小左室病人行二尖瓣置换术机械瓣膜型号的选择

Perioperative hemodynamics study of small left ventricle patients after mitral replacement.

目的探讨小左室病人行二尖瓣置换术时选择大口径机械瓣膜的可行性。方法将左室舒张末径小于40 mm 进行单独二尖瓣置换手术者分为小口径 M-1二尖瓣25号瓣膜组和大口径 M-2二尖瓣25号组。每组病人手术后均测定各瓣膜跨瓣压差、流速和肺动脉压,应用 SPSS 行统计分析。结果大口径 M-2二尖瓣组和小口径 M-1二尖瓣25号瓣膜组相比,跨瓣压差小[(5.9±1.6)mm Hg 对(10.7±3.2)mm Hg],在体瓣口面积大[(2.9±0.2)cm^2对(2.6±0.2)cm^2)],瓣膜匹配指数大[(1.92±0.23)cm^2/m^2对(1.73±0.18)cm^2/m^2],差异有统计学意义。结论在注意心肌保护和围术期处理的条件下,左室舒张末径较小者行二尖瓣置换手术时也应置入较大口径的机械二尖瓣瓣膜,以取得良好围术期血流动力学结果和临床效果。

Objective To investigate the perioperative hemodynamic features of mitral replacement of patients with small left ventricle. Methods Patients with left ventricle end-diastolic dimension （LVEDD） less than 40mm received mitral replacement surgery were divided into big size M-2 group and small size M-1 group. The perioperative echo results were analyzed with SPSS software. Results The big size M-2 group has lower transmitral gradient [ （5.9 ± 1.6） mm Hg vs. （ 10.7 ± 3.2） mm Hg], larger in vivo valularacre[（2.9 ± 0.2） cm^2 vs. （2.6±0.2） cm^2], and high mitral match index [（1.92 ± 0.23）cm^2/m^2 vs. （1.73 ±0.18） cm^2/m^2 ]. Conclusion With the meticulous perioperative treatment and myocardial protection, the patients with small left ventricle should also receive a mitral replacement as big as possible to achieve the ideal hemodynamics results.