Hachida U, Koyanagi H, Nonoyama M, Bonkohara Y, Saitou S, Nakamura K
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical College.
J Heart Valve Dis. 1998 Jan;7(1):81-5.
The purpose of this study was to evaluate the hemodynamic performance after aortic valve replacement using different surgical options in small (19-mm diameter) annuli.
Postoperative hemodynamics were assessed in three groups according to the surgical method. A 19-mm St. Jude Medical (SJM) valve was used in nine patients (group A), a 19-mm SJM HP in nine patients (group B), and annular enlargement was performed in eight patients (group C). Echocardiography was performed and percent fraction shortening, peak pressure gradient, effective orifice area and left ventricular mass were measured.
Postoperative peak systolic pressure gradient was decreased to 31.1+/-8.7 mmHg in group B, and to 22.3+/-11.7 mmHg in group C, but was 42.9+/-16.5 mmHg in group A (p <0.01). Percent fraction shortening and left ventricular mass index were improved in groups B and C, soon after surgery compared with group A (p <0.01). The effective orifice area significantly increased during exercise in group C, from 1.59 to 1.87 cm2 (p <0.01), but was not increased in groups A and B (N.S.).
The small SJM HP provides a better hemodynamic performance than the standard 19 mm SJM. However, annular enlargement may be beneficial in patients with poor ejection fraction and severe ventricular hypertrophy.
本研究旨在评估在小（直径19毫米）瓣环中采用不同手术方式进行主动脉瓣置换术后的血流动力学表现。
根据手术方法将患者分为三组并评估术后血流动力学。9例患者使用19毫米圣犹达医疗（SJM）瓣膜（A组），9例患者使用19毫米SJM高性能瓣膜（B组），8例患者进行瓣环扩大术（C组）。进行超声心动图检查并测量缩短分数百分比、峰值压力阶差、有效瓣口面积和左心室质量。
术后B组的收缩期峰值压力阶差降至31.1±8.7毫米汞柱，C组降至22.3±11.7毫米汞柱，而A组为42.9±16.5毫米汞柱（p<0.01）。与A组相比，B组和C组术后不久缩短分数百分比和左心室质量指数得到改善（p<0.01）。C组运动期间有效瓣口面积显著增加，从1.59平方厘米增至1.87平方厘米（p<0.01），而A组和B组未增加（无统计学差异）。
小尺寸SJM高性能瓣膜比标准19毫米SJM瓣膜具有更好的血流动力学表现。然而，对于射血分数低和严重心室肥厚的患者，瓣环扩大术可能有益。
