Functional mitral stenosis after surgical annuloplasty for ischemic mitral regurgitation: importance of subvalvular tethering in the mechanism and dynamic deterioration during exertion.
Functional mitral stenosis after surgical annuloplasty for ischemic mitral regurgitation: importance of subvalvular tethering in the mechanism and dynamic deterioration during exertion.
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DOI：
10.1016/j.jtcvs.2009.11.003
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发表时间：
2010-09
期刊：
影响因子：
--
通讯作者：
Tei C
中科院分区：
文献类型：
--
作者：
Kubota K;Otsuji Y;Ueno T;Koriyama C;Levine RA;Sakata R;Tei C
在缺血性二尖瓣反流手术导致瓣下小叶缩小的情况下，左心室重构导致的舒张期二尖瓣下小叶栓缩限制了小叶的开放，这可能在没有器质性小叶病变的情况下导致功能性二尖瓣狭窄。运动，已知会加重收缩期栓系和缺血性二尖瓣反流，也可能通过增加栓系而动态加重二尖瓣狭窄。本研究评估二尖瓣狭窄的机制和对运动的反应。我们通过超声心动图测量了20名健康个体和31名因缺血性二尖瓣返流而行二尖瓣成形术的患者的舒张期二尖瓣面积、二尖瓣环面积、峰值和平均二尖瓣传压梯度。虽然健康人的二尖瓣面积和环面积没有显著差异（4.7±0.6 cm2 vs 5.2±0.6 cm2，无统计学意义），但环成形术后患者的二尖瓣面积明显小于环面积（1.6±0.2 cm2 vs 3.3±0.5 cm2, P < 0.01）。仅术后二尖瓣面积小于1.5 cm2 (P < 0.01)，与受限小叶开口（r2 = 0.74, P < 0.001）、左室扩张（r2 = 0.17, P < 0.05）、纽约心脏协会功能分级（P < 0.05）显著相关。05）. 12例患者运动应激超声心动图显示功能性二尖瓣狭窄动态恶化（二尖瓣面积：2.0±0.5 cm2 ~ 1.4±0.2 cm2, P < 0.01；平均压力梯度：1.5±0.9 mmhg ~ 6.0±2.2 mmhg, P < 0.01）。在缺血性二尖瓣反流中，在手术缩小环的情况下，持续的瓣下小叶栓系经常导致小叶尖端水平的功能性二尖瓣狭窄，这与心力衰竭症状有关，并且可能是动态的，伴有明显的运动引起的恶化。
Diastolic subvalvular mitral leaflet tethering by left ventricular remodeling that restricts leaflet opening in the presence of annular size reduction by surgery for ischemic mitral regurgitation potentially causes functional mitral stenosis in the absence of organic leaflet lesions. Exercise, known to worsen systolic tethering and ischemic mitral regurgitation, might also dynamically exacerbate such mitral stenosis by increasing tethering. This study evaluates the mechanism and response of such mitral stenosis to exercise. We measured the diastolic mitral valve area, annular area, and peak and mean transmitral pressure gradient by echocardiography in 20 healthy individuals and 31 patients who underwent surgical annuloplasty for ischemic mitral regurgitation. Although the mitral valve area and annular area did not significantly differ in healthy individuals (4.7 ± 0.6 cm2 vs 5.2 ± 0.6 cm2, not significant), mitral valve area was significantly smaller than the annular area in patients after annuloplasty (1.6 ± 0.2 cm2 vs 3.3 ± 0.5 cm2, P < .01). The mitral valve area was less than 1.5 cm2 only after the surgery (P < .01) and was significantly correlated with restricted leaflet opening (r2 = 0.74, P <.001), left ventricular dilatation (r2 = 0.17, P <.05), and New York Heart Association functional class (P <. 05). Exercise stress echocardiography of 12 patients demonstrated dynamic worsening in functional mitral stenosis (mitral valve area: 2.0 ± 0.5 cm2 to 1.4 ± 0.2 cm2, P < .01; mean pressure gradient: 1.5 ± 0.9 mm Hg to 6.0 ± 2.2 mm Hg, P < .01). Persistent subvalvular leaflet tethering in the presence of annular size reduction by surgery in ischemic mitral regurgitation frequently causes functional mitral stenosis at the leaflet tip level, which is related to heart failure symptoms and can be dynamic with significant exercise-induced worsening.
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DOI：
10.1016/s0022-5223(95)70348-9
发表时间：
1995-04-01
影响因子：
6
作者：
BOLLING, SF;DEEB, GM;BACH, DS
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