小主动脉瓣环患者应用Regent机械瓣术后心功能变化的评价

Evaluation of the heart function of replace st.jude medical regent valae in patients with small aortic

目的探讨小主动脉瓣环（直径≤19mm）患者行St．Jude Medical Regent（SJM Regent）瓣膜置换术后的心功能改变，研究是否存在植入瓣膜与患者不匹配（Prosthesis-Patient Mismatch，PPM）现象．以及是否有行主动脉瓣瓣环扩大术的必要。方法2004年3月-2005年3月，22例主动脉瓣环直径≤19mm患者置换SJM Regent机械瓣，用彩色多普勒超声仪对左心功能进行术前、术后监测．并与22例置换St．Jude Medical Hemodynamic Plus Series（SJMHP）机械瓣及22例置换外径23mm常规机械瓣患者进行对比。结果置换SJM Regent机械瓣膜患者术后的左心功能指标较术前明显好转，左室射血分数、左室缩短分数、瓣膜有效开口面积／体表面积之比（EOA指数）明显上升，左室重量指数及主动脉跨瓣压差也有不同程度降低。左心功能各项指标改善明显好于置换SJMHP机械瓣患者．部分指标接近或好于置换外径23mm瓣膜者。结论对于小主动脉瓣环患者．置换Regent机械瓣后指标已经接近或达到置换外径23mm常规瓣膜者，无PPM现象，大部分患者无须行主动脉瓣瓣环扩大术。

Purpose To evaluate the change of left heart function in patients who replace st. jude medical regent valve of small aortic. Methods Twenty-two patients receiving small st. jude medical regent valve prosthesis（≤19 mm in diameter）were studied by Doppler echocardiography（groupⅠ）. Before the operation and 1 year after operation, the results were compared with those of 22 patients receiving st. jude medical hemodynamic plus series（groupⅡ） and bigger valve prosthesis（23 mm in diameter）（groupⅢ）. Results There was a significant increase in the left ventricular ejection fraction, fractional shortening, the indexed effective orifice area in all groups. There was a significant reduction in the left ventricular mass index,peak pressure gradients across aortic valve in all groups. But left heart function of the patients in groupⅠ was improved better than groupⅡ. Conclusions Patients receiving small st. Jude Medical Regent valve prosthesis have no prosthesis-patient mismatch. Left heart function of replace St. Jude Medical Regent valve is better than replace st. jude medical henlodynamic plus series valve.