ECHOCARDIOGRAPHY IN CHRONIC AORTIC-INSUFFICIENCY - IS VALVE-REPLACEMENT TOO LATE WHEN LEFT-VENTRICULAR END-SYSTOLIC DIMENSION REACHES 55 MM
ECHOCARDIOGRAPHY IN CHRONIC AORTIC-INSUFFICIENCY - IS VALVE-REPLACEMENT TOO LATE WHEN LEFT-VENTRICULAR END-SYSTOLIC DIMENSION REACHES 55 MM
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DOI：
10.1161/01.cir.67.1.216
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发表时间：
1983-01-01
期刊：
影响因子：
37.8
通讯作者：
HUGENHOLTZ, PG
中科院分区：
文献类型：
--
作者：
FIORETTI, P;ROELANDT, J;HUGENHOLTZ, PG
确定左室（LV）收缩末期尺寸（ESD）。55 mm和左室分数缩短< 25%是主动脉瓣不全（AI）患者主动脉瓣置换术（AVR）的危险因素，分析47例连续行AVR的孤立症状性AI患者的临床病程和m型超声心动图。组1患者（n = 27）术前ESD < 55 mm（平均44 mm，范围30-52 mm），组2患者（n = 20）术前ESD。55毫米（平均62毫米，范围55-85毫米）。1组1例，2组10例左心室缩短< 25%。平均随访41个月（6-76个月），无围手术期或术后死亡病例。围手术期心肌梗死5例，1组3例，2组2例。由于采用冷K心脏截瘫术进行心肌保护，没有患者发生围手术期心肌梗死。纽约心脏协会术前平均功能分级为2.3（第1组）和2.6（第2组）。术后1组为1.2,2组为1.1。患者（1组20例，2组13例）在AVR后至少1年复查超声心动图。其中左室舒张末期尺寸由67±-减小。6到53 .+-。6mm(平均+-。SD) (P < 0.001)；3到55 .+-。2组6mm （P < 0.001）。LVESD也下降，但由于术后频繁的室间隔异常运动，这很难解释。1组左室横截面积（左室质量指数）由25 .+-减小。5到20 .+-。5 cm2 (P < 0.001)， 2组为32。9到20 +-。5 cm2 （P < 0.001）。两组患者术后舒张末期尺寸和横截面积差异无统计学意义。主动脉功能不全，术前需进行ESD检查。根据长期生存、症状缓解和超声心动图评估的左室尺寸正常化来判断，55mm不排除AVR成功。
To determine whether a left ventricular (LV) end-systolic dimension (ESD) .gtoreq. 55 mm and LV left fractional shortening < 25% are risk factors for aortic valve replacement (AVR) in patients with aortic insufficiency (AI), the clinical course and M-mode echocardiograms in 47 consecutive patients who underwent AVR for isolated symptomatic AI were analyzed. Group 1 patients (n = 27) had a preoperative ESD < 55 mm (mean 44 mm, range 30-52 mm) and group 2 patients (n = 20) had a preoperative ESD .gtoreq. 55 mm (mean 62 mm, range 55-85 mm). One patient in group 1 and 10 patients in group 2 had left ventricular fractional shortening < 25%. There were no perioperative or postoperative deaths during an average follow-up of 41 months (range 6-76 mo.). Five patients had perioperative myocardial infarctions (MI), 3 in group 1 and 2 in group 2. Since myocardial protection with cold K cardioplegia was instituted, no patient has suffered a perioperative MI. The average preoperative New York Heart Association functional classification was 2.3 (group 1) and 2.6 (group 2). Postoperatively, it was 1.2 in group 1 and 1.1 in group 2. Patients (20 in group 1 nad 13 in group 2) had echocardiograms at least 1 yr after AVR. Of these, LV end-diastolic dimension decreased from 67 .+-. 6 to 53 .+-. 6 mm (mean .+-. SD) in group 1 (P < 0.001) and from 79 .+-. 3 to 55 .+-. 6 mm in group 2 (P < 0.001). The LVESD also decreased, but this is difficult to interpret because of frequent postoperative abnormal interventricular septal motion. The LV cross-sectional area, an index of LV mass, decreased in group 1 from 25 .+-. 5 to 20 .+-. 5 cm2 (P < 0.001) and in group 2 from 32 .+-. 9 to 20 .+-. 5 cm2 (P < 0.001). Postoperative end-diastolic dimension and cross-sectional area were not significantly different between the 2 groups. Apparently in aortic insufficiency, a preoperative ESD .gtoreq. 55 mm does not preclude successful AVR, as judged by long-term survival, symptomatic relief and normalization of LV dimensions assessed by echocardiography.