Burger W, Brinkies C, Illert S, Teupe C, Kneissl G D, Schräder R
Department of Interventional Cardiology, St Georg Hospital Leipzig, Germany.
Int J Cardiol. 1997 Jan 3;58(1):7-15. doi: 10.1016/s0167-5273(96)02860-4.
Aim of this study was to evaluate right ventricular performance in patients with mitral stenosis and its modification by balloon valvuloplasty. Right ventricular volumes of 24 patients with postrheumatic mitral stenosis were determined by thermodilution 1 or 2 days before and 1 or 2 days after valvuloplasty. Right ventricular ejection fraction at rest was 43 (36-47)% (median and interquartile range). Right ventricular end-diastolic volume was 100 (86-119) ml/m2. Supine bicycle exercise (50 Watt) reduced right ventricular ejection fraction to 30 (29-37)% (P < 0.0001) and increased right ventricular end-diastolic volume to 124 (112-141) ml/m2 (P < 0.0001). At rest, right ventricular ejection fraction correlated inversely with pulmonary vascular resistance (r = -0.64, P < 0.0001), while no significant correlation with mitral valve area was found. Valvuloplasty increased right ventricular ejection fraction at rest to 48 (44-50)% (P < 0.005), and during exercise to 42 (38-45)% (P < 0.0001). This improvement of right ventricular ejection fraction correlated inversely with the value of this parameter before valvuloplasty (r = -0.88, P < 0.0001) and with the gain in stroke volume (r = 0.57, P < 0.01). The right ventricular function curve, disturbed before commissurotomy, was reestablished by the procedure. In conclusion, at the here investigated stage of mitral stenosis right ventricular function is reversibly impaired. This is predominantly caused by the hemodynamic consequences of the valvular defect and not by an impairment of right ventricular myocardial function.
本研究的目的是评估二尖瓣狭窄患者的右心室功能及其经球囊瓣膜成形术的改善情况。对24例风湿性二尖瓣狭窄患者在瓣膜成形术前1或2天以及术后1或2天通过热稀释法测定右心室容积。静息时右心室射血分数为43（36 - 47）%（中位数和四分位数间距）。右心室舒张末期容积为100（86 - 119）ml/m²。仰卧位自行车运动（50瓦）使右心室射血分数降至30（29 - 37）%（P < 0.0001），并使右心室舒张末期容积增加至124（112 - 141）ml/m²（P < 0.0001）。静息时，右心室射血分数与肺血管阻力呈负相关（r = -0.64，P < 0.0001），而与二尖瓣瓣口面积无显著相关性。瓣膜成形术使静息时右心室射血分数增至48（44 - 50）%（P < 0.005），运动时增至42（38 - 45）%（P < 0.0001）。右心室射血分数的这种改善与瓣膜成形术前该参数的值呈负相关（r = -0.88，P < 0.0001），并与每搏量的增加呈正相关（r = 0.57，P < 0.01）。瓣膜切开术前紊乱的右心室功能曲线通过该手术得以重建。总之，在本研究调查的二尖瓣狭窄阶段，右心室功能存在可逆性损害。这主要是由瓣膜缺陷的血流动力学后果引起的，而非右心室心肌功能受损所致。
