19mm St.Jude Regent瓣有效瓣口面积和血流动力学的早期在体研究

The Effective Orifice Area and Haemodynamics of 19mm St.Jude Regent Valve——An Early in Vivo Study

目的 了解19mmSt．Jude Regent瓣的在体有效瓣口面积及植入后是否发生瓣膜一患者不匹配现象（PPM）。方法 23例心脏瓣膜病患者根据术中测量的主动脉瓣环径大小分为19mm Regent瓣组和21mm其它双叶机械瓣膜组，均常规行二尖瓣、主动脉瓣双瓣膜置换术；运用彩色多普勒超声心动图技术，于术前和术后3～6个月测量血流动力学指标，并计算左心室重量及有效瓣口面积等参数。结果 两组患者围术期及术后3～6个月内未发生心脏事件，术后3～6个月左心室重量均较术前减轻；两组患者的主动脉瓣有效瓣口面积、有效瓣口面积指数、左心室重量减轻程度差异无统计学意义（P〉0．05）。结论 （1）19mm St.Jude Regent瓣与21mm其它进口双叶机械瓣有相同的有效瓣口面积和血流动力学效果；（2）在二尖瓣、主动脉瓣双瓣膜置换术中，当主动脉瓣瓣环径偏小时应用19mm St．Jude Regent瓣是比较安全的，不会增加术后早期的心脏事件，不会发生术后早期的PPM；（3）对于PPM的标准，应进一步扩大病例数量、延长随访时间，进行深入研究；（4）St．Jude Regent瓣有临床应用价值，但需进一步随访观察。

Objective To investigate the in vivo effective orifice area （EOA） and whether prosthesis-patient mismatch （PPM） is going to happen after 19mm St. Jude Regent valves replacement were performed. Methods Twenty-three patients with valvular heart diseases were divided into 2 groups according to aortic annular diameter. 19mm St. Jude Regent valves were replaced in aortic valve place （Regent valve group）, and 21mm other double- leaflet mechanical valves were replaced in aortic place （other valves group）. All of the operations were accomplished under cardiopulmonary bypass in West China Hospital. All of the patients were followed up in 3 to 6 months after their surgery processes. Color Doppler echocardiography was used to measure the hemodynamic parameters in their follow-up. Then left ventricular mass （LV mass）, EOA and effective orifice area index （EOAI） etc. were calculated and compared by using SPSS 12.0. Results No cardiac episodes were detected during the perioperative period and 3-6 months after operation. LVmass reduced in 3-6 months after operation in both groups. No statistical significance of EOA, EOAI and LVmass reduction were detected between the two groups. Conclusions （1）The EOA and in vivo hemodynamic effects of 19mm Regent valve are similar to 21mm other double leaflet mechanical valve. （2）It is safe to use 19mm Regent valve in those patients whose aortic annular diameter are small and need double valve replacement. Using 19mm Regent valve will not cause short time cardiac episodes and PPM. （3）More further works should be done to make sure what is the standard of PPM in Chinese people, such as enlarging the patients number and prolonging the follow-up time. （4） Further clinical and follow-up works should be done to make St. Jude Regent valve＇s feature out.