Aryanpur I, Paydar M, Shakibi J G, Siassi B, Yazdanyar A
Chest. 1977 Mar;71(3):354-60. doi: 10.1378/chest.71.3.354.
Forty-one children with advanced chronic rheumatic disease of the mitral valve had preoperative and postoperative hemodynamic studies. Twenty-three cases had open mitral commissurotomy, and 20 had mitral valvular replacement. After surgery the average pulmonary arterial systolic pressure in the group with valve replacement decreased from 78 to 42 mm Hg, the pulmonary vascular resistance decreased from 974 to 313 dynes sec cm 5, and the cardiac index rose from 2.29 to 4.15 L/min sq m. In the group with mitral commissurotomy, the average pulmonary arterial systolic pressure decreased from 90 to 63 mm Hg, the pulmonary vascular resistance decreased from 1,201 to 616 dynes sec cm-5, and the cardiac index rose from 2.5 to 3.5 L/min sq m. While all patients with mitral valve replacement showed a drop in pulmonary arterial pressure, the postoperative pressures were higher after commissurotomy in four patients, two of whom required a second operation of valve replacement. The study shows that in children, even severe degrees of pulmonary hypertension secondary to mitral valve abnormality is corrected.
41例患有晚期二尖瓣慢性风湿性疾病的儿童接受了术前和术后血流动力学研究。23例行二尖瓣直视交界切开术，20例行二尖瓣置换术。术后，二尖瓣置换组的平均肺动脉收缩压从78毫米汞柱降至42毫米汞柱，肺血管阻力从974达因秒/平方厘米⁵降至313达因秒/平方厘米⁵，心脏指数从2.29升/分钟/平方米升至4.15升/分钟/平方米。在二尖瓣交界切开术组，平均肺动脉收缩压从90毫米汞柱降至63毫米汞柱，肺血管阻力从1201达因秒/平方厘米⁻⁵降至616达因秒/平方厘米⁻⁵，心脏指数从2.5升/分钟/平方米升至3.5升/分钟/平方米。虽然所有二尖瓣置换患者的肺动脉压均下降，但4例交界切开术后患者的术后压力较高，其中2例需要再次行瓣膜置换手术。该研究表明，在儿童中，即使是继发于二尖瓣异常的重度肺动脉高压也可得到纠正。
