Comparison of exercise hemodynamics among nonstented aortic bioprostheses, mechanical valves, and normal native aortic valves
Comparison of exercise hemodynamics among nonstented aortic bioprostheses, mechanical valves, and normal native aortic valves
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DOI：
10.1111/j.1540-8191.1998.tb01105.x
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发表时间：
1998-09-01
影响因子：
1.6
通讯作者：
Bitran, D
中科院分区：
文献类型：
--
作者：
Silberman, S;Shaheen, J;Bitran, D
背景：虽然已知主动脉瓣假体在休息时表现良好，但很少有研究对其在压力下进行检查。我们比较了主动脉位置机械瓣膜和未支架猪瓣膜与正常天然主动脉瓣膜的应力血流动力学。方法：采用多巴酚丁胺超声心动图评估使用多伦多无支架猪瓣膜（SPV） （n = 13，平均植入物尺寸25.7 mm）、Sorin biccarbon机械瓣膜（SOR） （n = 11，平均植入物尺寸24.5 mm）和正常主动脉瓣（NOR）患者（n = 10）休息和运动时的平均梯度和峰值梯度和有效孔面积指数（EOAI）。多巴酚丁胺输注以每分钟5 mu/kg的速度开始，然后以每分钟5 mu/kg的速度增加，直到达到目标心率或直到最大剂量为每分钟40 mu/kg。结果：在休息和运动时，多伦多SPV的心输出量（L/min）分别为5.2和10.4；SOR为7.4和13.5；NOR为4.6和11.2。测量的EOAI （cm(2)）为TORONTO SPV的1.1 +/- 0.2和1.15 +/- 0.2；SOR为1.60 +/- 0.3和1.58 +/- 0.3；NOR为1.45 +/- 0.2和1.46 +/- 0.2。多伦多SPV的平均梯度（mmHg）分别为5.48 +/- 1.1和5.83 +/- 0.9；SOR为5.26 +/- 0.8和11.3 +/- 1.8；NOR为1.54 +/- 0.4和2.18 +/- 0.7。多伦多SPV的峰值梯度（mmHg）分别为11.9 +/- 2.0和21.0 +/- 3.7；SOR为10.79 +/- 1.7和25.9 +/- 3.4；NOR为2.38 +/- 0.9和6.1 +/- 2.3。结论：尽管机械组（SOR）测量的EOAI较大，但该组运动时梯度的较大增加表明TORONTO SPV对血流的阻碍较小。
Background: While aortic valve prostheses are known to perform well at rest, few studies have examined them under stress. We compared stress hemodynamics of mechanical valves and nonstented porcine valves in the aortic position to that of normal native aortic valves. Methods: Dobutamine echocardiography was used to assess mean and peak gradients and effective orifice area index (EOAI) at rest and exercise in patients with the Toronto Stentless Porcine Valve (SPV) (n = 13, mean implant size 25.7 mm), Sorin Bicarbon mechanical valve (SOR) (n = 11, mean implant size 24.5 mm), and patients with normal native aortic valves (NOR) (n = 10). Dobutamine infusion was started at 5 mu/kg per minute, and increased by increments of 5 mu/kg per minute until the target heart rate was achieved or until a maximal dose of 40 mu/kg per minute. Results: At rest and exercise, respectively, cardiac output (L/min) was 5.2 and 10.4 for Toronto SPV; 7.4 and 13.5 for SOR; and 4.6 and 11.2 for NOR. Measured EOAI (cm(2)) was 1.1 +/- 0.2 and 1.15 +/- 0.2 for TORONTO SPV; 1.60 +/- 0.3 and 1.58 +/- 0.3 for SOR; and 1.45 +/- 0.2 and 1.46 +/- 0.2 for NOR. Mean gradients (mmHg) were 5.48 +/- 1.1 and 5.83 +/- 0.9 for TORONTO SPV; 5.26 +/- 0.8 and 11.3 +/- 1.8 for SOR; and 1.54 +/- 0.4 and 2.18 +/- 0.7 for NOR. Peak gradients (mmHg) were 11.9 +/- 2.0 and 21.0 +/- 3.7 for TORONTO SPV; 10.79 +/- 1.7 and 25.9 +/- 3.4 for SOR; and 2.38 +/- 0.9 and 6.1 +/- 2.3 for NOR. Conclusions: Although the mechanical group (SOR) had larger measured EOAI, the greater increase in gradients with exercise in this group suggests that the TORONTO SPV is less obstructive to flow.