Hamm C, Kupper W, Bleifeld W
Dtsch Med Wochenschr. 1980 May 9;105(19):686-90. doi: 10.1055/s-2008-1070730.
Coronary venous blood flow measured by continuous thermodilution, myocardial oxygen consumption and lactate extraction rate were estimated at rest and during graded heart rate exercise in 21 patients with compensated aortic valve stenosis and in 10 patients without heart disease. Significant differences between the groups were found only in coronary sinus flow, however not in coronary perfusion related to 100 g of left ventricular muscle mass. As regards indication for operation patients with aortic valve stenosis were differentiated according to transvalvular pressure differences. Pressure gradients of more than 90 mm Hg (n = 5) were associated with significant lowering of weight-related myocardial perfusion and oxygen consumption and high lactate production during stimulation. This evidence of myocardial ischaemia was also seen in 3 out of 11 patients with a pressure gradient between 51 and 90 mm Hg. The rest of the patients showed no significantly different measurements in comparison with the control group. Thus insufficient myocardial perfusion during exercise is likely in patients with transvalvular pressure differences of more than 90 mm/Hg and possible when the difference is more than 50 mm Hg.
通过连续热稀释法测量21例代偿性主动脉瓣狭窄患者和10例无心脏病患者静息时及分级心率运动期间的冠状静脉血流量、心肌耗氧量和乳酸摄取率。两组之间仅在冠状窦血流量方面存在显著差异，而与100克左心室肌肉质量相关的冠状动脉灌注无差异。关于手术指征，主动脉瓣狭窄患者根据跨瓣压差进行区分。超过90毫米汞柱（n = 5）的压力梯度与刺激期间体重相关的心肌灌注和氧耗量显著降低以及高乳酸生成有关。在11例压力梯度在51至90毫米汞柱之间的患者中，有3例也出现了心肌缺血的证据。其余患者与对照组相比，测量结果无显著差异。因此，跨瓣压差超过90毫米汞柱的患者在运动期间可能存在心肌灌注不足，而当压差超过50毫米汞柱时则可能出现这种情况。
