Takahashi S, Kawana M, Hirosawa K
Jpn Circ J. 1983 Sep;47(9):1112-20. doi: 10.1253/jcj.47.1112.
The postoperative course of 294 patients with rheumatic mitral valve disease, who underwent mitral valve surgery during a period from July, 1978 to June, 1981, was studied by comparing the influences of the following clinical parameters: a low left ventricular ejection fraction (LVEF), a high pulmonary arterial systolic pressure (PASP), a high pulmonary vascular resistance (PVR), tricuspid regurgitation (TR), a high right ventricular end-diastolic pressure (RVEDP) and a giant left atrium (GLA). The patients with a functional capacity of class III or IV according to the New York Heart Association were classified into 3 groups (improved, unimproved and died), and from this data we calculated the improvement ratio and the mortality rate. The improvement ratios were 73% in patients with a low LVEF, 70% with a high PASP, 78% with a high PVR, 66% with TR, 11% with a high RVEDP and 77% with a GLA; the mortality rates were 19, 14, 17, 24, 78 and 19%, respectively. As compared with the case of deteriorated left ventricular performance and pulmonary hypertension, deteriorated right ventricular performance, especially high RVEDP, was accompanied by a comparatively poorer surgical prognosis. It is concluded that mitral valve surgery should be performed during the period in which the right ventricular function is still preserved.
对1978年7月至1981年6月期间接受二尖瓣手术的294例风湿性二尖瓣疾病患者的术后病程进行了研究，比较了以下临床参数的影响：低左心室射血分数（LVEF）、高肺动脉收缩压（PASP）、高肺血管阻力（PVR）、三尖瓣反流（TR）、高右心室舒张末期压力（RVEDP）和巨大左心房（GLA）。根据纽约心脏协会功能分级为III或IV级的患者被分为3组（改善、未改善和死亡），并据此数据计算改善率和死亡率。LVEF低的患者改善率为73%，PASP高的患者为70%，PVR高的患者为78%，TR患者为66%，RVEDP高的患者为11%，GLA患者为77%；死亡率分别为19%、14%、17%、24%、78%和19%。与左心室功能恶化和肺动脉高压的情况相比，右心室功能恶化，尤其是高RVEDP，伴随着相对较差的手术预后。结论是二尖瓣手术应在右心室功能仍保留的时期进行。
