Walther T, Falk V, Autschbach R, Scheidt A, Baryalei M, Schindewolf K, Dalichau H, Mohr F W
Department of Thoracic and Cardiovascular Surgery, Georg-August-University Göttingen, Germany.
J Heart Valve Dis. 1994 Nov;3(6):657-65.
Since March 1993 the Toronto SPVTM bioprosthesis has been implanted in 100 patients. Our prospective study evaluated the echocardiographic valve characteristics and the influence of the echocardiographic assessment on surgical technique. Transesophageal echocardiography (TEE) was applied before and during surgery, and transthoracic echocardiography (TTE) postoperatively. The average valve size implanted was 26.5 mm. Follow up was complete in 74 patients at six months and in 38 patients at one year. Pre-cardiopulmonary bypass (CPB) TEE valve sizing was accurate by +/- 1 mm in 81 patients as compared to mechanical sizing. Post-CPB valve closure was concentric in 99 patients. Minimal aortic incompetence was present in seven patients at one week, in two patients at six months and in one patient at one year. Mean pressure gradients ranged from 7.7 to 11.1 mmHg postoperatively. Overall mortality was 4%. One patient with non-structural dysfunction and another with endocarditis at one year postoperatively were reoperated successfully. At follow up there was a significant decrease in transvalvular pressure gradients and an increase in valve orifice areas. In 32 patients a decrease in left ventricular posterior wall (LVPW) hypertrophy was found (p < 0.001). There was a decrease in tissue depth and recurrence of the dynamic movement of the aortic root. It is concluded that TEE valve sizing is reliable for early valve selection. Valve incompetence is not a clinically relevant issue using the oversizing technique. Improved hemodynamics at follow up can be explained by remodeling of the aortic root and by a decrease in left ventricular hypertrophy. The excellent hemodynamic profile, resembling native aortic valve function, is impressive and has to be confirmed by long term evaluation.
自1993年3月以来，多伦多SPVTM生物假体已植入100例患者体内。我们的前瞻性研究评估了超声心动图瓣膜特征以及超声心动图评估对手术技术的影响。手术前和手术期间应用经食管超声心动图（TEE），术后应用经胸超声心动图（TTE）。植入瓣膜的平均尺寸为26.5毫米。74例患者在六个月时完成随访，38例患者在一年时完成随访。与机械测量相比，81例患者在体外循环（CPB）前通过TEE测量瓣膜尺寸的误差在±1毫米以内。99例患者在CPB后瓣膜关闭呈同心性。7例患者在术后一周存在轻度主动脉瓣反流，2例患者在六个月时存在，1例患者在一年时存在。术后平均压力阶差在7.7至11.1毫米汞柱之间。总体死亡率为4%。一名术后一年出现非结构性功能障碍的患者和另一名患有心内膜炎的患者成功接受了再次手术。随访时跨瓣膜压力阶差显著降低，瓣膜开口面积增加。在32例患者中发现左心室后壁（LVPW）肥厚减轻（p<0.001）。组织深度减小，主动脉根部动态运动复发。结论是，TEE测量瓣膜尺寸对于早期瓣膜选择是可靠的。使用加大尺寸技术，瓣膜反流不是一个临床相关问题。随访时血流动力学改善可通过主动脉根部重塑和左心室肥厚减轻来解释。其出色的血流动力学特征类似于天然主动脉瓣功能，令人印象深刻，必须通过长期评估来证实。
