摘要
目的评价单纯重度主动脉瓣狭窄合并左室扩大和左室射血分数减低及左心衰的患者行主动脉瓣置换术后的临床疗效和心功能改变。方法采集因单纯重度主动脉瓣狭窄(AS)(瓣口面积<1.0cm2)伴左室扩大、左室射血分数减低和左心衰而行主动脉瓣置换术的患者15例。术前二维超声心动图测量左室舒张末期内径(LVDd)、左室后壁厚度(PWTd)和室间隔厚度(IVSTd),计算左室重量指数(LVMI),Simpson法测量LVEF以及连续多普勒测量主动脉瓣跨瓣血流速度和最大压力阶差(AVP)。术后1周复查超声心动图,并于术后3个月至3年随访观察。结果15例患者术后一周症状改善,AVP由平均(112±66)mmHg显著降至(28±17)mmHg(P<0.05)。平均随访1.6±1.3年期间,心衰症状改善明显,纽约心脏病学会(NYHA)心功能分级由3.3±0.5级降至1.7±0.9(P<0.05),与术前相比,LVDd有显著的降低、LVEF显著性增加(P<0.05),与术后1周比较也有改善;LVMI与术前和术后1周比较均有一定程度的降低,尽管尚无显著性差异(P>0.05);AVP在术后1周已有显著降低的基础上,在随访期间无明显变化(P>0.05)。4例患者在随访期间死亡,其中因心源性死亡的3例患者均是合并严重冠脉三支病变曾同时行冠脉搭桥术。结论单纯重度主动脉瓣狭窄合并左室扩大、左室射血分数降低和左心衰的患者,外科主动脉瓣置换术是有效的治疗方法,术后跨主动瓣压差、左室内径及左室射血分数均有明显改善。合并严重冠状动脉狭窄或术前跨主动脉瓣压差较低的患者应进一步评价其手术风险及获益。
Objective To evaluate the clinical outcome and echocardiographic left ventricular function after aortic valve replacement （AVR） in severe aortic stenosis patients with an enlarged left ventricle and low ejection fraction. Methods Fifteen severe aortic stenosis patients with an enlarged left ventricle, low ejection fraction and left heart failure treated with AVR were analyzed. All patients were assessed by clinical examination and echocardiography before AVR and 1 week, 3 months and up to 3 years after AVR. Results Postoperative transaortic valve pres- sure（AVP） changed from 112 ± 66 mmHg to 28 ± 17 mmHg （ P 〈 0.05 ）. During follow -up period, NYHA functional class changed from 3.3 ±0.5 to 1.7 ±0.9 （ P 〈0.05）, left ventricular ejection fraction （LVEF） improved from 39.9 ＋9.2% to 51.1 ± 10.7% （ P 〈0.05）, left ventricular diastolic diameter （LVDd） changed from 61.8 ± 7.2 mm to 53.8 ±11.7mm （ P 〈 0. 05 ）, left ventricular mass index （ LVMI ） changed from 192.4 ±39.9 （ g/m2 ） to 154.8 ±61.6 （ g/m2 ） （ P 〉 0.05 ）. Three patients died of heart disease, 1 patients died of gastric cancer. Conclusion For severe aortic stenosis with an dilated left ventricle and low ejection fraction, aortic valve replacement is an effective treatment method. NYHA functional class, LVEF, AVP and LVDd were all improved significantly, but the patients with severe coronary stenosis or low - gradient aortic stenosis should be assessed cautiously prior to surgery.
出处
《临床和实验医学杂志》
2010年第10期733-735,共3页
Journal of Clinical and Experimental Medicine
