Long-term follow-up and dobutamine stress echocardiography of 19-mm prosthetic heart valves
Long-term follow-up and dobutamine stress echocardiography of 19-mm prosthetic heart valves
复制标题
DOI：
10.1111/j.1540-8175.1998.tb00659.x
复制
发表时间：
1998-10-01
影响因子：
1.5
通讯作者：
Buser, P
中科院分区：
文献类型：
--
作者：
Hunziker, PR;Spöndlin, B;Buser, P
背景：在主动脉根部较小的患者中，由于这些瓣膜的孔口面积较小，因此使用 19 毫米人工瓣膜进行瓣膜置换术存在争议。方法：为了评估 19 mm 瓣膜假体患者的应力血流动力学，寻找不利血流动力学的预测因素，并记录长期随访，我们对 30 名患者（年龄，64 +/- 19 岁；27 名女性和 3 名融化者；随访 38 +/- 50 个月）进行了临床检查，并使用多巴酚丁胺负荷超声心动图。询问了病史，并进行了体格检查。在休息时和多巴酚丁胺应激期间，进行多普勒超声心动图检查。结果：休息时，经假体梯度适度升高，平均梯度和峰值梯度分别为 15 +/- 7 和 32 +/- 14 mmHg，有效孔口面积较小（0.91 +/- 0.31 cm(2)）。压力期间梯度显着上升（平均值，37 +/- 14 mmHg；峰值，83 +/-: 41 mmHg）。高经假体梯度的预测因素是较大的体表面积、较年轻的年龄和瓣膜类型。使用 St. Jude Medical Hemodynamic Plus 阀门的平均梯度和峰值梯度低于。与标准 St. Jude Medical (P < 0.05) 和其他阀门相比，该阀门模型的有效孔口面积最高（1.07 +/- 0.29 cm(2)；与标准 St. Jude Medical 相比，P < 0.05）。 60% 的患者在多巴酚丁胺应激期间出现显着的动态瓣膜下或心室内梯度 (84 +/- 41 mmHg)。结论：在主动脉根部较小的患者中使用 19 毫米假体进行主动脉瓣置换后，多巴酚丁胺应激导致高跨瓣膜梯度，这取决于瓣膜模型、年龄和体表面积。此外，60% 的患者出现明显的动态流出道阻塞。这些发现以及 70% 的患者持续存在某种程度的运动诱发症状表明，如果主动脉环的尺寸需要 19 毫米的瓣膜，则应考虑替代手术技术，特别是如果患者寻求体力活动、年轻或体型较大。
Background: In patients with a small aortic root, the use of 19-mm valve prostheses for valve replacement is controversial because of the small orifice area of these valves. Methods: To assess stress hemodynamics in patients with 19-mm valve prostheses, to find predictors of unfavorable hemodynamics, and to document the long-term follow-up, we examined 30 patients (age, 64 +/- 19 years; 27 women and 3 melt; follow-up, 38 +/- 50 months) clinically and with the use of dobutamine stress echocardiography. A history was taken, and a physical examination was performed. At rest and during dobutamine stress, Doppler echocardiography was performed. Results: At rest, transprosthetic gradients were moderately elevated with mean and peak gradients of 15 +/- 7 and 32 +/- 14 mmHg, and effective orifice areas were small (0.91 +/- 0.31 cm(2)). Gradients rose markedly during stress (mean, 37 +/- 14 mmHg; peak, 83 +/-: 41 mmHg). Predictors of high transprosthetic gradients were larger body surface area, younger age, and valve type. Mean and peak gradients were Lower with St. Jude Medical Hemodynamic Plus valves than. with standard St. Jude Medical (P < 0.05) and other valves, and the effective orifice area was highest (1.07 +/- 0.29 cm(2); P < 0.05 versus standard St. Jude Medical) in this valve model. Sixty percent of patients developed significant dynamic subvalvular or intraventricular gradients (84 +/- 41 mmHg) during dobutamine stress. Conclusions: After aortic valve replacement with 19-mm prostheses in patients with a small aortic root, dobutamine stress leads to high transvalvular gradients, which are dependent on, valve model, age, and body surface area. In addition, 60% of patients develop significant dynamic outflow obstructions. These findings and the persistence of some degree of exercise-induced symptoms in 70% of patients suggest that alternative surgical techniques should be considered if the size of the aortic annulus demands a 19-mm valve, especially if the patient seeks physical activity, is young, or is of larger body size.