Important pressure recovery in patients with aortic stenosis and high Doppler gradients
Important pressure recovery in patients with aortic stenosis and high Doppler gradients
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DOI：
10.1016/s0002-9149(01)01608-3
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发表时间：
2001-07-15
影响因子：
2.8
通讯作者：
Bech-Hanssen, O
中科院分区：
文献类型：
--
作者：
Gjertsson, P;Caidahl, K;Bech-Hanssen, O
压力恢复在主动脉瓣狭窄中有描述，可以解释多普勒和导管测量的压差之间偶尔观察到的差异。狭窄的升主动脉（AA）和中度严重狭窄有利于压力恢复。本研究的目的是调查这些情况在主动脉瓣狭窄和高多普勒梯度患者中存在的程度，并评估压力恢复的幅度。本文对116例主动脉瓣置换术前患者进行了多普勒超声心动图检查。纳入最大压差> 70 mm Hg的患者（n = 81）。测量AA的直径并与年龄和体型匹配的正常对照组（n = 23）的直径进行比较。通过测量最大多普勒梯度、有效瓣口面积（EOA）和AA直径，根据先前验证的方程估计压力恢复。（平均3.0 cm，范围2.1 - 4.1）和正常对照组（平均3.0 cm，范围2.3 - 3.5）。最大多普勒梯度为107 mm Hg（范围71 - 170），EOA为0.6 cm（2）（范围0.2 - 1.3），计算的压力恢复为18 mm Hg（范围6 - 37），净梯度为89 mm Hg（范围51 - 151），23%的患者净梯度< 70 mm Hg。EOA/AA直径的截止值>0.2 cm确定了84%的患者（16/19）的净压差< 70 mm Hg。总之，我们发现，在大多数主动脉瓣狭窄和高多普勒梯度的患者中，可以预期重要的压力恢复。压力恢复可以解释为什么有些高多普勒梯度患者无症状。此外，当必须决定瓣膜置换术时，压力恢复是非典型瓣膜病和高多普勒梯度患者的一个考虑因素。(C)2001年由Excerpta Medico，Inc.
Pressure recovery has been described in aortic stenosis and may explain the difference occasionally observed between Doppler- and catheter-measured gradients. A narrow ascending aorta (AA) and moderately severe stenosis favors pressure recovery. The aims of this study were to investigate the degree to which these conditions are present in patients with aortic stenosis and high Doppler gradients and to evaluate the magnitude of pressure recovery. One hundred sixteen patients were examined with Doppler echocardiography before aortic valve replacement. Patients with a maximum gradient > 70 mm Hg (n = 81) were included. The diameter of the AA was measured and compared with the diameter in an age- and body sire-matched group of normal controls (n = 23), Pressure recovery was estimated from a previously validated equation by measuring the maximum Doppler gradient, the effective orifice area (EOA), and the diameter of the AA, The diameter of the AA was similar for patients (mean 3.0 cm, range 2.1 to 4.1) and normal controls (mean 3.0 cm, range 2.3 to 3.5). The maximum Doppler gradient was 107 mm Hg (range 71 to 170) and the EOA was 0.6 cm(2) (range 0.2 to 1.3), The calculated pressure recovery was 18 mm Hg (range 6 to 37), which gives a net gradient of 89 mm Hg (range 51 to 151), Twenty-three percent had a net gradient < 70 mm Hg. A cutoff of EOA/AA diameter at >0.2 cm identified 84% of patients (16 of 19) with a net gradient < 70 mm Hg. In conclusion, we found that important pressure recovery con be expected in most patients with aortic stenosis and high Doppler gradients. Pressure recovery may explain why some patients with high Doppler gradients ore asymptomatic. Also, pressure recovery is a factor to consider in patients with atypical symptomatology and high Doppler gradients when one must decide on valvular replacement. (C) 2001 by Excerpta Medico, Inc.