人工瓣膜置换对血流动力学影响的系统分析

System analysis of prosthetic valve replacement effects on hemodynamics

目的:评价人工瓣膜置换后的血流动力学性能,分析不同类型、不同外径人工瓣膜对血流动力学的影响。方法:以计算机检索方法检索中国期刊全文数据库中(CNKI:2001/2008)关于人工瓣膜置换相关文献,检索词为"人工瓣膜、瓣膜置换"。检索后对每项研究的资料结果进行提取、分析。结果:共有13项实验770例心脏瓣膜病患者符合纳入标准,人工瓣膜置换后左房内径、最大跨瓣压差、平均跨瓣压差和峰值流速均较置换前显著降低,左室射血分数较置换前显著升高;双叶瓣与单叶瓣比较,双叶瓣置换后左房直径、最大跨瓣压差、平均跨瓣压差各血流动力学指标下降较显著;与有支架瓣膜比较,无支架生物主动脉瓣跨瓣压差、左室射血分数等指标优于有支架生物主动脉瓣。为小主动脉瓣患者研制的外径21mm主动脉瓣,初步研究显示其置换后最大跨瓣压差在22mmHg(1mmHg=0.133kPa)左右,与23mm机械瓣的血流动力学效果相同。结论:人工瓣膜置换可明显改善瓣口的血流动力学及左室构型,其中双叶瓣置换的血流动力学指标优于单叶瓣,无支架生物瓣明显优于有支架生物瓣,外径21mm人工瓣膜置换后左室射血分数、最大跨瓣压差与23mm人工瓣膜差异不明显,有临床应用价值,但仍需进一步临床随访观察。

OBJECTIVE： To evaluate hemodynamic function following prosthetic valve replacement, and to analyze effects of prosthetic valve at different types and various external diameter on hemodynamics. METHODS： Articles concerning prosthetic valve replacement were retrieved in China National Knowledge Infrastructure （CNKI） from 2001 to 2008, using the key words of ＂prosthetic valve, valve replacement＂. Data of each study were extracted and analyzed following retrieval. RESULTS： A total of 770 valvular heart disease patients from 13 articles were in accorded with inclusion criteria. Following prosthetic valve replacement, left atrial diameter, peak transprosthetic gradients, mean mitral pressure gradient and peak velocity were significantly reduced; left ventricle ejection fraction was significantly increased. Comparison between bilobed flap and single-leaflet valves showed that left atrial diameter, peak transprosthetic gradients and mean mitral pressure gradient were significantly decreased following bilobed flap replacement. Compared with stented valve, mitral pressure gradient and left ventricle ejection fraction were better in stentless valve. Primary study concerning aortic valve with 21-mm external diameter for small aortic valve patients demonstrated that peak transprosthetic gradients was about 22 mm Hg following replacement, which obtained identical effects as hemodynamics of 23-mm mechanical prosthetic valve. CONCLUSION： Prosthetic valve replacement can significantly improve hemodynamics in valve orifice and left ventricle configuration. The hemodynamic indices are better in bilobed flap compared with single-leaflet valves, and better in stentless valve compared with stented valve. No significant differences in left ventricle ejection fraction and peak transprosthetic gradients were determined between aortic valve with 21-mm external diameter and aortic valve with 23-mm external diameter.