在患有慢性 mitrale 吐症的患者中,用或不用带状保持的 mitrale 置换. 术后喷射性能差异的机制
J D Rozich1, B A Carabello, B W Usher
1Department of Medicine, Medical University of South Carolina, Charleston 29525.
Circulation
|December 1, 1992
概括
带弦保存的副心置换 (MVR-CP) 通过减少末压力来维持左心室喷射性能. 带有弦切口的标准MVR (MVR-CT) 由于增加的应力和体积而损害了弹射性能.
科学领域:
- 心血管外科心血管外科
- 心脏生理学 心脏生理学
- 心声回声扫描 (Echocardiography) 是一种心声回声扫描.
背景情况:
- 对于慢性肌反而进行的标准心肌置换 (MVR) 往往会降低左心室 (LV) 喷射性能.
- 这种下降与在消除了用于LV排空的低阻抗路径后改变的负载条件有关.
- 与标准MVR不同的是,以节保护 (MVR-CP) 替换中枢通常可以保持LV喷射性能.
研究的目的:
- 为了研究背后的机制不同手术后喷射性能之间的MVR与和没有带弦保护.
- 阐明弦保存如何影响LV负载条件和MVR后的功能.
主要方法:
- 在手术前后对15名患有慢性 mitrale 吐的患者进行了心声和血压测量.
- 患者被分为两组:带弦切割的MVR (MVR-CT) (n=7) 和带弦保存的MVR (MVR-CP) (n=8).
- 计算包括心室体积,喷射率和末缩壁应力.
主要成果:
- MVR-CT导致LV末缩体积和末缩应力 (89至111g/cm2) 的增加,显著降低射出分数 (0.60至0.36).
- MVR-CP导致LV终端-透析和终端-静脉缩体积下降.
- 在MVR-CP患者中,末缩壁应力降低 (95至66g/cm2),喷射分数保持不变 (0.63至0.61).
结论:
- MVR-CT 损害了喷射性能,因为增加了末压力和体积.
- 在消除低阻抗心房通路后,MVR-CP通过减少LV大小和末性应激来保持喷射性能,即使消除了低阻抗心房通路.
- 带膜的保存对于维持中心膜手术后的LV功能至关重要.
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