Weir E K, Matisonn R E, Mitha A S, LeRoux B T, Rogers N M, Chesler E
Thorax. 1978 Oct;33(5):608-11. doi: 10.1136/thx.33.5.608.
The timing of valve replacement in patients with rheumatic aortic regurgitation is assessed by balancing the mortality and complications associated with the operation and the prosthetic valves against the natural history of the lesion. The time course without surgery is determined by the severity of the volume overload and the gradual deterioration of myocardial function. We wished to obtain information both on the haemodynamic recovery achieved after aortic valve replacement in young patients and also on the risks of operation in this group. Twenty patients, in whom the aortic valve was replaced at a mean age of 15 years, were reviewed. An improvement in symptoms and in the cardiothoracic ratio on the chest radiograph occurred in every case, and the voltage measurements suggestive of left ventricular hypertrophy on electrocardiogram diminished in all but two. The left ventricular end-diastolic pressure decreased in the 11 patients who were recatheterised after operation. The ejection fraction improved in three patients and stayed the same in three others. While there were no operative deaths in our series the incidence of serious morbidity, in terms of myocardial damage at or after operation, was disappointingly high. Early valve replacement to preserve myocardial function is especially attractive in young patients but cannot be advised if the insertion of the prosthetic valve is associated with appreciable myocardial damage.
对于风湿性主动脉瓣关闭不全患者，瓣膜置换时机的评估需权衡手术及人工瓣膜相关的死亡率和并发症与病变自然病程之间的关系。未经手术情况下的病程取决于容量超负荷的严重程度以及心肌功能的逐渐恶化。我们希望获取有关年轻患者主动脉瓣置换术后血流动力学恢复情况以及该组患者手术风险的信息。对20例平均年龄15岁时接受主动脉瓣置换的患者进行了回顾性研究。所有患者的症状均有改善，胸部X线片显示心胸比率降低，除2例患者外，其余患者心电图上提示左心室肥厚的电压测量值均降低。术后接受再次心导管检查的11例患者左心室舒张末期压力降低。3例患者射血分数提高，另外3例保持不变。虽然我们的系列研究中没有手术死亡病例，但就手术时或术后心肌损伤而言，严重并发症的发生率高得令人失望。早期瓣膜置换以保护心肌功能对年轻患者尤其有吸引力，但如果人工瓣膜植入与明显的心肌损伤相关，则不建议进行。
