Ren J F, Aksut S, Lighty G W, Vigilante G J, Sink J D, Segal B L, Hargrove W C
Philadelphia Heart Institute, Presbyterian Medical Center, PA, USA.
Am Heart J. 1996 May;131(5):974-81. doi: 10.1016/s0002-8703(96)90182-9.
The immediate effect or mitral valve repair (MVP) or replacement (MVR) on cardiac function was compared in patients with mitral regurgitation in relation to the changes in left ventricular (LV) function and geometry by using intraoperative transesophageal echocardiography in 29 patients with MVP and 21 patients with MVR, before and immediately after cardiopulmonary bypass. The LV volumes, ejection fraction, and long-axis and short-axis lengths and eccentricity index (ratio of long axis to short axis) at end-systole and end-diastole were measured. After both MVP and MVR, there were significant decreases in LV end-diastolic volume (p < 0.0001). However, the ejection fraction did not change after MVP, whereas it decreased after MVR (p < 0.0001). After MVP, there was an increase in eccentricity index at end-systole (p < 0.0001). After MVR, there was no decrease in end-systolic volume, and the eccentricity index was lower than that after MVP (p < 0.0001). The change in LV ejection fraction correlated with the changes in eccentricity index at end-systole (r = 0.55; p < 0.0001) and end-diastole (r = 0.42; p < 0.0003). Immediate intraoperative LV function is preserved after MVP but is depressed after MVR for mitral regurgitation. The changes in ejection fraction correlate with changes in ventricular geometry.
通过术中经食管超声心动图，比较了29例二尖瓣修复（MVP）或21例二尖瓣置换（MVR）患者在体外循环前后二尖瓣反流对心脏功能的即时影响，以及左心室（LV）功能和几何形态的变化。测量了收缩末期和舒张末期的左心室容积、射血分数、长轴和短轴长度以及偏心指数（长轴与短轴之比）。MVP和MVR术后，左心室舒张末期容积均显著降低（p<0.0001）。然而，MVP术后射血分数未改变，而MVR术后射血分数降低（p<0.0001）。MVP术后，收缩末期偏心指数增加（p<0.0001）。MVR术后，收缩末期容积没有降低，偏心指数低于MVP术后（p<0.0001）。左心室射血分数的变化与收缩末期（r=0.55；p<0.0001）和舒张末期（r=0.42；p<0.0003）偏心指数的变化相关。二尖瓣反流患者，MVP术后术中即时左心室功能得以保留，而MVR术后左心室功能则受到抑制。射血分数的变化与心室几何形态的变化相关。
