Croke R P, Pifarre R, Sullivan H, Gunnar R, Loeb H
Ann Thorac Surg. 1977 Jul;24(1):38-43. doi: 10.1016/s0003-4975(10)64569-9.
A series of 12 consecutive patients who underwent aortic valve replacement (AVR) for aortic stenosis complicated by severe left ventricular dysfunction was reviewed. Ventricular dysfunction was reflected by pulmonary congestion, edema, renal and hepatic dysfunction, and by severely depressed ejection fractions (mean, 13%; range equal to 0-20%). Aortic valve replacement was accompanied by mitral commissurotomy in 1 patient and aortocoronary bypass in 5. Three of 5 patients with greater than 50% coronary obstruction died without reversal of heart failure, and 1 of the 5 died after a stroke. The 1 survivor of this group has done well. All 7 patients with minimal or no coronary disease survived operation and are now in New York Heart Association Class I or II. Postoperative catheterization (2 to 12 months) in 6 patients showed improved cardiac index and filling pressures. Left ventricular diastolic volume fell from 159 to 82 ml/m2, and ejection fraction rose from 13 to 45%. We conclude that left ventricular dysfunction owing to aortic stenosis alone is reversible and that AVR results in great clinical improvement. When coronary disease is present, survival may be accompanied by great improvement but the operative mortality is much higher.
回顾了连续12例因主动脉瓣狭窄合并严重左心室功能不全而接受主动脉瓣置换术（AVR）的患者。心室功能不全表现为肺淤血、水肿、肾和肝功能障碍，以及射血分数严重降低（平均为13%；范围为0 - 20%）。1例患者在主动脉瓣置换术的同时进行了二尖瓣交界切开术，5例进行了主动脉冠状动脉搭桥术。5例冠状动脉阻塞超过50%的患者中有3例死于心力衰竭未逆转，5例中有1例死于中风。该组中的1名幸存者情况良好。所有7例冠状动脉疾病轻微或无冠状动脉疾病的患者手术存活，目前纽约心脏协会心功能分级为I级或II级。6例患者术后（2至12个月）的心导管检查显示心脏指数和充盈压有所改善。左心室舒张容积从159降至82 ml/m²，射血分数从13%升至45%。我们得出结论，单纯因主动脉瓣狭窄导致的左心室功能不全是可逆的，主动脉瓣置换术可带来显著的临床改善。当存在冠状动脉疾病时，存活者可能有很大改善，但手术死亡率要高得多。
