Jin X Y, Pepper J R, Brecker S J, Carey J A, Gibson D G
Cardiac Department, Royal Brompton Hospital, London, United Kingdom.
Am J Cardiol. 1994 Dec 1;74(11):1142-6. doi: 10.1016/0002-9149(94)90468-5.
To assess the immediate effects of aortic valve replacement (AVR) for valvular aortic stenosis (AS) on left ventricular (LV) systolic and diastolic function and global hemodynamics, 17 patients with AS underwent transesophageal echocardiography combined with high-fidelity LV pressure recording and thermodilution cardiac output measurements before cardiopulmonary bypass and 0.5, 6, 12, and 20 hours after AVR. Compared with results before bypass, LV systolic function had already changed 30 minutes after AVR, and remained constant thereafter: peak LV systolic wall stress decreased (from 210 +/- 60 to 130 +/- 40 g.cm-2), peak rate of dimension shortening increased (from 7.3 +/- 2.2 to 9.7 +/- 2.1 cm.s-1), both p < 0.01. Peak segmental external power thus remained constant (16.6 +/- 6.7 vs 17.7 +/- 7.6 mW.cm-3); p = NS. Changes in LV diastolic function and global hemodynamics were delayed. The peak rate of ventricular pressure decrease, normalized to developed end-systolic pressure, increased (from 15 +/- 3.2 to 19 +/- 5.2 s-1) by 6 hours. The minimal ventricular pressure of early diastole decreased (from 8.9 +/- 4.9 to 4.3 +/- 3.7 mm Hg), the peak rate of dimension lengthening of early diastole increased (from 6.0 +/- 3.0 to 8.8 +/- 2.0 cm.s-1), and LV stroke volume index increased (from 24 +/- 7 to 31 +/- 6 ml.m-2) by 12 hours, all p < 0.01. LV incoordination, defined as the dimension changes during isovolumic periods, had also improved significantly at 20 hours. Heart rate and LV enddiastolic dimension did not change.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估主动脉瓣置换术（AVR）治疗瓣膜性主动脉狭窄（AS）对左心室（LV）收缩和舒张功能以及整体血流动力学的即时影响，17例AS患者在体外循环前以及AVR后0.5、6、12和20小时接受了经食管超声心动图检查，并结合高保真LV压力记录和热稀释法心输出量测量。与体外循环前的结果相比，LV收缩功能在AVR后30分钟就已发生变化，此后保持稳定：LV收缩期峰值壁应力降低（从210±60降至130±40 g·cm⁻²），峰值缩短速率增加（从7.3±2.2增至9.7±2.1 cm·s⁻¹），两者p均<0.01。因此，节段性峰值外部功率保持稳定（16.6±6.7对17.7±7.6 mW·cm⁻³）；p =无显著差异。LV舒张功能和整体血流动力学的变化出现延迟。将心室压力下降峰值标准化为收缩末期压力后，在6小时时增加（从15±3.2增至19±5.2 s⁻¹）。舒张早期的最小心室压力降低（从8.9±4.9降至4.3±3.7 mmHg），舒张早期的峰值伸长速率增加（从6.0±3.0增至8.8±2.0 cm·s⁻¹），LV每搏量指数在12小时时增加（从24±7增至31±6 ml·m⁻²），所有p均<0.01。定义为等容期尺寸变化的LV不协调在20小时时也有显著改善。心率和LV舒张末期尺寸未发生变化。（摘要截短于250字）
