Evaluation of 17-mm St. Jude Medical Regent prosthetic aortic heart valves by rest and dobutamine stress echocardiography.
Evaluation of 17-mm St. Jude Medical Regent prosthetic aortic heart valves by rest and dobutamine stress echocardiography.
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DOI：
10.1186/1749-8090-1-27
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发表时间：
2006-09-19
影响因子：
1.6
通讯作者：
Musumeci F
中科院分区：
文献类型：
--
作者：
Minardi G;Manzara C;Creazzo V;Maselli D;Casali G;Pulignano G;Musumeci F
用于主动脉根部较小的患者的主动脉瓣置换术的假体相对于身体尺寸来说可能太小，因此在休息和/或应激条件下表现出高跨瓣膜梯度。本研究旨在评估 17-mm St. Jude Medical Regent (SJMR-17 mm) 在平均 24 个月随访期间对相对老年患者的休息和多巴酚丁胺负荷超声心动图 (DSE) 血流动力学反应。研究人群包括 19 名患者（2 名男性，17 名女性，平均年龄 69.2 ± 7.3 岁）。所有患者在手术前后均接受静息多普勒超声心动图检查，并在随访时接受基础和DSE检查（以5微克/公斤/分钟的速度输注，并以5分钟间隔增加5微克/公斤/分钟，直至40微克/公斤/分钟）。在静息和/或 DSE 下评估以下参数：心率 (HR)、射血分数 (EF)、心输出量 (CO)、峰值和平均速度和压力梯度 (MxV、MnV、MxPG、MnPG)、有效孔口面积 (EOA)、指数 EOA (EOAi)、左心室质量 (LVM)、指数 LVM (LVMi)、左心室流出道速度时间积分 (VTI) LVOT）和跨瓣膜（主动脉 VTI）、多普勒速度指数（DVI）。静息时 MxPG 和 MnPG 分别为 29.2 ± 7.1 和 16.6 ± 5.8mmHg； EOA 和 EOAi 结果为 1.14 ± 0.3 cm2 和 0.76 ± 0.2 cm2/m2； DVI 正常（0.50 ± 0.1）。随访时LVM和LVMi分别从术前的258±43g和157.4±27.7g/m2显着下降至191±23.8g和114.5±10.6g/m2。 DSE显着增加HR、CO、EF、MxGP（高达83.4±2±1.9mmHg）、MnPG（高达43.2±12.7mmHg）。 EOA、EOAi、DVI 增加不显着（从基线分别增加至 1.2 ± 0.4 cm2、0.75 ± 0.3 cm2/m2 和 0.48 ± 0.1）。两名患者出现明显的脑室内梯度。这些数据表明，SJMR 17毫米假体可以安全地植入相对老年患者的主动脉位置，在休息和DSE下提供令人满意的血流动力学性能，并充分利用其可用的孔口，这表明当使用这种小型假体时，可能的轻度假体与患者不匹配不是临床相关的问题。休息和多巴酚丁胺负荷超声心动图是评估假体血流动力学和监测预期 LVH 回归的有用且有效的方法。
The prosthesis used for aortic valve replacement in patients with small aortic root can be too small in relation to body size, thus showing high transvalvular gradients at rest and/or under stress conditions. This study was carried out to evaluate rest and Dobutamine stress echocardiography (DSE) hemodynamic response of 17-mm St. Jude Medical Regent (SJMR-17 mm) in relatively aged patients at mean 24 months follow-up. The study population consisted of 19 patients (2 men, 17 women, mean age 69.2 ± 7.3 years). All patients underwent rest Doppler echocardiography before and after surgery and basal and DSE at follow up (infused at rate of 5 micrg/Kg/min and increased by 5 microg/Kg/min at 5 min intervals up to 40 microg/Kg/min). The following parameters were evaluated at rest and/or under DSE: heart rate (HR), ejection fraction (EF), cardiac output (CO), peak and mean velocity and pressure gradients (MxV, MnV, MxPG, MnPG), effective orifice area (EOA), indexed EOA (EOAi), left ventricular mass (LVM), indexed LVM (LVMi), Velocity Time Integral at left ventricular outflow tract (VTI LVOT) and transvalvular (Aortic VTI), Doppler velocity index (DVI). At rest MxPG and MnPG were 29.2 ± 7.1 and 16.6 ± 5.8mmHg, respectively; EOA and EOAi resulted 1.14 ± 0.3 cm2 and 0.76 ± 0.2 cm2/m2; DVI was normal (0.50 ± 0.1). At follow-up LVM and LVMi decreased significantly from pre-operative value of 258 ± 43g and 157.4 ± 27.7g/m2 to 191 ± 23.8g and 114.5 ± 10.6g/m2, respectively. DSE increased significantly HR, CO, EF, MxGP (up to 83.4 ± 2 1.9mmHg), MnPG (up to 43.2 ± 12.7mmHg). EOA, EOAi, DVI increased insignificantly (from baseline up to 1.2 ± 0.4 cm2, 0.75 ± 0.3cm2/m2 and 0.48 ± 0.1 respectively). Two patients developed significant intraventricular gradients. These data show that SJMR 17-mm prostheses can be safely implanted in aortic position in relatively aged patients, offering a satisfactory hemodynamic performance at rest and under DSE, with full utilization of its available orifice, suggesting that a possible mild prosthesis-patient mismatch is not an issue of clinical relevance when this small prosthesis is used. Rest and Dobutamine stress echocardiography is a useful and effective means for evaluating prosthesis hemodynamics and for monitoring the expected LVH regression.
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DOI：
10.1067/s0894-7317(03)00638-2
发表时间：
2003-11-01
影响因子：
6.5
作者：
Rosenhek, R;Binder, T;Baumgartner, H
通讯作者：
Baumgartner, H
影响因子：
4.6
作者：
Tasca, G;Brunelli, F;Quaini, E
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Quaini, E
影响因子：
37.8
作者：
SAHN, DJ;DEMARIA, A;WEYMAN, A
通讯作者：
WEYMAN, A
DOI：
10.1111/j.1540-8175.1998.tb00659.x
发表时间：
1998-10-01
影响因子：
1.5
作者：
Hunziker, PR;Spöndlin, B;Buser, P
通讯作者：
Buser, P
影响因子：
1.6
作者：
Silberman, S;Shaheen, J;Bitran, D
通讯作者：
Bitran, D