CAJ | 학술논문

目的应用超声心动图评价二尖瓣置换术后2年CarboMedics(CM)瓣膜的功能,并比较压力半降时间(PHT)法和连续方程(CON)法计算的有效瓣口面积(EOA).方法 49例应用CM瓣膜行单纯二尖瓣置换手术的患者进入本研究.置换的CM瓣膜为:25 mm 13例,27 mm 36例.术后2年行经胸彩色超声心动图检查,测量及计算指标:左心室射血分数(LVEF),左室每搏输出量(SV),PHT,二尖瓣舒张早期峰值流速(E velocity),平均跨瓣压差(MG),二尖瓣人工瓣膜/左室流出道血流时间速率积分比率(TVI_(MVP)/TVI_(LVOT)).以PHT<130 ms、E velocity<2.0 m/s及TVI_(MVP)/TVI_(LVOT)<2.2为评价人工瓣膜功能正常的标准.结果同时符合E velocity<2 m/s、TVI_(MVP)/TVI_(LVOT)<2.2及PHT<130 ms者26例(53.1%).采用25 mm瓣膜或采用27 mm瓣膜患者的PHT、MG、TVI_(MVP)/TVI_(LVOT)、EOA之间的差异无统计学意义(P>0.05),但采用25 mm瓣膜患者的E velocity大于采用27 mm瓣膜患者的E velocity(P<0.05),采用PHT法计算的瓣膜的EOA大于CON法计算的相应瓣号瓣膜的EOA(P<0.05). 结论二尖瓣置换术后2年CM瓣膜功能是可以接受的,这表现在多数患者PHT<130 ms、E velocity<2.0 m/s及TVI_(MVP)/TVI_(LVOT)<2.2;对于超过上述范围的患者应加强随访及复查.二尖瓣置换术后采用PHT法计算的瓣膜EOA明显高于CON法计算的瓣膜EOA.
목적 응용초성심동도평개이첨판치환술후2년CarboMedics(CM)판막적공능,병비교압력반강시간(PHT)법화련속방정(CON)법계산적유효판구면적(EOA).방법 49례응용CM판막행단순이첨판치환수술적환자진입본연구.치환적CM판막위:25 mm 13례,27 mm 36례.술후2년행경흉채색초성심동도검사,측량급계산지표:좌심실사혈분수(LVEF),좌실매박수출량(SV),PHT,이첨판서장조기봉치류속(E velocity),평균과판압차(MG),이첨판인공판막/좌실류출도혈류시간속솔적분비솔(TVI_(MVP)/TVI_(LVOT)).이PHT<130 ms、E velocity<2.0 m/s급TVI_(MVP)/TVI_(LVOT)<2.2위평개인공판막공능정상적표준.결과 동시부합E velocity<2 m/s、TVI_(MVP)/TVI_(LVOT)<2.2급PHT<130 ms자26례(53.1%).채용25 mm판막혹채용27 mm판막환자적PHT、MG、TVI_(MVP)/TVI_(LVOT)、EOA지간적차이무통계학의의(P>0.05),단채용25 mm판막환자적E velocity대우채용27 mm판막환자적E velocity(P<0.05),채용PHT법계산적판막적EOA대우CON법계산적상응판호판막적EOA(P<0.05). 결론 이첨판치환술후2년CM판막공능시가이접수적,저표현재다수환자PHT<130 ms、E velocity<2.0 m/s급TVI_(MVP)/TVI_(LVOT)<2.2;대우초과상술범위적환자응가강수방급복사.이첨판치환술후채용PHT법계산적판막EOA명현고우CON법계산적판막EOA.
Objective To evaluate the CarboMedics (CM) prosthesis function two years after mitral valve replacement, and to compare the effective orifice area(EOA) calculated by pressure half-time (PHT) method and continuity method (CON). Methods Forty nine patients who underwent isolated mitral valve replacement with a CM prosthesis were recruited in this study, which included 13 cases of 25 mm CM prosthesis and 36 cases of 27 mm CM prosthesis. Two years after the mitral valve replacement, transthoracic echocardiography (TTE) was performed, measuring left ventricular ejection fraction (LVEF), stroke volume mean gradient (SV), PHT, peak early mitral diastolic velocity (E velocity), mean gradient (MG), time-velocity integral of left ventricular outflow tract/time-velocity integral of mitral valve prosthesis (TVI_(MVP)/TVI_(LVOT)). The function of the prosthetic valve was considered normal when PHT <130 ms, E velocity <2. 0 m/s and TVI_(MVP)/TVI_(LVOT)<2. 2. Results More than half (53. 1%) of the patients had normal function of the prosthetic valve. No significant differences were found in PHT, MG, TVI_(MVP)/TVI_(LVOT)>EOA or IEOA between the patients with 25 mm valve and the patients with 27 mm valve (P> 0. 05). But the patients with 25 mm valve had higher E velocity than the patients with 27 mm valve (P <0. 05). The PHT method produced greater EOA than by the CON method (P<0. 05). Conclusion The function of CM prosthesis is acceptable two years after the mitral valve replacement, with most patients having PHT<130 ms, E velocity <2. 0 m/s and TVI_(MVP)/TVI_(LVOT)<2. 2. PHT method produces greater EOA than CON method.