小主动脉瓣环患者生物瓣与机械瓣置换术后心功能变化的比较  

Comparing Study of Heart Function of Biological Valves Replacement with Mechanical Valves Replacement in Patients with Small Aortic Root

作　　者：赵东[1] 王春生[1] 李化[1] 

机构地区：[1]复旦大学附属中山医院心外科上海市心血管病研究所,上海200032

出　　处：《中国胸心血管外科临床杂志》2008年第1期7-9,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析比较小主动脉瓣环(直径≤21mm)患者人工生物瓣置换与人工机械瓣置换术后心功能的变化,探讨人工生物瓣置换术后是否存在植入瓣膜与患者不匹配(PPM)现象。方法40例主动脉瓣环直径≤21mm的患者,其中20例置换人工生物瓣(生物瓣组),20例置换人工机械瓣(机械瓣组)。采用彩色多普勒超声心动图于术前和术后6个月～1年期间,检测两组患者的左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室重量指数、瓣膜有效开口面积/体表面积的比值(EOAI)和主动脉瓣跨瓣压差的变化,并进行对比分析。结果术后6个月～1年,两组患者LVEF、LVFS和EOAI均较术前明显升高,左心室重量指数和主动脉瓣跨瓣压差均较术前明显减小或降低。所有患者术后EOAI为0.88～1.32cm2/m2,术后6个月～1年生物瓣组与机械瓣组比较:LVEF79%±8%vs.81%±10%;LVFS43%±9%vs.37%±8%;EOAI1.11±0.14vs.0.92±0.11;左心室重量指数89.10±16.70g/m2vs.95.30±15.10g/m2;主动脉瓣跨瓣压差18.80±12.60mmHgvs.22.30±12.00mmHg,差异无统计学意义(P>0.05)。结论小主动脉瓣环患者(直径≤21mm)置换人工生物瓣术后左心功能指标明显改善,无PPM现象。Objective To compare the change of left heart function in patients with biological valves replacement of small aortic root with mechanical valve replacement, and to find whether there is prosthesis-patient mismatch （PPM） or not after operation. Methods Left ventricular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS）, left ventricular mass index, the indexed effective orifice area （EOAI）, and peak pressure gradients across aortic valve in 20 patients with small aortic root（≤21mm in diameter） receiving biological valves replacement （biological valves group） were studied by Doppler echocardiography before the operation and 6 months to 1 year after operation. The results were compared with those of 20 patients who received mechanical valves replacement （mechanical valves group）. Results Comparing with those before operation, there was a significant increase in LVEF, LVFS, EOAI of all patients 6 months to 1 year after operation . There was a significant reduction in the left ventricular mass index,peak pressure gradients across aortic valve in all patients. EOAI of all patients were between 0. 88 cm^2/m^2 and 1. 32 cm^2/m^2. LVEF, LVFS, EOAI, left ventricular mass index, and peak pressure gradients across aortic valve between biological valves group and mechanical valves group （79% ± 8% vs. 81% ± 10%; 43%±9% vs. 37%±8%; 1.11±0.14 vs. 0.925=0.11; 89.10±16.70g/m^2vs. 95.30±15.10 g/m^2; 18.80± 12. 60 mmHg vs. 22.30±12.00 mmHg） showed no significant difference 6 months to 1 year after operation （P〉 0. 05）. Conclusion Patients with small aortic root receiving biological valves have a significant increase in the left heart function,and have no PPM.

关 键 词：小主动脉瓣环 人工生物瓣 左心功能 植入瓣膜与患者不匹配 

分 类 号：R654.2[医药卫生—外科学]