机械瓣主动脉瓣置换术后患者远期的超声心动图特征及其临床意义

Long-term Characteristics and Clinical Significance of Echocardiogram in Patients after Mechanical Prosthesis Aortic Valve Replacement

观察及分析机械瓣主动脉瓣置换术后患者远期的超声心动图特征及其临床意义。55例机械瓣主动脉瓣置换术后随访达5年或5年以上的,完成了相应超声心动图检查的患者作为研究对象。以术前病变分为狭窄为主和反流为主组。以有效瓣口面积指数将患者分为:重度患者-人工瓣膜不匹配(PPM)、中度PPM及无PPM组。观察这些患者术后远期超声心动图特征。术前主动脉瓣狭窄患者术后半年室间隔厚度、左室后壁厚度明显减小(P<0.05)。主动脉瓣反流患者术后半年左室舒张期末径、左室收缩期末径减小,射血分数增加(P<0.05)。重度PPM、中度PPM及无PPM组患者之间的平均跨主动脉瓣压、主动脉瓣前向血流速度、射血分数的差异不明显(P>0.05)。随时间的推移其它瓣膜发生病变,升主动脉增粗的例数逐渐增加。机械瓣主动脉瓣置换术后患者心功能得到明显改善,但术后患者可出现其他瓣膜及升主动脉病变,因此术后定期的超声心动图评估及长期药物治疗是必要的。

The main purpose of this study is to observe and analyze the characteristics and the clinical significance of long-term echocardiogram data in patients after mechanical aortic valve replacement operation. Fifty-five eases were recruited over 5 years after mechanical aortic valve replacement operation, with complete echoeardiogram examination profiles. The 55 subjects were divided into predominate aortic stenosis group and predominate aortic regurgitation group, based on preoperative examinations. And another way of division was also carried out that according to the effective orifice area index （EOAI）, the subjects were divided into three groups, i. e. , severe prosthesis-patient mis- match （PPM） group, moderate PPM group, and non PPM group. Characteristics of long-term echocardiogram data of the subjects were analyzed. Patients with aortic stenosis showed significantly decreased thickness of intraventricu- lar septum and left ventrieular posterior wall about half a year after operation （P^O. 05）. Half a year after opera- tion, patients with aortic regurgitation showed decreased left ventricular internal dimension diastole and left ventricu- far internal dimension systole, and increased ejection fraction （P〈0. 05）. Differences in mean aortic valve pressure gradient, forward blood flow across the aortic valves, and ejection fraction were not significant among those with se- vere PPM, moderate PPM, and non PPM groups （P〉0.05）. Number of cases of ascending aorta dimension in- creased as time goes on and pathogenesis of other valve diseases. A conclusion could be drawn that the heart function of patients with aortic valve disease could be improved after mechanical aortic valve replacement operation, but pa- thologies in other valves and ascending aorta might be increased, and therefore periodical postoperative echocardio- gram evaluation with long tern pharmaceutical therapy could be necessary.