中老年人左心瓣膜钙化的超声心动图分析

目的：了解中老年人左心瓣膜钙化的患病情况及其临床意义。方法：回顾分析2016例50岁以上中老年人群中超声心动图资料。结果：检出左心瓣膜钙化病252例（12．5％），其中女81例，男171例，且随年龄增长而增加，主动脉瓣受累率高（94．4％），临床中常合并高血压（30．2％）、冠心病（16．7％）、糖尿病（19％）及高脂血症（22．2％）。结论：性别、年龄、高血压、冠心病、糖尿病及高血脂症与左心瓣膜钙化有密切关系；左心瓣膜钙化是引起老年心衰和心律失常的重要因素。     

经胸及经食管超声对人工心脏机械瓣正常及病理性反流的对比研究

目的：评估经食管超声及彩色血流显像对人工机械瓣膜正常及病理性反流的诊断价值。方法：分析2004—05～2014—02期间经TTE及TEE检查的人工机械瓣资料完整的病例52例,男25例,女27例,平均年龄44．66-＋5．09岁,其中二尖瓣位置机械瓣置换数52个,主动脉瓣位置机械瓣置换数27个,双瓣置换的重叠病例18例。二尖瓣位机械瓣反流分级标准以反流口缩流宽度划分。主动脉瓣位机械瓣的偏心性反流分级标准以Jet宽／LVO宽度划分,瓣周漏分级以漏口彩色血流占瓣环周长比率划分。结果：（1）二尖瓣替换病人,1TrE显像诊断人工机械瓣二尖瓣正常及病理性反流的准确性为59．62％,低估率为28．85％,高估率为36．54％,漏检率为19．23％。（2）主动脉瓣替换病人,TTE诊断人工机械主动脉瓣正常及病理性反流的准确性为85．18％,低估率11．1％,高估率为14．81％。结论：TEE在评价人工机械瓣膜病理性反流方面尤其是对人工心脏机械瓣二尖瓣的评价优于经胸超声,起到了明确诊断的决定性作用。     

Live three-dimensional transesophageal echocardiography in mitral valve surgery

Background Live three-dimensional transesophageal echocardiography （live-3D-TEE） is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.
Methods Twenty-four patients with mitral valve disease （mean age （47.1±11.6） years, mean weight （64.7±10.5） kg） underwent live-3D-TEE and two dimensional transesophageal echocardiography （2D-TEE） before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon＇s findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.
Results Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases （12.5%） preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired （4.2%） using guidance by live-3D-TEE.
Conclusion Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery.     

心脏瓣膜置换术后机械瓣功能不全再次手术

目的对心脏瓣膜机械瓣发生功能不全的原因进行分析,讨论再次手术方法的选择。方法选择心脏瓣膜置换术后发生机械瓣膜功能不全的病人16例,对其手术资料及临床资料进行回顾性分析,手术种类包括二尖瓣置换术及主动脉瓣置换术．均为择期手术,对其发生功能不全的原因及再次手术方法进行汇总分析,并统计不同方法的救治成功率。结果本组患者再次手术的原因均为瓣环组织增生和血栓形成,其中包括机械瓣置换术9例,生物瓣置换术7例,机械瓣组死亡4例（44.44％）,生物瓣组死亡1例（14．28％）,两组比较差异具有显著性意义。结论对于瓣环组织增生和血栓形成引起的术后机械瓣功能不全,应用生物瓣进行再次手术的成功率较高。     

One year echocardiographic study of rheumatic heart disease at Enugu, Nigeria

BACKGROUND: Rheumatic heart disease is one of the commonest causes of heart disease in Nigeria. Previous studies on rheumatic heart disease in Nigeria were either clinical or retrospective echocardiographic studies. This study was aimed at determining the burden of chronic rheumatic mitral valve disease, pattern of valvular involvement, severity and associated valvular lesions, using echocardiography. PATIENTS AND METHODS: Between May, 2004 and April 2005, patients with symptomatic rheumatic heart disease, seen in the cardiac clinics of University of Nigeria Teaching Hospital, Enugu, were recruited for the study. The patients were investigated non-invasively with M-mode, Two-dimensional, Pulsed wave, Continuous wave and colour flow Doppler echocardiographic techniques in order to assess the mitral and other intracardiac valves for evidence of rheumatic heart disease. RESULTS: There were a total of 55 patients, 39 (70.9%) females and 16 (29.1%) males with a mean age of 29.34 +/- 11.57 years. Mitral valve disease was found in 54 (98.2%) and isolated aortic valve disease in 1 (1.8%) of cases. Mitral regurgitation occurred in 64.8%, mixed mitral valve disease in 25.9% and pure mitral stenosis in 9.3%. Mitral valve disease was associated with aortic valve disease in 33.3%, with tricuspid valve disease in 24.1% and with functional pulmonary incompetence in 9.3% of cases. CONCLUSION: Rheumatic heart disease in Nigeria is essentially a disease of the mitral valve as seen elsewhere in the world. Echocardiography should be done routinely for patients with rheumatic heart disease to facilitate accurate diagnosis and definitive treatment.     

老年人心脏瓣膜置换围术期处理（附123例分析）

目的总结老年人心脏瓣膜置换围术期处理经验。方法对本院123例接受心脏瓣膜置换60岁以上老年患者围术期处理的特点进行回顾性分析。结果二尖瓣置换66例,主动脉瓣置换39例,二尖瓣＋主动脉瓣置换15例,三尖瓣置换2例,同期进行其他手术共105例,早期死亡率8.9%（11/123）,并发症出现率41.5%（50/123）,晚期死亡3例,其中与心脏有关死亡1例,死于反复心力衰竭。随访6个月～14年,96例存活,失访13例,随访率88.4%（96/112）。结论重视老年人心脏瓣膜置换围术期的处理措施,合理的手术方法和心肌保护,可以减少围术期并发症,降低手术围术期的死亡率。     

心脏瓣膜直视手术后再次瓣膜手术155例分析

目的:总结直视下瓣膜成形术或人工瓣膜置换术后再次行瓣膜手术的临床资料和外科经验.方法:收集1996年1月至2010年10月的155例瓣膜直视手术后再次行瓣膜手术患者,包括各种瓣膜的再次单瓣置换术,双瓣置换术和三尖瓣成形术,以及瓣周漏修补术等.再次手术间隔1～266(94.82±85.37)月.手术均在中低温体外循环下,...     

冠心病合并二尖瓣返流的二尖瓣成形术104例临床分析

目的:回顾分析同期行二尖瓣成形和冠状动脉搭桥术的临床经验。方法:104例病人中男性60例,女性44例。冠状动脉单支病变6例,左主干病变7例,双支病变40例,三支病变58例。合并室壁瘤7例,室间隔穿孔4例,主动脉瓣病变7例。均在全麻体外循环下行冠状动脉旁路手术同时行二尖瓣成形手术,同期行主动脉瓣置换术5例,三尖瓣成形手术26例,室壁瘤切除3例,室间隔穿孔修补4例,冲洗射频迷宫消除房颤术1例。冠状动脉搭桥平均(3.33±1.5)支(1-6支)。结果:死亡1例(0.96%),术后随访二尖瓣返流0-Ⅰ级78例(75%),Ⅱ级23例(22.1%),Ⅲ级3例(2.9%)。结论:冠状动脉搭桥术同期二尖瓣成形手术效果良好,近期效果满意。     

Low standard oral anticoagulation therapy for Chinese patients with St.Jude mechanical heart valves

Objective To study the efficacy of the low standard oral anticoagulation therapy following St Jude Medical (SJM) valve implantation for Chinese patients.Methods Totally 805 patients with a mean age of 42.70±11.09 years, enrolled into this study. Among them, 230 underwent aortic valve replacements (AVR), 381 mitral valve replacements (MVR), 189 double valve replacements (DVR) and 5 tricuspid valve replacememts (TVR). All patients received postoperative oral anticoagulation therapy based on a low standard of international normalized ratio (INR, 2.0-2.5). Of the 805 patients, 710 were followed up for 0.25-13 years (a median, 4.15 years). Results Postoperatively, 17 adverse events occurred. Operative mortality was 2.11%. The most frequent cause of operative mortality was a low cardiac output. During follow-up, there were 47 anticoagulant-induced hemorrhages ［1.59%/patient-year (pt-yr)］, 10 cases of thromboembolism (0.34%/pt-yr), and 3 mechanical valve thromboses (0.19%/pt-yr). There were 44 late deaths and the linearized late mortality rates were 0.51%pt-yr. Estimates of actuarial survival for all patients at 5 and 10 years was 97.45% (0.70%) and 77.96% (17.44%), respectively.Conclusions A low target INR range of 2.0-2.5 is preferable for Chinese patients so as to reduce the severe bleeding complications in those with conventionally higher levels of INR. The long-term results were satisfactory in terms of the numbers of those who suffered thrombosis, embolism and bleeding.     

External valvuloplasty technique in deep venous valve insufficiency of the lower limbs

ＶｅｎｏｕｓｒｅｆｌｕｘｄｉｓｅａｓｅｏｆｔｈｅｌｏｗｅｒｌｉｍｂｓｉｓｔｈｅｃｏｍｍｏｎｖｅｎｏｕｓｄｉｓｅａｓｅｉｎＣｈｉｎａａｎｄｒｅｓｕｌｔｓｆｒｏｍｃｏｎｇｅｎｉｔａｌｖａｌｖｕｌａｒａｐｌａｓｉａａｎｄｄｙｓｐｌａｓｉａ,ｃｒｙｐｔｏｇｅｎｉｃ（ｐｒｉｍａｒｙ）ｖａｌｖｅｉｎｓｕｆｆｉｃｉｅｎｃｙ,ａｎｄｐｏｓｔｔｈｒｏｍｂｏｔｉｃ（ｓｅｃｏｎｄａｒｙ）ｖａｌｖｅｉｎｓｕｆｆｉｃｉｅｎｃｙＰｒｉｍａｒｙｖａｌｖｅｉｎｓｕｆｆｉｃｉｅｎｃｙｈａｓｂｅｅｎｒｅａｌｉｚｅｄａｓｔｈｅｍ…     

Hypertension in aortic valve disease and its response to valve replacement.

We have investigated the prevalence of hypertension and the response of blood pressure to operation in 87 patients with lone aortic valve disease who underwent aortic valve replacement. In patients with aortic stenosis alone 26% were hypertensive pre-operatively (age and sex adjusted blood pressure greater than 160 systolic and or greater than 95 mmHg diastolic) and 24% were hypertensive post-operatively. In those with aortic regurgitation alone, hypertension was present in 65% before and 57% after valve replacement using the same criterion. For combined stenosis and regurgitation, the prevalence was 54% and 62%, respectively. The post-operative increase in systolic pressure in patients with aortic stenosis occurred mainly in those with a history of left ventricular failure. In those with aortic regurgitation or combined stenosis with regurgitation, diastolic pressure rose after valve replacement resulting in a prevalence of diastolic hypertension of 44% and 35%, respectively. Blood pressure changes were not predicted by the type of valve inserted nor its size. Our data show that despite severe symptomatic aortic valve disease, systolic hypertension was common in aortic stenosis and diastolic hypertension was found in aortic regurgitation. This underlines the importance of blood pressure monitoring in patients following aortic valve replacement.     

二尖瓣-主动脉瓣置换术近期和远期效果的评价

目的 :评价单瓣与双瓣置换术的近期与远期效果。方法 :70例风湿性心脏病人采用国产上海碟瓣行机械瓣置换术 ,其中单纯行二尖瓣 (MV)置换术者 47例 ,二尖瓣加主动脉瓣 (AV)双瓣置换术者 2 3例。生存者 10 0 %随访 1～ 7年 (平均 4.76± 1.7年 )。结果 :院内死亡 4例 ,死亡率为 5 .71%。随访中死亡 2例 ,远期死亡率为 0 .63 %人·年。 7年生存率为 95 .69% ,10年生存率为 93 .89%。 94.0 0 %术后心功能均改善Ⅰ～Ⅱ级。结论 :房颤 (Af)并Ⅱ度房室传导阻滞的病人应暂缓手术 ;国产上海碟瓣有良好的血流动力学特性 ;只要处理恰当 ,双瓣手术的危险性不比单瓣手术的危险性高。     

Hemodynamic evaluation and morphological changes of right ventricular out-flow tract and pulmonary valve after balloon pulmonary valvuloplasty

Balloon pulmonary valvuloplasty (BPV) was attempted in 38 cases of congenital pulmonary valve stenosis. It was effective and was done without complication in 36 cases, however it was not effective in two cases of pulmonary valve dysplasia. The balloon used was 20-50% larger in diameter than the pulmonary valve annulus. In the seven cases in which the transvalvular pressure gradient was above 100 mmHg on cardiac catheterization, right ventriculography demonstrated that the functional obstruction of the right ventricular outflow tract increased immediately after BPV, however it subsequently improved at one year after the procedure. At between one and three months after BPV, two-dimensional echocardiography demonstrated that the morphological obstruction to the right ventricular outflow tract had diminished. In two cases, localized right ventricular septal hypertrophy with severe pulmonary valve stenosis was observed by two-dimensional echocardiography and right ventriculography, and persisted at one year. In all cases, two-dimensional echocardiography and angiography demonstrated doming pulmonary valves with valve stenosis, which was diminished by BPV. The pulmonary valve morphology was observed by two-dimensional echocardiography in three cases following BPV. In one case, partial relief of pulmonary valve obstruction was seen to be due to commissural splitting and in the other two, to tearing of cusp tissue. Inspection of the pulmonary valve at operation was made in one case who underwent elective surgery for repair of an atrial septal defect which was associated with pulmonary valve stenosis. It demonstrated partial relief of pulmonary valve stenosis by tearing of cusp tissue. In conclusion, BPV is as effective a treatment for congenital pulmonary valve stenosis as open valvulotomy. In our follow-up study, it has shown no apparent complications. The transient obstruction in the right ventricular outflow tract immediately after BPV improved within one month and improved further after three months and one year. However, in the more long-standing cases the localized right ventricular septal hypertrophy persisted and these cases will require, a long term follow-up.     

瓣膜支架上种植内皮细胞的离体研究

目的研究人工培养的内皮细胞在瓣膜支架上的生长情况及黏附力。方法脐带静脉内皮细胞在体外培养扩增，将培养的内皮细胞种植在经激光处理的瓣膜支架上，培养2，4，6，8d后扫描电镜观察内皮细胞在瓣膜支架上的生长情况；并进行剪切力试验，观察内皮细胞的黏附力。结果培养8d后，内皮细胞可在瓣膜支架上形成细胞单层，经模拟血流冲击后，仍有部分内皮细胞粘附在瓣膜支架表面。结论体外扩增内皮细胞种植瓣膜支架是一种可行的方法。     

不同类型人工心脏瓣膜在感染性心内膜炎合并瓣膜毁损患者中的应用比较

目的 比较不同人工瓣膜类型（人工生物瓣和人工机械瓣）对感染性心内膜炎合并瓣膜毁损患者围术期及术后远期临床结局的影响。方法 回顾性分析2005年8月至2016年7月在四川大学华西医院行人工瓣膜置换术的患者的临床资料,纳入接受人工生物瓣置换的全部感染性心内膜炎合并瓣膜毁损的患者52例,平均年龄（47±18）岁,平均随访时间（6.2±3.8）年,按年龄±5岁、体质量指数±20%、病变瓣膜位置、男女比例、手术时间±1年等配对条件以1∶3频数匹配接受人工机械瓣置换的同类患者156例。比较分析人工生物瓣与机械瓣对感染性心内膜炎合并瓣膜毁损患者围术期及远期临床结局的影响。结果 接受生物瓣置换及机械瓣置换患者的围术期死亡率分别为17.3%±2.2%和19.9%±1.8%（P=0.27）。两类患者术后10年生存率分别为56.1%±5.2%和61.2%±8.1%（P=0.58）,术后10年无并发症生存率分别为75.0%±3.2%和82.3%±4.4%（P=0.29）。年龄≤60岁的感染性心内膜炎患者,人工生物瓣与机械瓣术后10年再手术率分别为41.4%±7.2% 和30.5%±5.4%（P=0.02）,而对年龄＞60岁的感染性心内膜炎患者,人工生物瓣与机械瓣的术后10年再手术率分别为24.1%±8.5%和14.7%±5.7%（P=0.36）。结论 人工瓣膜类型对感染性心内膜炎合并瓣膜毁损患者围术期死亡率及术后远期生存率无明显影响。人工机械瓣膜在年龄≤60岁感染性心内膜炎患者中术后远期再手术率相比人工生物瓣膜更低。     

经食管三维超声在二尖瓣成形术中的应用

目的 探讨经食管实时三维超声心动图（RT3D-TEE）在二尖瓣成形术中的应用价值。方法 18 例 拟行二尖瓣成形术的二尖瓣脱垂患者,术前及术后即刻均接受RT3D-TEE 检查。术前观察二尖瓣脱垂的三 维特征及小叶区域,与外科术中所见对照;术后即刻评估二尖瓣成形的手术效果,比较手术前后二尖瓣的对合 高度、瓣环周长和反流面积。结果 RT3D-TEE 显示二尖瓣脱垂的三维图像与外科视野所见高度一致,术前诊 断脱垂小叶的敏感性、特异性分别为96.00%、100.00%。18 例患者中有2 例转行二尖瓣置换术,其余16 例 成功完成二尖瓣成形术。RT3D-TEE 观察术后二尖瓣叶及人工瓣环的形态良好,二尖瓣反流程度明显改善。 二尖瓣的对合高度较术前增加,瓣环周长、反流面积较术前减少,差异有统计学意义（t =-13.556,37.789 和 20.847,均P =0.000）。结论 RT3D-TEE 能清晰显示二尖瓣的三维形态,术前准确诊断脱垂小叶及术后即刻评 估手术效果,在二尖瓣成形术中发挥重要的作用。     

颈动脉粥样硬化与老年退行性心脏瓣膜病的相关性研究

目的：通过高频超声对老年患者颈动脉及超声心动图检查,探讨颈动脉粥样硬化与老年退行性心脏瓣膜病的相关性。方法：选择88例老年退行性心脏瓣膜病患者作为研究组,49例无老年退行性心脏瓣膜病患者作为对照组。检测并比较2组患者二尖瓣和主动脉瓣情况、颈动脉内-中层厚度（IMT）及颈动脉粥样硬化斑块情况。结果：研究组患者IMT、斑块积分、斑块检出率均高于对照组（P〈0.05~P〈0.01）。研究组管腔闭塞率2.27%,管腔狭窄率90.91%;对照组无管腔闭塞,管腔狭窄率18.37%;2组患者管腔闭塞率差异无统计学意义（P=0.573）,研究组患者管腔狭窄率明显高于对照组（P〈0.01）;研究组合并冠心病、高血压、糖尿病及高脂血症率均明显高于对照组（P〈0.01）。结论：颈动脉粥样硬化与老年退行性心脏瓣膜病变有密切关系,颈动脉粥样硬化程度随心脏瓣膜钙化程度的加重而加重,对于老年退行性心脏瓣膜病患者应行颈动脉超声检查。     

Analysis of risk factors for valve replacements in 5128 cases from a single heart center in China

Background Numerous studies have developed a ＂severity score＂ or ＂risk index＂ for short-term mortality associated with coronary artery bypass grafting （CABG）. Due to the different distribution of disease types, the number of valve surgeries in the US and Europe is relatively small. Thus, a risk-scoring system for valve surgeries was developed later and used less than that for the CABG surgery. We retrospectively reviewed 5128 cases of heart valve replacement, to quantitatively assess the risk factors for hospital mortality, and establish risk models for the hospital mortality of cardiac valve replacement patients.Methods A total of 1549 cases of aortic valve replacement, 2460 cases of mitral valve replacement, and 1119 cases of combined aortic valve and mitral valve replacement that were recorded from January 2005 to December 2009 in the cardiac surgery database at Beijing Anzhen Hospital were selected for this study. The cases were randomly assigned to a indicators were selected as possible influencing factors for hospital mortality. Single-factor analysis was performed to screen these factors, and then multi-factor analysis was used to determine the risk factors for hospital mortality in the three surgeries and to establish risk models.Results In the multi-factor analysis, age, body surface area, etiology, cardiopulmonary bypass time, preoperative cardiothoracic ratio, cardiac functional classification, and preoperative creatinine were risk factors for aortic valve replacement. Etiology, preoperative history of heart failure, cardiopulmonary bypass time, preoperative cardiothoracic ratio, and preoperative left ventricular end systolic diameter were risk factors for mitral valve replacement. Age, body mass index, cardiopulmonary bypass time, and cardiac function classification were risk factors for combined aortic valve and mitral valve replacement. The risk models showed good predictive ability （Hosmer-Lemeshow test： P=0.981 in the model for aortic valve replacement, P=0.503 in the model for mitral valve replacement, and P=0.154 in the model for combined aortic valve and mitral valve replacement）. The area under the ROC curve of the validation group was 0.958 （95% CI： 0.936-0.975） for the aortic valve replacement model, 0.876 （95% CI： 0.805-0.948） for the mitral valve replacement model, and 0.845 （95% CI： 0.753-0.939） for the combined aortic valve and mitral valve replacement,indicating that the risk models were good in predicting hospital mortality for surgeries.Conclusion The three risk models can quantitatively assess the hospital mortality risk in the patients treated with cardiac valve replacement.     

冠脉搭桥、瓣膜置换术同期实施超声消融术治疗心房颤动

目的对于行冠状动脉旁路移植或瓣膜置换术伴有心房颤动的病人同期实施经心外膜途径的超声消融术治疗房颤的治疗效果进行随访总结。方法选择房颤病史〉6个月的89名病人,其中永久性房颤67人,阵发性房颤22人,所有病人需同期实施冠状动脉旁路移植术或瓣膜手术。首先在心脏跳动下,应用Epico Cinch装置行经心外膜途径围绕肺静脉的房颤超声消融术,随后采用EpicoWand装置在肺静脉环形消融线与二尖瓣环之间附加一条消融线,然后行冠状动脉旁路移植术、瓣膜置换术或瓣膜成形术。结果术后6～12个月随访时,房颤治愈率为83%,其中永久性房颤的治愈率为78%,阵发性房颤的治愈率为100%。房颤的治愈率与房颤病史长短及房颤的类型有关。结论在心脏跳动下经心外膜途径的超声消融术对于冠心病和瓣膜病等器质性心脏病所合并的心房颤动是一种安全可行、简便有效的治疗方法。     

自膨式带瓣膜主动脉瓣支架对冠脉影响的体外研究

目的 探讨自膨式带瓣膜主动脉瓣支架(瓣膜支架)行体外原位主动脉瓣置换后对冠状动脉的影响.方法 采用12只离体小香猪的升主动脉,经冠脉流量测试系统测得基础的左右冠脉流量(基础流量)、瓣膜支架植入后的冠脉流量(保留瓣膜组)及去除正常瓣膜后再次植入支架的左右冠脉流量(去除瓣膜组),并结合内窥镜检查及解剖观察支架及冠脉开口的情况.结果 保留瓣膜组左冠流量较基础流量明显较少(29.46%, P<0.05),右冠流量虽有所减少,但差异无统计学意义(P>0.05).去除瓣膜组左右冠脉流量较基础流量有所减少(左冠6.82%,右冠5.37%),但差异均无统计学意义(P>0.05),左冠流量较保留瓣膜时明显改善(32.09%,P<0.05).解剖发现左冠开口相对较低.内窥镜检查发现,在保留瓣膜组正常主动脉瓣瓣叶被支架压向侧壁,造成左冠开口完全阻塞3只,部分阻塞4只,右冠开口部分阻塞3只.两组中共见5只瓣膜支架的瓣脚影响冠脉开口,使其部分阻塞,其中左冠4只,右冠1只.结论 该自膨式瓣膜支架行原位主动脉瓣植入后,被压向侧壁的瓣叶易使左冠开口阻塞.同时瓣膜支架的瓣脚有时也会部分影响冠脉流量.