Greaves S C, Reimold S C, Lee R T, Cooke K A, Aranki S F
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Heart Valve Dis. 1995 Jan;4(1):14-7.
Echocardiography may allow preoperative selection of appropriately sized aortic homograft valves. This study compared measurement of aortic annulus diameter from the preoperative transthoracic two-dimensional echocardiogram with prosthetic valve annulus diameter in 178 consecutive patients under-going primary aortic valve replacement. Aortic annulus diameter was measured independently from the two-dimensional parasternal long axis view by two experienced observers blinded to the size of valve implanted. Mean annulus diameter from three end-diastolic frames was recorded. Of the 178 patients, 124 (70%) of Observer 1 measurements and 102 (57%) of Observer 2 measurements were within 2mm of valve annulus diameter (p < 0.0001 for both observers). Six percent of Observer 1 measurements and 12% of Observer 2 measurements were more than 4mm away from valve annulus diameter. The echocardiographic prediction of valve size corresponded to actual prosthetic valve annulus diameter in 69 patients (39%) for Observer 1 and 60 patients (34%) for Observer 2. The percentages of echocardiographic measurements within two millimeter of valve annulus diameter were significantly different for the two observers (p < 0.05). The percentages of echocardiographic measurements within two millimeter of valve annulus diameter in 39 patients without significant aortic valve calcification were not significantly different from the remaining 139 patients with calcified valves. The interobserver coefficient of variation was 6.2% and the intraobserver coefficient of variation was 4.3%. Although preoperative measurement of aortic annulus diameter from transthoracic echocardiography approximates prosthetic valve annulus diameter in the majority of patients undergoing primary aortic valve replacement, a significant minority of estimates may be inaccurate, even in the absence of heavy calcification.(ABSTRACT TRUNCATED AT 250 WORDS)
超声心动图检查可能有助于术前选择尺寸合适的主动脉同种异体移植瓣膜。本研究比较了178例连续接受初次主动脉瓣置换术患者术前经胸二维超声心动图测量的主动脉瓣环直径与人工瓣膜瓣环直径。由两名经验丰富的观察者在不知道所植入瓣膜尺寸的情况下，从二维胸骨旁长轴视图独立测量主动脉瓣环直径。记录三个舒张末期图像的平均瓣环直径。在178例患者中，观察者1的测量值有124例（70%）、观察者2的测量值有102例（57%）与瓣膜瓣环直径相差在2mm以内（两位观察者的p值均<0.0001）。观察者1的测量值有6%、观察者2的测量值有12%与瓣膜瓣环直径相差超过4mm。观察者1对69例患者（39%）、观察者2对60例患者（34%）的瓣膜尺寸超声心动图预测与实际人工瓣膜瓣环直径相符。两位观察者测量值与瓣膜瓣环直径相差在2mm以内的百分比有显著差异（p<0.05）。39例无明显主动脉瓣钙化患者测量值与瓣膜瓣环直径相差在2mm以内的百分比，与其余139例有钙化瓣膜患者相比无显著差异。观察者间变异系数为6.2%，观察者内变异系数为4.3%。虽然术前经胸超声心动图测量的主动脉瓣环直径在大多数接受初次主动脉瓣置换术的患者中接近人工瓣膜瓣环直径，但即使在没有严重钙化的情况下，仍有相当一部分估计值可能不准确。（摘要截断于250字）
