主动脉瓣置换术后显著肥大左心室的逆转  

Reversal of Left Ventricular Dilatation,Hypertrophy,and Dysfunction After Aortic Valve

作　　者：于伟勇[1] 王尔松[1] 张宝仁[1] 王连才[1] 金海[1] 侯明君[1] 

机构地区：[1]第二军医大学长海医院胸心外科,上海市200433

出　　处：《中国循环杂志》2003年第1期49-51,共3页Chinese Circulation Journal

基　　金：获军队"九五"医药卫生科研基金资助 (96Z0 31 )

摘　　要：目的 :探讨主动脉瓣置换术后显著肥大左心室的逆转和收缩功能的恢复趋势及其影响因素。方法 :分析 1991年 1月至 2 0 0 0年 12月间 3 2例左心室显著肥大患者施行主动脉瓣置换术后超声心动图随访资料。结果 :主动脉瓣置换术后左心室形态呈进行性缩小、心肌肥厚显著减轻。影响显著肥大左心室术后完全逆转的主要术前因素是左心室的收缩末内径≥ 6 0cm、舒张末容积指数≥ 2 10ml/m2 和重量指数≥ 15 0g/m2 (P <0 0 1)。术前射血分数≥ 0 40者术后射血分数和短轴内径缩短率的恢复显著优于术前射血分数 <0 40者 (P <0 0 5～ 0 0 1)。术后射血分数≥ 0 5 0或短轴内径缩短率≥ 2 5 %与术后恢复时间呈正相关 ,与术前左心室收缩末内径≥ 6 0cm呈负相关 (R2 =0 5 5 ,P <0 0 1)。　　结论 :在左心室的收缩末内径≥ 6 0cm或舒张末容积指数≥ 2 10ml/m2 、重量指数≥ 15 0 g/m2 和射血分数 <0 40前手术 ,有利于术后左心室逆转和左心室收缩功能恢复 ,术后 6个月～ 1年是恢复的关键期。Objective: To observe the time course of reversal of left ventricular dilatation,hypertrophy,and dysfunction after aortic valve replacement (AVR) in patients with extremely dilated left ventricle.Methods: The serial postoperative echocardiographic follow up data of 32 patients with extremely dilated left ventricle undergoing AVR between Jan.1991 and Dec.2000 were analyzed retrospectively.Results: The left ventricular dilatation and hypertrophy were reduced progressively and significantly after AVR.The independent preoperative factors influencing the complete reversal of dilated and hypertrophic left ventricle after AVR were left ventricular end systolic diameter (LVDs)≥6 0 cm,end diastolic volume index (LVVI)≥210 ml/m 2 and mass index (LVMI)≥150 g/m 2( p <0 01).The post operative left ventricular ejection fraction (EF) and fraction shortening (FS) were higher in patients with EF≥0 40 than in patients with EF<0 40 before operation.EF≥0 50 or FS≥25% after operation was positively correlated with time course of regression after operation,and negatively with pre operative LVDs≥6 0 cm( R 2=0 55, p <0 01).Conclusion: Early operation,especially before LVDs≥6 0 cm or LVVI≥210 ml/m 2,LVMI≥150 g/m 2 and EF<0 40,is in favor of left ventricular geometry reversal,mass regression and systolic function improvement for patients with extremely dilated left ventricle due to severe chronic aortic regurgitation.The key period for the reversal of left ventricular dilatation,hypertrophy,and dysfunction is from 6 months to one year after AVR.

关 键 词：主动脉瓣置换术 手术后 心室逆转 左心室收缩功能 左心室肥大 

分 类 号：R654.2[医药卫生—外科学]