主动脉瓣重度狭窄伴左心室收缩功能受损患者的外科疗效分析

目的分析主动脉瓣置换术在治疗主动脉瓣重度狭窄伴左心室收缩功能受损患者中的疗效。方法回顾性分析2000年1月至2011年12月在第二军医大学长海医院接受手术治疗的主动脉瓣重度狭窄伴左心室收缩功能受损左心室射血分数（LVEF）〈50％]患者的临床资料，排除二尖瓣狭窄患者。共纳入29例患者，男22例、女7例，年龄14～76（56.3±12．9）岁。将患者手术前后临床及心脏超声心动图相关指标进行比较，评价手术效果，并根据患者LVEF恢复情况，分析可能影响患者术后心脏功能恢复的危险因素。结果术后早期死亡1例。其余28例患者术后主动脉瓣跨瓣压差由（97．6±25．1）mmHg降至（25．0±9．7）mmHg，LVEF由41％±6％增加至56％±11％，左心室舒张／收缩期末直径／容积均较术前明显改善（P均〈0．001）。结论主动脉瓣膜置换术是主动脉瓣重度狭窄伴左心室收缩功能受损患者的有效治疗方法，术后左心室超声指标显著改善。术前左心室扩大程度较低可能更利于术后LVEF的恢复。

Clinical Outcomes of Aortic Valve Replacement for Surgical Treatment of Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction

Objective To investigate clinical outcomes of aortic valve replacement （AVR） for surgical treatment of patients with severe aortic stenosis （AS） and left ventricular dysfunction （LVD）. Methods Clinical data of 29 patients with severe AS and LVD （ left ventricular ejection fraction （LVEF） 〈 0.50 ） who underwent AVR in Changhai Hospital between January 2000 and December 2011 were retrospectively analyzed. Patients with mitral stenosis were excluded from this study. There were 22 male and 7 female patients with their age of 14-76 （ 56.3 ± 12.9 ） years. Preoperative and postoperative clini- cal and echocardiographic findings were compared to assess AVR effects. Possible risk factors affecting postoperative recovery of left ventricular function were analyzed according to postoperative LVEF changes. Results One patient died within 30 days after AVR. In the other 28 patients, postoperative aortic pressure gradient （APG） decreased from 97.6 ± 25.1 mm Hg to 25.0± 9.7 mm Hg, while LVEF increased from 41% ± 6% to 56% ±11%. Postoperative left ventricular enddiastolic/systolic diameter/volume all significantly improved （all P 〈 0.001 ）. Conclusions AVR is an effective treatment for patients with severe AS and LVD. Left ventricular function improves significantly in most patients after AVR. Patients with a less dilated left ventricle may have a better LVEF recovery.