Clark R E, Pavlovic T A, Knight B E, Joist J H, Burrows S D, McKnight R C, Brown E B
Circulation. 1977 Sep;56(3 Suppl):II139-43.
Fifty-five patients (35 females and 20 males) were studied by noninvasive means 3.5-8.6 years after isolated mitral valve replacement with Models 103 and 104 Beall prostheses. History and physical exams by three physicians, complete hemograms, SMA 18, iron excretion rates, and coagulation profiles were performed. Additionally, electrocardiograms, echocardiograms, phonocardiograms, cardiac series, and high-speed cinefluorography of the prostheses were obtained. Valve wear was assessed by the disc/cage ratio measured from a "three-legged view" with magnification. At a mean duration of 5.85 years after operation, the entire group had a mean disc/cage ratio of operation, the entire group had a mean disc/cage ratio of 0.906 +/- 0.031 vs a normal value of 0.944 +/- 0.014. The group was mildly anemic and had a urinary iron loss that was 40 times normal. The lactic dehydrogenase (LDH) concentration was more than five times normal. The coagulation profiles were abnormal with respect to the bleeding and stypven times, antiheparin activity, fibrin degradation products, and megathrombocyte index. These abnormalities were unrelated to sex, degree of valve wear, and history of thromboembolism. Males were less anemic and had higher urine iron losses than females. Nine patients with severe valve wear (disc/cage ratio less than or equal to 0.87) were significantly more anemic with large urine iron losses and had elevated total bilirubin, serum glutamic oxaloacetic transaminase, and LDH concentrations (ninefold), when compared to nine patients with minimal wear (disc/cage ratio greater than or equal to 0.925). It is emphasized that the findings of a significant anemia, an LDH concentration greater than 1500 mU/ml, and a disc/cage ratio of less than 0.87 in a patient with an isolated Beall mitral valve prosthesis are indicators for the need to replace the prosthesis in the near future. Re-replacement is urged before significant clinical deterioration.
55例患者（35例女性和20例男性）在使用103型和104型比尔人工心脏瓣膜进行单纯二尖瓣置换术后3.5至8.6年接受了非侵入性检查。由三位医生进行病史采集和体格检查，并进行了全血细胞计数、SMA 18、铁排泄率和凝血指标检查。此外，还获取了心电图、超声心动图、心音图、心脏系列检查以及人工瓣膜的高速电影荧光造影。通过从“三足视图”放大测量盘/笼比来评估瓣膜磨损情况。术后平均5.85年时，整个组的平均盘/笼比为0.906±0.031，而正常值为0.944±0.014。该组患者有轻度贫血，尿铁流失是正常情况的40倍。乳酸脱氢酶（LDH）浓度超过正常值五倍以上。凝血指标在出血时间、蝰蛇毒时间、抗肝素活性、纤维蛋白降解产物和巨血小板指数方面均异常。这些异常与性别、瓣膜磨损程度和血栓栓塞病史无关。男性贫血程度较轻，尿铁流失比女性高。与9例磨损最小（盘/笼比大于或等于0.925）的患者相比，9例严重瓣膜磨损（盘/笼比小于或等于0.87）的患者贫血明显更严重，尿铁流失量大，总胆红素、血清谷草转氨酶和LDH浓度升高（升高九倍）。需要强调的是，对于使用比尔二尖瓣人工瓣膜的患者，出现严重贫血、LDH浓度大于1500 mU/ml以及盘/笼比小于0.87这些表现，提示需要在近期更换人工瓣膜。强烈建议在临床症状明显恶化之前进行再次置换。
