瓣下结构对St.Jude机械瓣下游血流动力学影响的临床研究  

Clinical Research on the Influence of Subvalvular Apparatus on the Hemodynamics in the Downstream of St.Jude Medical TM Mechanical Valve

作　　者：张浒[1] 张桂敏[1] 梅松[1] 陶杰[1] 喻卓[2] 

机构地区：[1]昆明医科大学第一附属医院心血管外科,云南昆明650032 [2]昆明医科大学第一附属医院心脏内科,云南昆明650032

出　　处：《昆明医科大学学报》2015年第3期45-50,共6页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(30860279)

摘　　要：目的明确瓣下结构不同保留方式对St.Jude二尖瓣机械瓣下游血流动力学的影响.方法将入选的39名患者依据瓣下结构保留方式分为未保留瓣下结构组、保留后瓣组和保留全瓣组.多普勒超声心动图仪检测常规多普勒指标(平均跨瓣压差PGmean,跨瓣流量Qmv),心功能指标(左室射血分数LVEF),流场均匀性指标(二尖瓣峰值流速Vmax,峰值流速最大差值ΔVmax),然后应用计算机图像分析技术计算湍流剪应力(TSS)和相对扰动强度(Irel).结果保留瓣下结构可在一定程度上增加跨瓣血流的扰动性,使St.Jude机械瓣下游流场均匀性变差,TSS和Irel增大(P<0.05).结论保留后瓣瓣下结构可改善术后心功能,对跨瓣血流影响较保留全瓣轻,适合大多数二尖瓣置换术患者.Objective To research the effect of subvalvular apparatus on the hemodynamics in the downstream of prosthetic mitral valve. Methods 39 Patients were divided into different groups according to different preservation of subvavular apparatus. PGmean, Qmv, LVEF, LVESD, Vmax, △Vmax were measued by Doppler echocardiography,TSS and Irel was computed by Doppler echocardiography combined with the analysis of image by computer. Results Preservation of subvalvular apparatus to some extent resulted in an incremental disturbance of transvalvular flow, which caused that the flow field uniformity in the downstream of prosthetic mitral valve became worse and that TSS increased. Conclusion To preserve posterior subvalvular apparatus may be more beneficial to most patients with Mitral valve replacement,as it can improve the cardiac function.

关 键 词：瓣下结构 人工瓣 二尖瓣置换术 血流动力学 多普勒超声 

分 类 号：R654.2[医药卫生—外科学]