Early changes in left ventricular size and function after correction of left ventricular volume overload.
Early changes in left ventricular size and function after correction of left ventricular volume overload.
复制标题
纠正左心室容量超负荷后左心室大小和功能的早期变化。
DOI：
10.1016/0002-9149(81)90204-6
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
Pohost,GM
中科院分区：
文献类型：
--
作者：
Boucher,CA;Bingham,JB;Osbakken,MD;Okada,RD;Strauss,HW;Block,PC;Levine,FH;Phillips,HR;Pohost,GM
在瓣膜置换术前和术后2 - 4周（主动脉瓣，20例患者;二尖瓣，20例患者），使用多门控血池成像确定了预测孤立性主动脉瓣或二尖瓣返流患者术后早期左心室大小和功能的能力。术后早期，两组患者的射血分数均显著降低（p <0.001）（主动脉瓣返流患者从0.55 ± 12降至0.40 ± 0.14 [平均值± 1标准差]，二尖瓣返流患者从0.66 ± 0.09降至0.48 ± 0.11）。射血分数降低与每搏输出量大幅降低相关，收缩末期容积变化极小或无变化;与术前射血分数无关。术后早期射血分数与术前收缩末期容积相关性最好，14例患者射血分数正常，术前射血分数高于0.60的21例患者中有4例（67%）;术前射血分数为0.50至0.60的15例患者中有4例（27%）;术前射血分数低于0.50的4例患者中无1例（p <0.05）。此外，16例患者术后晚期（1 - 2年）的重复扫描显示，主动脉瓣返流患者的收缩末期容积进一步减少，射血分数向术前值增加。术后早期舒张末期容积显著下降（P <0.001），主动脉瓣反流组从162 ± 60 ml/m2降至102 ± 41 ml/m2，二尖瓣反流组从131 ± 40 ml/m2降至78 ± 30 ml/m2。这种减少与每搏输出量减少密切相关，与术前射血分数无关。术后早期舒张末期容积与术前收缩末期容积相关性最好。大部分舒张末期容积的减少发生在瓣膜置换术后2周内，去除主动脉瓣或二尖瓣返流引起的慢性左心室容量超负荷可使射血分数和舒张末期容积减少。早期的减少部分是由于负荷条件的改变，并不一定意味着心肌收缩功能的改变。二尖瓣返流患者射血分数的降低似乎持续存在。
The ability to predict early postoperative left ventricular size and function in patients with isolated aortic or mitral regurgitation was determined utilizing multigated blood pool imaging before and 2 to 4 weeks after valve replacement (aortic valve, 20 patients; mitral valve, 20 patients). Early postoperatively, ejection fraction decreased significantly (p <0.001) in both patient groups (from 0.55 ± 12 to 0.40 ± 0.14 [mean ± 1 standard deviation] in patients with aortic regurgitation and from 0.66 ± 0.09 to 0.48 ± 0.11 in patients with mitral regurgitation). The decrease in ejection fraction was associated with a large decrease in stroke volume with minimal or no change in end-systolic volume; it was unrelated to the preoperative ejection fraction. Early postoperative ejection fraction correlated best with preoperative end-systolic volume and was normal in 14 (67 percent) of 21 patients with a preoperative ejection fraction above 0.60; 4 (27 percent) of 15 patients with a preoperative ejection fraction of 0.50 to 0.60; and in 0 of 4 patients with a preoperative ejection fraction below 0.50 (p <0.05). In addition, a repeated scan in 16 patients late (1 to 2 years) after operation showed a further reduction in endsystolic volume in patients with aortic regurgitation with an increase in ejection fraction toward preoperative values. There was no significant change in patients with mitral regurgitation.End-diastolic volume decreased significantly (p <0.001) early postoperatively (from 162 ± 60 to 102 ± 41 ml/m2in patients with aortic regurgitation and from 131 ± 40 to 78 ± 30 ml/m2in patients with mitral regurgitation). This decrease was closely related to a decrease in stroke volume and was unrelated to preoperative ejection fraction. Early postoperative end-diastolic volume correlated best with the preoperative end-systolic volume. The major part of the reduction in end-diastolic volume occurred within 2 weeks of valve replacement.Removal of chronic left ventricular volume overload due to aortic or mitral regurgitation produces a decrease in ejection fraction and end-diastolic volume. The early reduction is in part a result of altered loading conditions and may not necessarily imply alterations in myocardial contractile function. The reduction in ejection fraction appears to persist in patients with mitral regurgitation.