主动脉瓣替换术后右心室功能中期变化的临床特征

The Medium period Changes in Right Ventricular Function after Aortic Valve Replacement

目的为了解主动脉瓣替换术后右心室功能中期变化的临床特征。方法采用心室长轴Ｍ型超声心动图数字定量分析方法，对５０例无支架生物瓣替换患者的术前、术后１月、６月、１２月、２４月的心室长轴功能进行了随访。结果术后早期，左心室长轴功能即得到改善，ＬＸＰＳＲ和ＬＸＰＬＲ分别增加了３３．１％和４２．８％（Ｐ＜０．０１，Ｐ＜０．０１）；术后６月改善明显且在其后的随访期间保持稳定。与之相比，术后１月，右心室ＬＸＰＳＲ和ＬＸＰＬＲ仅为术前的８２．１％和７０．５％，尽管术后６月开始恢复，但术后２年，亦未恢复到术前水平。结论主动脉瓣替换术后右心室功能的滞后性恢复与术后右心室顺应性改变有关，右心室舒张功能的异常是影响右心室该期心内膜下血液供应的重要原因。逆行灌注心肌保护对右心室功能的保护不佳亦为术后右心室功能恢复缓慢的可能原因。

Objective To characterize the medium period changes in right ventricular function (RVF) after aortic valve replacement (AVR).Methods 50 cases undergone the stentless bioprosthese replacement were investigated using digitizing of both ventricular long axis M mode echocardiograms before and 1, 6,12 and 24 months after AVR.Results The results demonstrated that rapid recovery of left ventricular function (LVF) was achieved one month postoperatively, LXPSR and LXPLR were both increased (33.1%, 42.8%, respectively, both P <0.01) and reached a statisfactory level 6 months later, and remained stable during the subsequent follow up. In contract to the LVF, depressed RVF was detected early postoperatively. Although slight improvement of RVF started 6 months after AVP, LXPSR and LXPLR did not reach their preoperative levels up to total 2 years follow up period.Conclusion It is conclused that the abnormal diastolic function and impaired complaince of RV will contribute to the delayed RVF recovery after AVP, the imcompleted RV myocardial preservation with retrograde perfusion intraoperatively, however, is also likely to be responsible for the delayed improvement of RVF.