CAJ | 학술논문

目的探讨主动脉瓣置换术后室间隔厚度对主动脉瓣跨瓣压差的影响.方法 2005年1月至2010年12月,接受主动脉瓣置换术患者273例,全部为单纯主动脉瓣狭窄.根据手术时使用的主动脉瓣不同品牌,将患者分为3组:Regent组、On-x组、其他品牌组.定义术后跨瓣压差大小为:轻度(0～30 mm Hg,1 mm Hg=0.133 kPa)、中度(30 ～60 mm Hg)及重度(大于60 mm Hg).分别比较术前、术后测量的左心室收缩期末径、左心室舒张期末径、左心室射血分数(EF值)和室间隔厚度.结果 3组患者术前的左心室收缩期末径、左心室舒张期末径及EF值差异无统计学意义(P＞0.05).Regent组患者,术后跨瓣压差为重度的患者术前室间隔厚度明显多于轻、中度(P＜0.05).使用On-x组患者,术后跨瓣压差为重度与中度的患者术前室间隔厚度者明显多于轻度组(P＜0.05).其他品牌组患者,术后跨瓣压差为重度的患者术前室间隔厚度明显多于中、轻度组(P＜0.05).结论行主动脉瓣置换术后,术前室间隔厚度大于13.6 mm的患者其主动脉瓣跨瓣压差较厚度小于13.6 mm的患者显著增高.室间隔厚度大于15.3 mm的患者,应同期行室间隔部分切除或替换无支架瓣膜以减少主动脉瓣替换后的跨瓣压差.
목적 탐토주동맥판치환술후실간격후도대주동맥판과판압차적영향.방법 2005년1월지2010년12월,접수주동맥판치환술환자273례,전부위단순주동맥판협착.근거수술시사용적주동맥판불동품패,장환자분위3조:Regent조、On-x조、기타품패조.정의술후과판압차대소위:경도(0～30 mm Hg,1 mm Hg=0.133 kPa)、중도(30 ～60 mm Hg)급중도(대우60 mm Hg).분별비교술전、술후측량적좌심실수축기말경、좌심실서장기말경、좌심실사혈분수(EF치)화실간격후도.결과 3조환자술전적좌심실수축기말경、좌심실서장기말경급EF치차이무통계학의의(P＞0.05).Regent조환자,술후과판압차위중도적환자술전실간격후도명현다우경、중도(P＜0.05).사용On-x조환자,술후과판압차위중도여중도적환자술전실간격후도자명현다우경도조(P＜0.05).기타품패조환자,술후과판압차위중도적환자술전실간격후도명현다우중、경도조(P＜0.05).결론 행주동맥판치환술후,술전실간격후도대우13.6 mm적환자기주동맥판과판압차교후도소우13.6 mm적환자현저증고.실간격후도대우15.3 mm적환자,응동기행실간격부분절제혹체환무지가판막이감소주동맥판체환후적과판압차.
Objective To investigate the effects of interventticular septal thickness (IST) on postoperative trans-aonic valve pressure after aortic valve replacement (AVR).Methods 273 patients were divided into 3 groups with different mechanical valves and postoperative trans-aortic valve pressure (TAVP).Hemodynamic parameters including left ventricular end diastolic diameter,left ventricular end systolic diameter,ejection fraction and IST were analyzed.Results There was no significant difference in left ventricular diastolic diameter,left ventricular systolic diameter and ejection fraction in three groups with different mechanical valves ( P ＞ 0.05 ).In patients with St.Jude Regent valve,preoperative IST in severe TAVP group was significantly thicker than those of moderate and mild groups ( P ＜ 0.05 ).In patients with On-x valve,preoperative IST in severe and moderate TAVP groups were thicker than that of mild group ( P ＜0.05 ).In patients with other mechanical valve,preoperative IST in severe TAVP group is greater than those of moderate and mild groups ( P ＜ 0.05 ).Conclusion Interventricular septal thickness did have positive influence on postoperative trans-aortic valve pressure after AVR.When IST was more than 13.6mm,the postoperative trans-aortic valve pressure after aortic valve replacement was higher than the IST was less than 13.6mm.When IST was thicker than 15.3mm,partial ventticular septal resection or replacement of stentless valve should be considered.