Hemodynamic Evaluation of St. Jude Medical Aortic Valve Prostheses Using Dobutamine Stress Echocardiography

使用Dobutamine壓力心臟超音波於St. Jude Medical人工主動脈辦之血液動力學評估

王致皓(Chih-Hao Wang) ； 李聰明(Tsung-Ming Lee) ； 蔡長和(Chang-Her Tsai)

《Acta Cardiologica Sinica》 19卷4期 (2003/11) Pp. 229-236

摘要

背景：小尺寸之人工主動脈辦與trans-prosthetic pressure gradient過高被認為造成病人與人工主動脈辦之不適合有關，本研究主要評估不同尺寸之人工主動脈辦病人之血液動力學。
方法：使用dobutamine輸液於39位已植入St. Jude Medical 21-,23-,25-,毫米尺寸之人工主動脈辦之病人，dobutamine壓力採漸進式輸從5 µg/kg/min開始，每15分鐘，分別增加到10，及20 µg/kg/min，於病人休息及dobutamine壓力之時，使用脈衝波及連續波杜普樂心臟超音波測量並計算血液動力學之各項參數。
結果：在dobutamine輸液反應之下，平均血壓、心跳速率及心縮量分別增加14%、50%及52%，就21-,23-,25-毫米人工主動脈辦之peak trans-prosthetic pressure gradient分別由休息時之32.7±12.3,23.8±5.9,20.6±5.8毫米汞柱增加到75.3±20.3,57.2±23.1,51.2±20.8毫米汞柱，利用ANOVA分析發現在21-毫米人工主動脈辦不論休息或是壓力下，有顯著較高之peak trans-prosthetic pressure gradient (p值分別 ＝0.04, 0.03)，但是3種尺寸之人工主動脈辦不論休息或壓力下都有相似之effective orifice area index, discharge coefficient performance index (p值 ＞ 0.05)。
結論：雖然值入St. Jude Medical 21-毫米人工主動脈辦之病人不論休息或壓力下都有較高之peak trans-prosthetic pressure gradient，但effective orifice area及effective orifice area index與23-,25-毫米者不相上下。

關鍵字

人工主動脈辦 ； Dobutamine壓力 ； 心臟超音波

並列摘要

Background: Small-sized mechanical aortic prostheses are proposed to be associated with high trans-prosthetic gradients and consequent patient-prosthesis mismatch. This study aimed to assess the hemodynamic performance of patients with St. Jude aortic mechanical prostheses of various sizes.
Methods: Dobutamine infusion was performed in 39 patients with three different sizes of St. Jude Medical aortic prostheses. A graded infusion of dobutamine was administered at increments of 5, 10, and 20 µg/kg/min at 15-minute intervals. Pulse-wave and continuous-wave Doppler echocardiograms were performed at rest and stress. Hemodynamic parameters were measured and calculated.
Results: In response to dobutamine infusion, mean blood pressure, heart rate and cardiac output were increased by 14%, 50%, and 52%, respectively, at maximum stress. Dobutamine stress produced a similar increase in cardiac output in patients with 21-, 23-, and 25-mm, aortic prostheses. Peak trans-prosthetic pressure gradient of 21-, 23-, and 25-mm prostheses increased from 32.7±12.3, 23.8±5.9, and 20.6±5.8mm Hg, respectively, at rest to 75.3±20.3, 57.2±23.1, and 51.2±20.8 mm Hg, respectively, at maximum stress. Using one-way ANOVA, significantly higher peak trans-prosthectic pressure gradient was shown in 21-mm aortic prostheses at rest and maximum stress (p = 0.004, and 0.03 respectively). Effective orifice area index, discharge coefficient, and performance index were comparable in the three valve sizes at rest and maximum stress (all p values ＞ 0.05).
Conclusions: St. Jude Medical 21-mm prosheses carriers had higher peak trans-prosthetic pressure gradients at rest and stress but had comparable effective orifice area and effective orifice area index.

並列關鍵字

aortic valve prostheses ； dobutamine stress ； echocardiography