Badano L, Mocchegiani R, Bertoli D, DeGaetano G, Carratino L, Pasetti L, Caudullo M, Budini A, Mannello B, Passerone G
Servizio di Cardiologia, Ospedale di Nervi, Genoa, Italy.
J Am Soc Echocardiogr. 1997 Jul-Aug;10(6):632-43. doi: 10.1016/s0894-7317(97)70026-9.
Doppler echocardiographic characteristics of normally functioning Sorin Bicarbon prostheses were prospectively assessed in 226 consecutive patients (135 male and 91 female patients, mean age 61 +/- 10 years) with 233 valves in the mitral (n = 67) and aortic (n = 166) positions whose function was considered normal by clinical and echocardiographic evaluation. Patterns of "normal" transprosthetic leakage were assessed with transthoracic echocardiography in all valves and with transesophageal echocardiography in six selected mitral valve prostheses. For the mitral valve prostheses, we found that peak and mean gradient, as well as pressure half-time, were not significantly different in either the 25 or the 31 mm valves (median values from 15 to 10 mm Hg, from 4 to 4 mm Hg, and from 70 to 83 ms; p = Not significant for all). On transthoracic study, 12 patients (17%) with a Sorin Bicarbon valve in the mitral position showed minimal transprosthetic leakage. On transesophageal study, all patients showed a transprosthetic leakage whose spatial distribution had a complex pattern: in planes orthogonal to the leaflet axis, two to four jets arising from the hinge points and converging toward the center of the valve plane could be visualized; in planes parallel to the leaflet axis, there were three jets, the two lateral ones diverging and the central one perpendicular to the valve plane. For the aortic valve prostheses, there was a significant decrease in transprosthetic gradients and an increase in effective orifice areas as prosthesis size increased. Peak and mean gradients decreased from a median value of 25 and 13 mm Hg in the 19 mm valves to 9 and 5 mm Hg in the 29 mm valves, respectively. Effective prosthetic valve area calculated with the continuity equation increased from a median value of 0.97 cm2 for the 19 mm size valves to 3.45 cm2 for the 29 mm size. With analysis of variance, effective prosthetic aortic valve area differentiated various valve sizes (F = 40.9, p < 0.0001) better than peak (F = 10.3, p < 0.0001) or mean (F = 8.04, p < 0.0001) gradients alone did. Furthermore, effective prosthetic aortic valve area correlated better than peak and mean gradients with prosthetic size (r = 0.76, r = -0.45, and r = -0.39, respectively). On transthoracic study, 109 patients (66%) showed minimal transprosthetic leakage. These normal values, obtained in a large number of patients with normofunctioning mitral and aortic Sorin Bicarbon valves, may help to identify Sorin Bicarbon prosthesis dysfunction.
对226例连续患者（135例男性和91例女性患者，平均年龄61±10岁）的233枚处于二尖瓣（n = 67）和主动脉瓣（n = 166）位置的Sorin Bicarbon人工瓣膜进行前瞻性评估，这些瓣膜经临床和超声心动图评估功能正常。通过经胸超声心动图评估所有瓣膜的“正常”人工瓣膜反流模式，并对6枚选定的二尖瓣人工瓣膜进行经食管超声心动图评估。对于二尖瓣人工瓣膜，我们发现25mm和31mm瓣膜的峰值和平均压差以及压力减半时间均无显著差异（中位数分别为15至10mmHg、4至4mmHg和70至83ms；所有p值均无统计学意义）。经胸研究显示，12例（17%）二尖瓣位置植入Sorin Bicarbon瓣膜的患者存在最小程度的人工瓣膜反流。经食管研究显示，所有患者均存在人工瓣膜反流，其空间分布呈复杂模式：在与瓣叶轴正交的平面上，可观察到两到四股从铰链点发出并汇聚至瓣膜平面中心的血流束；在与瓣叶轴平行的平面上，有三股血流束，两侧的血流束发散，中间的血流束垂直于瓣膜平面。对于主动脉瓣人工瓣膜，随着瓣膜尺寸增加，人工瓣膜压差显著降低，有效瓣口面积增加。峰值和平均压差分别从19mm瓣膜的中位数25mmHg和13mmHg降至29mm瓣膜的9mmHg和5mmHg。用连续方程计算的有效人工瓣膜面积从19mm尺寸瓣膜的中位数0.97cm²增加到29mm尺寸瓣膜 的3.45cm²。通过方差分析，有效人工主动脉瓣面积对不同瓣膜尺寸的区分能力（F = 40.9，p < 0.0001）优于单独的峰值（F = 10.3，p < 0.0001）或平均（F = 8.04，p < 0.0001）压差。此外，有效人工主动脉瓣面积与瓣膜尺寸的相关性优于峰值和平均压差（r分别为0.76、-0.45和-0.39）。经胸研究显示,109例（66%）患者存在最小程度的人工瓣膜反流。在大量二尖瓣和主动脉瓣功能正常的Sorin Bicarbon瓣膜患者中获得的这些正常值，可能有助于识别Sorin Bicarbon人工瓣膜功能障碍。
