Mathur A, Agrawal V V, Thatai D, Bhargava B, Bahl V K, Wasir H S
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Int J Cardiol. 1996 Oct 25;56(3):217-21. doi: 10.1016/0167-5273(96)02751-9.
Sixty consecutive patients of rheumatic mitral stenosis who underwent percutaneous transvenous mitral commissurotomy were evaluated and followed up for 3 months in order to study the effect of the procedure on left ventricular ejection fraction and to elucidate the pathophysiology of impaired left ventricular function. The response in 16 patients (26.7%) with left ventricular dysfunction (ejection fraction less than 50%) was compared to that in 44 patients with normal left ventricular ejection fraction. Patients with left ventricular dysfunction had relatively larger left ventricular end-diastolic (84 +/- 15 vs. 76 +/- 14 ml) and end-systolic (45 +/- 11.5 vs. 35 +/- 12 ml) volumes. Percutaneous transvenous mitral commissurotomy was successful in all patients. Mitral valve area increased in all patients, from 0.8 +/- 0.2 cm2 to 1.82 +/- 0.37 cm2. After commissurotomy there was a trend towards increase of the left ventricle end-diastolic volumes in both groups of patients. Left ventricular ejection fraction also marginally increased in both groups. A reduced left ventricular compliance due to thickened and fibrotic mitral valve apparatus and excessive afterload due to increased systemic vascular resistance because of low output are possible mechanisms for left ventricular dysfunction in patients with mitral stenosis.
对连续60例接受经皮经静脉二尖瓣交界切开术的风湿性二尖瓣狭窄患者进行了评估，并随访3个月，以研究该手术对左心室射血分数的影响，并阐明左心室功能受损的病理生理学。将16例左心室功能不全（射血分数小于50%）患者（26.7%）的反应与44例左心室射血分数正常的患者进行比较。左心室功能不全的患者左心室舒张末期容积（84±15 vs. 76±14 ml）和收缩末期容积（45±11.5 vs. 35±12 ml）相对较大。所有患者经皮经静脉二尖瓣交界切开术均成功。所有患者二尖瓣面积均增加，从0.8±0.2 cm²增加到1.82±0.37 cm²。交界切开术后，两组患者左心室舒张末期容积均有增加趋势。两组患者左心室射血分数也略有增加。二尖瓣装置增厚和纤维化导致左心室顺应性降低，以及低输出量导致全身血管阻力增加引起的后负荷过大，可能是二尖瓣狭窄患者左心室功能不全的机制。
