主动脉瓣置换术后室间隔厚度对主动脉瓣跨瓣压差的影响

The influence of interventricular septal thickness to trans-aortic valve pressure after aortic valve replacement

目的探讨主动脉瓣置换术后室间隔厚度对主动脉瓣跨瓣压差的影响。方法2005年1月至2010年12月，接受主动脉瓣置换术患者273例，全部为单纯主动脉瓣狭窄。根据手术时使用的主动脉瓣不同品牌，将患者分为3组：Regent组、On—X组、其他品牌组。定义术后跨瓣压差大小为：轻度（0～30mmHg，1mmHg=0．133kPa）、中度（30～60mmHg）及重度（大于60mmHg）。分别比较术前、术后测量的左心室收缩期末径、左心室舒张期末径、左心室射血分数（EF值）和室间隔厚度。结果3组患者术前的左心室收缩期末径、左心室舒张期末径及EF值差异无统计学意义（P〉0．05）。Regent组患者，术后跨瓣压差为重度的患者术前室间隔厚度明显多于轻、中度（P〈0．05）。使用On—X组患者，术后跨瓣压差为重度与中度的患者术前室间隔厚度者明显多于轻度组（P〈0．05）。其他品牌组患者，术后跨瓣压差为重度的患者术前室间隔厚度明显多于中、轻度组（P〈0．05）。结论行主动脉瓣置换术后，术前室间隔厚度大于13．6mm的患者其主动脉瓣跨瓣压差较厚度小于13．6mm的患者显著增高。室间隔厚度大于15．3mm的患者，应同期行室间隔部分切除或替换无支架瓣膜以减少主动脉瓣替换后的跨瓣乐善。

Objective To investigate the effects of interventricular septal thickness （IST） on postoperative trans-aortic valve pressure after aortic valve replacement （AVR）. Methods 273 patients were divided into 3 groups with different me- chanical valves and postoperative trans-aortie valve pressure （TAVP）. Hemodynamic parameters including left ventricular end diastolic diameter, left ventrieular end systolic diameter, ejection fraction and IST were analyzed. Results There was no sig- nificant difference in left ventrieular diastolic diameter, left ventricular systolic diameter and ejection fraction in three groups with different mechanical valves （ P 〉 0.05 ）. In patients with St. Jude Regent valve, preoperative IST in severe TAVP group was significantly thicker than those of moderate and mild groups （ P 〈 0.05 ）. In patients with On-x valve, preoperative IST in severe and moderate TAVP groups were thicker than that of mild group （P 〈 0.05 ）. In patients with other mechanical valve, preoperative IST in severe TAVP group is greater than those of moderate and mild groups （P 〈 0.05 ）. Conclusion Interven- tricular septal thickness did have positive influence on postoperative trans-aortic valve pressure after AYR. When IST was more than 13.6mm, the postoperative trans-aortic valve pressure after aortic valve replacement was higher than the IST was less than 13.6mm. When IST was thicker than 15.3mm, partial ventricular septal resection or replacement of stentless valve should be considered.