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二尖瓣狭窄手术前后下游湍流剪应力的多普勒超声研究(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2003年第2期
页码:
151-154
栏目:
影像学
出版日期:
2003-03-01

文章信息/Info

Title:
Pre-and Post-operative study of turbulent shear stress down stream of mitral stenosis by Doppler echocardiography
作者:
张桂敏1; 石应康2; 唐红3; 张尔永2; 郭仲三4; 樊渝波5; 蒲放5; 曾智6
1.山东医科大学附属第一医院心外科,山东 济南 250012;2.华西医科大学附属第一医院胸心外科; 3.华西医科大学附属第一医院彩超室;4.中科院成都分院计算机应用研究所;5.四川大学生物力学系; 6.华西医科大学附属第一医院心内科
Author(s):
ZHANG Gui-min1; SHI Ying-kang2; TANG Hong3; ZHANG Er-yong2; GUO Zhong-san4;  FAN Yu-bo5; PU Fang5; ZENG Zhi6
1.Department of CardiacSurgery,First Hospital,Shan dong University of Medical Sciences,Jinan,Shan dong 250012,China
关键词:
二尖瓣狭窄; 手术; 湍流剪应力; 超声心动描记术; 多普勒
Keywords:
mitral stenosis; operation; turbulent shear stress; echocardiography; Doppler
分类号:
R542.5;R454.3
DOI:
-
文献标识码:
A
摘要:
目的:明确二尖瓣狭窄患者瓣膜病变及其下游湍流剪应力(turbulentshearstress,TSS)与手术时机和预后之 间的关系,为选择合适的诊治手段和最佳手术时机提供科学依据。方法:应用多普勒超声与计算机图像分析技术, 以正常人为对照,对一组接受经皮球囊二尖瓣狭窄扩张术或闭式二尖瓣分离术患者术前后与随访期间瓣膜下游 TSS进行检测,同期对另一组非手术患者进行TSS随访观测。结果:术后TSS较术前显著改善(P<0.05),而与正 常对照相比仍有明显差距(P<0.05)。手术患者两次随访前后TSS等指标的增加值均显著低于非手术患者(P<0. 05)。结论:对于中、重度二尖瓣狭窄患者,球囊扩张术或闭式分离术不能达到根治目的,但在一定程度上起到了减 缓病情加重的作用。从远期疗效的角度上,考虑到术后残留狭窄下游TSS仍将导致瓣膜病变进行性加重,建议推 广超声心动图普查,有助于早期发现该病,同时可以考虑将手术时机选择在瓣膜病变早期、瓣叶和瓣下结构尚无明 显损害时,以彻底解除瓣口狭窄、消除TSS。
Abstract:
AIM:To make clear the relationship between valvularlesion and turbulent shear stress (TSS) downstream of mitral valve in patients with mitral stenosis and time of operation and their prognosis so as to provide us with scientific basis for choosing suitable method of diagnosis and treatment and optimal opportunity of operation.METHODS:Using Doppler echocardiography and analysis of image by computer, with normal as control we observed TSS downstream of mitral stenosis in a group of patients before and after the operation of percutaneous balloon dilatation or closed commissurplasty and during 2 years'follow-up.At the same time we also observed TSS in a group of non-operative patients who completed the same period of follow-up.RESULTS:Comparedwithpreoperation,TSSinpatientsofpost-operation was significantly improved(P<0.05).But compared with that of the control,there was a significant difference(P< 0.05). Besides,the levels of all the items in the group undergoing operation were significantly lower than that in the non-operative group (P< 0.05) after follow-up.CONCLUSION:The patients with moderate and severe stenosis,can not be radically cured by both of the operations.But to a certain degree the operations slow down the progress of valvular lesion.Considering long-term curative effect and post operative TSS downstream of residual stenosis that will cause the progressive aggravation of valvular lesion,we suggest that the general investigation of echocardiography should be popularized so that the disease can be early diagnosed, and that the operations should be advanced to early time of valvular lesion when there is no obvious leaflet lesion and subvalvular structures so as to eliminate thoroughly valvular stenosis and TSS.

参考文献/References

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[2] Nygaard H,Paulsen PK,Hasenkam JM,et al.Turbulent stresses downstream of three mechanical aortic valv eprostheses in human beings [J].J Thorac Cardiovasc Surg, 1994, 107:438.

[3] Hasenkam JM. Studies of velocity fields and turbulence downstream of aortic valve prostheses in vitro and in vivo [J].Danish Medical Bulletin,1990,37(3):235.

[4] Glower DD, White WD, Hatton AC, et al.Determinants of reoperation after 960 valve replacements with Carpentier Edwards prostheses [J]. J Thorac Cardiovasc Surg,1994,107(3):381.

[5] Hasenkam JM, Ringgaard S, Houlind K,et al.Prosthetic heart valve evaluation by magnetic resonance imaging [J].Eur J Cardiothorac Surg, 1999, 16 (3) : 300.

备注/Memo

备注/Memo:
收稿日期：2001-12-28.
更新日期/Last Update: 2003-03-01