二尖瓣位四个机械双叶人工瓣膜的血流动力学性能：一项超声心动图研究。

Hemodynamic performance of four mechanical bileaflet prosthetic valves in the mitral position: an echocardiographic study.

作者信息

Reisner S A, Harpaz D, Skulski R, Borenstein D, Milo S, Meltzer R S

机构信息

Department of Cardiology, Ramban and Walfson Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, 31096, Haifa, Israel.

出版信息

Eur J Ultrasound. 1998 Dec;8(3):193-200. doi: 10.1016/s0929-8266(98)00076-7.

DOI:10.1016/s0929-8266(98)00076-7

PMID:9971902

Abstract

OBJECTIVES

The CarboMedics, Duromedics, Sorin Bicarbon and the St. Jude Medical valves are bileaflet mechanical prostheses of modern but different design. Choosing a valve with the best hemodynamic profile is of clinical importance in patients with small ventricles and a small mitral annulus.

METHODS

The hemodynamic performance of these valves in the mitral position was compared in 76 asymptomatic, ambulatory patients with normally functioning prosthesis and left ventricle, using Doppler echocardiography. Of the 76 patients studied, 22 had the CarboMedics, 16 had the Duromedics, 17 had the Sorin Bicarbon and 21 had the St. Jude prosthesis. The patients ages ranged from 18 to 81 years. There were 44 women and 32 men. The time from implantation to echocardiographic study ranged from 1 to 55 months.

RESULTS

The echocardiographic study was performed earlier after surgery in the Sorin Bicarbon group. There was no significant difference in women/man ratio, incidence of atrial fibrillation, left ventricular or left atrial diameters between the four groups. The mean prosthesis size was significantly smaller for Sorin Bicarbon and Duromedics valves compared to the CarboMedics and the St. Jude valves (mean+/-SD, 27.2+/-1.3, 27.1+/-1.1 and 30.0+/-1.9 and 30.0+/-2.7 mm, respectively, P<0.001). Despite its smaller size the Sorin Bicarbon valve had significantly larger effective valve area by Doppler compared to the CarboMedics valve (290+/-40 vs 250+/-60 mm2, respectively, P=0.014). The ratio of effective valve area to prosthesis size was significantly larger for the Sorin Bicarbon valve when compared with any other type of prosthesis.

CONCLUSIONS

(1) The Sorin Bicarbon bileaflet valve offered the best hemodynamic results that may be explained by the valve's large leaflet opening angle and small thickness of the leaflets. (2) Since the Sorin Bicarbon is the newest bileaflet valve, durability of this valve remains uncertain.

摘要

目的

CarboMedics、Duromedics、Sorin Bicarbon和圣犹达医疗公司的瓣膜均为现代设计但不同的双叶机械瓣膜。对于心室小和二尖瓣环小的患者，选择具有最佳血流动力学特征的瓣膜具有临床重要性。

方法

使用多普勒超声心动图，对76例无症状、可走动且假体和左心室功能正常的患者二尖瓣位置的这些瓣膜的血流动力学性能进行比较。在76例研究患者中，22例使用CarboMedics瓣膜，16例使用Duromedics瓣膜，17例使用Sorin Bicarbon瓣膜，21例使用圣犹达假体。患者年龄在18至81岁之间。有44名女性和32名男性。从植入到超声心动图检查的时间为1至55个月。

结果

Sorin Bicarbon组术后更早进行了超声心动图检查。四组之间的男女比例、房颤发生率、左心室或左心房直径无显著差异。与CarboMedics和圣犹达瓣膜相比，Sorin Bicarbon和Duromedics瓣膜的平均假体尺寸明显更小（分别为平均±标准差，27.2±1.3、27.1±1.1和30.0±1.9以及30.0±2.7 mm，P<0.001）。尽管尺寸较小，但与CarboMedics瓣膜相比，Sorin Bicarbon瓣膜通过多普勒测量的有效瓣膜面积明显更大（分别为290±40与250±60 mm²，P = 0.014）。与任何其他类型的假体相比，Sorin Bicarbon瓣膜的有效瓣膜面积与假体尺寸之比明显更大。