Beloev I, Tomov I, Milev M, Lacheva T, Kaloianova A
Vutr Boles. 1981;20(6):78-83.
The data from the right cardiac catheterization, echocardiography M-type and radiocardiography were juxtaposed in 54 patients with "pure" or predominating severe mitral stenosis (MS)(mitral valvular opening under 1 cm2)--confirmed at operation, in the determination of their functional and hemodynamic characteristics. The patients were grouped into three groups depending on the degree of pulmonary--capillary pressure increase (PC)--greater than 2.666, greater than 3.999 and 4.132 kPa(greater than 20, greater than 30 and less than 31 mmHg). The first group covering 28 per cent of the patients with a mean PC--2,399 +/- 0.257 kPa = (18 +/- 1.93 mmHg) are of particular interest. A light to moderate increase of pulmonary arterial pressure, elevated TPVR, absence of right ventricular insufficiency with reduced M. V SI resp. were established in them. It was assessed as a group with hypovolemia and proper preoperation preparation but requiring attention as regards the eventual hypotension, intra- or post operation. The third group covers 22 per cent of the patients and is characterized with increased TPVR, high hypertension in pulmonary artery, elevated telediastolic pressure in right ventricle and normal or lightly increased MO, assessed as a group with an inadequate diuretic therapy pre-operatively. The second group is with typical hemodynamic characteristics of severe MS and includes 50 per cent of the patients. The analysis forces the conclusion, that for an adequate evaluation of hemodynamics and MS severity, the PC pressure is necessary to be always discussed in connection with blood volume and flow, as well as with the other hemodynamic indices, in order to avoid the omissions as regards MS operability.
对54例经手术证实为“单纯”或以重度二尖瓣狭窄（MS）（二尖瓣瓣口面积小于1平方厘米）为主的患者，将其右心导管检查、M型超声心动图和心脏X线造影的数据并列分析，以确定其功能和血流动力学特征。根据肺毛细血管压力（PC）升高程度，将患者分为三组，分别为PC大于2.666kPa（大于20mmHg）、大于3.999kPa（大于30mmHg）和4.132kPa（小于31mmHg）。第一组占患者总数的28%，平均PC为2.399±0.257kPa =（18±1.93mmHg），该组特别值得关注。他们表现为肺动脉压轻度至中度升高、总外周血管阻力（TPVR）升高、无右心功能不全伴二尖瓣反流分数（M.V SI resp.）降低。该组被评估为血容量不足且术前准备适当，但需注意术中或术后可能出现的低血压。第三组占患者总数的22%，其特征为TPVR升高、肺动脉高压、右心室舒张末期压力升高以及二尖瓣口面积正常或轻度增加，评估为术前利尿治疗不足的一组。第二组具有重度MS的典型血流动力学特征，包括50%的患者。分析得出结论，为了充分评估血流动力学和MS的严重程度，必须始终结合血容量、血流以及其他血流动力学指标来讨论PC压力，以避免在MS手术可行性方面出现遗漏。
