| 摘要: |
| 人工心脏瓣膜-患者不匹配是指植入瓣膜的有效开口面积相对于患者体型过小,术后残留明显的跨瓣压差进而影响患者预后。目前认为术后经胸超声测得的瓣膜有效开口面积指数是唯一可准确描述该现象的指标。各类瓣膜的有效开口面积差异较大,其不匹配发生率亦不相同。近年来介入置换主动脉瓣后的不匹配现象亦日益为人们所重视。人工瓣膜不匹配的临床意义目前争议仍较大。由于描述指标,定义标准及其他混杂因素不同,加之患者年龄、术前心功能状态、瓣膜病变类型等因素对其意义的影响,既往很多研究结论出入较大。左心功能不良及非高龄患者受其不良影响更为显著。手术时选用型号合适的瓣膜或在必要时实施根部拓宽术可有效预防不匹配的发生,具体采用何种策略须根据患者情况权衡利弊,但重度不匹配及心功能不良者的不匹配应尽力避免。本文就人工心脏瓣膜-患者不匹配现象近年来的研究进展作一综述。 |
| 关键词: 瓣膜-患者不匹配 人工心脏瓣膜 心脏瓣膜植入术 |
| DOI：10.3724/SP.J.1008.2011.0443 |
| 投稿时间：2010-12-10修订日期：2011-03-10 |
| 基金项目: |
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| Prosthesis-patient mismatch: recent progress |
| TAN Meng-wei,GUO Long,XU Zhi-yun* |
| (Department of Thoracic and Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China) |
| Abstract: |
| Prosthesis-patient mismatch occurs when the effective orifice area of the prothesis is too small according to the patient’s body size after insertion, which may consequently result in consistent presence of significant residual transvalvular pressure gradients postoperatively, hampering the prognoses of patients. Currently the indexed effective orifice area measured by postoperative transthoracic echocardiography is considered the only appropriate parameter which can accurately describe the mismatch. Valves of various types can have very different indexed effective orifice areas, so the incidence of mismatch also varies. Recently, the mismatch following transcatheter aortic valve implantation is drawing increasing attention. The clinical implication of prosthesis-patient mismatch is still debated. Many factors, including the indices, standard and other mixing factors, together with the age, preoperative cardiac function and types of valve disease of patients can be related to the mismatch, the previous conclusions have been various. Prosthesis-patient mismatch may cause a greater influence to patients with left heart dysfunction and young patients. It can be largely prevented by choosing prostheses of appropriate size or by enlarging the aortic root by operation if necessary; a final decision should be made according to the patients’ condition. Severe mismatch and mismatch in patients with severe cardiac dysfunction should be avoided. In this paper we reviews the recent progress on prosthesis-patient mismatch. |
| Key words: prosthesis-patient mismatch heart valve prosthesis heart valve prosthesis implantation |
