现人工瓣膜功能障碍。5例患者有瓣周漏；其中4例患者使用的是 Björk-Shiley 瓣，1例患者使用的是 Lillehei-Kaster 瓣。5例有瓣周漏的患者中，4例患者从每种途径获得的超声心动图均正常。在另一例患者中，发现一个 Björk-Shiley 人工瓣膜出现梗阻。术前和术后的超声心动图显示，胸骨上途径最适合观察梗阻的瓣膜。该研究表明，胸骨上技术在评估大多数主动脉瓣人工瓣膜患者时更具优势。
