■患有主动脉瓣反流(AR)的双叶主动脉瓣(AV)患者与年龄较小的三尖瓣AV患者不同,大左心室(LV)顺应性,和更普遍的主动脉瓣狭窄(AS)。缺乏指导房室置换或修复时机的双尖瓣房室特异性数据。
■研究了在我们中心接受主动脉瓣置换或修复的患有二尖瓣房室和中度或中度以上AR的成年人。术前超声心动图,术后3年内的超声心动图评估左心室几何结构/功能,和AV功能。在所有具有足够影像学的患者中进行半定量AS/AR评估。
■一百三十五名患者(85%的男性,年龄44.5±15.9岁)进行了研究(63%的纯AR,37%混合AS/AR)。主动脉瓣置换或修复后,左心室舒张末期内径的变化和左心室舒张末期容积的变化与术前左心室舒张末期内径相关(β=0.62Δcm/cm;95%CI,0.43-0.73Δcm/cm;P<.001),和左心室舒张末期容积(β=0.6ΔmL/mL;95%CI,0.4-0.7ΔmL/mL;P<.001),分别,每个独立于AR/AS严重程度(P=不显著)。基线左心室大小预测术后正常化(左心室舒张末期尺寸:比值比,3.75/cm;95%CI,1.61-8.75/cm,左心室舒张末期容积:比值比,1.01/mL;95%CI,1.004-1.019/mL,两个P值<0.01),而AR/AS严重程度没有(P=不显着)。在预测术后LV正常化(曲线下面积=0.74vs0.61)时,左心室舒张末期容积指数优于左心室舒张末期尺寸,最佳诊断临界值为99mL/m2和6.1cm,分别。术后指数化左心室舒张末期容积扩张与死亡风险增加相关,移植/心室辅助装置,室性心律失常,和再操作(危险比,6.1;95%CI,1.7-21.5;P<0.01)。
■二尖瓣房室和AR患者术后重塑程度与术前左心室大小相关,与瓣膜疾病表型或严重程度无关。许多左心室舒张末期尺寸低于当前手术阈值的患者并未使左心室尺寸正常化。左心室体积评估为预测残余左心室扩张提供了卓越的诊断性能,术后指数LV舒张末期容积扩张与不良预后相关。
UNASSIGNED: Bicuspid aortic valve (AV) patients with aortic regurgitation (AR) differ from tricuspid AV patients given younger age, greater left ventricle (LV) compliance, and more prevalent aortic stenosis (AS). Bicuspid AV-specific data to guide timing of AV replacement or repair are lacking.
UNASSIGNED: Adults with bicuspid AV and moderate or greater AR who underwent aortic valve replacement or repair at our center were studied. The presurgical echocardiogram, and echocardiograms within 3 years postoperatively were evaluated for LV geometry/function, and AV function. Semiquantitative AS/AR assessment was performed in all patients with adequate imaging.
UNASSIGNED: One hundred thirty-five patients (85% men, aged 44.5 ± 15.9 years) were studied (63% pure AR, 37% mixed AS/AR). Following aortic valve replacement or repair, change in LV end-diastolic dimension and change in LV end-diastolic volume were associated with preoperative LV end-diastolic dimension (β = 0.62 Δcm/cm; 95% CI, 0.43-0.73 Δcm/cm; P < .001), and LV end-diastolic volume (β = 0.6 ΔmL/mL; 95% CI, 0.4-0.7 ΔmL/mL; P < .001), respectively, each independent of AR/AS severity (P = not significant). Baseline LV size predicted postoperative normalization (LV end-diastolic dimension: odds ratio, 3.75/cm; 95% CI, 1.61-8.75/cm, LV end-diastolic volume: odds ratio, 1.01/mL; 95% CI, 1.004-1.019/mL, both P values < .01) whereas AR/AS severity did not (P = not significant). Indexed LV end diastolic volume outperformed LV end-diastolic dimension in predicting postoperative LV normalization (area under the curve = 0.74 vs 0.61) with optimal diagnostic cutoffs of 99 mL/m2 and 6.1 cm, respectively. Postoperative indexed LV end diastolic volume dilatation was associated with increased risk of death, transplant/ventricular assist device, ventricular arrhythmia, and reoperation (hazard ratio, 6.1; 95% CI, 1.7-21.5; P < .01).
UNASSIGNED: Remodeling extent following surgery in patients with bicuspid AV and AR relates to preoperative LV size independent of valve disease phenotype or severity. Many patients with LV end-diastolic dimension below current surgical thresholds did not normalize LV size. LV volumetric assessment offered superior diagnostic performance for predicting residual LV dilatation, and postoperative indexed LV end diastolic volume dilatation was associated with adverse prognosis.