Popovic Z, Barac I, Jovic M, Ristic M, Panic G, Miric M, Bojic M
Institute of Cardiovascular diseases Dedinje, Beograd, Yugoslavia.
Cardiovasc Surg. 1996 Oct;4(5):628-34. doi: 10.1016/0967-2109(96)00039-7.
Worsening of left ventricular performance had been recognized after mitral valve replacement for mitral regurgitation. The effects of chordal preservation on ventricular performance after mitral valve replacement have been assessed. Twelve patients with mitral regurgitation were allocated to group A (undergoing mitral valve replacement with chordal preservation), or to group B (undergoing mitral valve replacement with chordal excision). Transoesophageal echocardiography was recorded simultaneously with radial artery and pulmonary capillary wedge pressures. Load was varied by withdrawal of blood from a venous line of cardiopulmonary bypass and/or nitroglycerine bolus. Ventricular performance was assessed by the slope of peak systolic pressure-end-systolic volume relation (Eps), and by the slope of the left ventricular stroke work-end-diastolic volume relationship. Eps significantly decreased immediately after mitral valve replacement (P < 0.02), with no difference among two groups. Eps gradually increased to preoperative levels 10 days after surgery. Pre-load recruitable stroke work also significantly decreased after mitral valve replacement (P = 0.01). The decrease was significantly larger in group B (P < 0.04). These data support the hypothesis that chordal preservation during mitral valve replacement has beneficial effects on left ventricular performance.
二尖瓣反流患者行二尖瓣置换术后左心室功能会恶化。已对保留腱索对二尖瓣置换术后心室功能的影响进行了评估。12例二尖瓣反流患者被分为A组（行保留腱索的二尖瓣置换术）或B组（行腱索切除的二尖瓣置换术）。经食管超声心动图与桡动脉及肺毛细血管楔压同时记录。通过从体外循环静脉管路抽血和/或推注硝酸甘油来改变负荷。通过收缩压峰值-收缩末期容积关系（Eps）的斜率以及左心室每搏功-舒张末期容积关系的斜率来评估心室功能。二尖瓣置换术后Eps立即显著降低（P < 0.02），两组间无差异。术后10天Eps逐渐升至术前水平。二尖瓣置换术后前负荷可增加的每搏功也显著降低（P = 0.01）。B组的降低幅度显著更大（P < 0.04）。这些数据支持这样的假说，即二尖瓣置换术中保留腱索对左心室功能有有益影响。
