方法文章

经食管超声心动图在心脏手术中无创地测定涡旋形成时间

DOI：

10.3791/58374

⸱

2018年11月28日

 ,  ,  ,  ,  ,  ,  ,  ,  , 
1Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, 2Department of Anesthesiology, Medical College of Wisconsin

本文内容

摘要

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

我们描述了一个协议来测量涡流形成时间, 左心室充盈效率的指标, 使用标准的经食管超声心动图技术在心脏手术患者。我们应用这项技术来分析不同心脏病变的几组患者的涡旋形成时间。

摘要

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

经二尖瓣血流产生三维旋转的流体体, 称为涡环, 与连续线性射流相比, 提高了左心室填充的效率。涡旋环的发展最常用的是涡旋形成时间 (vft), 这是一个基于刚性管的流体喷射的无量纲参数。我们的小组对影响心脏手术期间 lv 灌装效率的因素感兴趣。在本报告中, 我们描述了如何使用标准二维 (2d) 和多普勒经食管超声心动图 (tee), 以非侵入性推导计算 vft 所需的变量。我们计算了心房充盈分数 (β) 的速度-时间积分的反二尖瓣早期 lv 充盈和心房收缩血流速度波形测量在中食管四室 tee 视图。行程体积 (sv) 计算为 lv 流出轨迹直径的乘积, 在中食管长轴 tee 视图中测量, 并在深经胃视图中使用脉冲波确定的流出轨迹的血流速度-时间积分多 普 勒。最后, 确定二尖瓣直径 (d) 为分别在正交食管中双轴和长轴成像平面上测量的主轴长度和小轴长度的平均值。然后将 vft 计算为 4x (1-β) xsv/(d 3)。我们已经使用这种技术来分析 vft 的几个组不同的心脏异常患者。我们讨论了我们在这一技术上的应用及其潜在的局限性, 并回顾了我们迄今的结果。在接受心脏手术的麻醉病人中, 使用 tee 进行 vft 无创测量是很简单的。该技术可以让心脏麻醉师和外科医生实时评估病理条件和手术干预对 lv 灌装效率的影响。

引言

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

流体力学是左心室 (lv) 充盈的一个关键但往往不被重视的决定因素。当流体穿过孔 1、2、3时, 就会产生一个三维旋转的流体体, 称为涡旋环.与连续线性射流4相比, 该涡流环提高了流体输运效率。在早期 lv 灌装过程中, 血液通过二尖瓣的运动会导致涡环形成5、6、7、8, 并通过保持流体动量和动能9。这些行动提高了 lv 灌装效率4、10、11、12、13。环不仅抑制血流停滞在 lv先端 14,15,16, 17, 但也引导流动优先下的前二尖瓣小叶7,18、分别降低顶部血栓形成风险、促进 lv 流出轨道19的充填效果。对比超声心动图17, 多普勒矢量血流映射6,20, 21, 磁共振成像7, 和粒子成像测速9,22 23,24已被用来证明在正常和病理条件下反二尖瓣涡旋环的外观和行为。左心房-lv 压力梯度、舒张二尖瓣环状偏移程度、舒张期最小 lv 压力以及 lv 松弛的速率和程度是决定其持续时间、大小、流量强度和位置的四个主要因素。反二尖瓣环2,12,25,26,27, 28, 29.

涡旋环发育最常用的量化与无量纲参数 (涡旋形成时间;vft) 基于刚性管3的流体喷射, 其中 vft 被定义为时间平均流体速度和喷射持续时间除以孔直径的乘积。当 vft 在体外为4时, 涡旋环的最佳尺寸是由, 因为尾随射流和能量限制使其无法达到较大的大小3,4。二尖瓣 vft 已近似临床使用经胸超声心动图8,30,31。基于对反式二尖瓣血流速度和二尖瓣直径 (d) 的分析, 可以很容易地显示8 , vft = 4x (1-β) xefxxxxα3, 其中β = 心房充盈分数, ef = lv 射血分数, 和α= edv \/d, 其中 edv =终末期舒张量。弹射分数是行程体积 (sv) 和 edv 的比率, 允许将该方程简化为 vft = 4x (1-β) xsv2 (d3)。由于 vft 是无量纲的 (体积/体积), 因此该指数允许在不调整体重或体表面积8的情况下直接比较不同大小的患者。在健康受试者8中, 最佳 vft 范围在3.3 到5.5 之间, 结果与流体动力学模型3,32中获得的结果一致。vft 在抑郁的 lv 收缩期功能患者中被证明是≤2.0, 这一发现也得到了理论预测8的支持.vft 的减少独立预测心力衰竭患者的发病率和死亡率30。lv 后负荷升高33, 阿尔茨海默氏症34, 舒张功能异常 19, 用假体35取代原生二尖瓣也被证明可以降低 vft。vft 的测量也可用于识别急性心肌梗死患者的血流淤积或血栓形成 36,37.

我们的小组对影响心脏手术期间 lv 灌装效率的因素感兴趣38,39,40,41。我们使用标准的二维和多普勒食管超声心动图 (tee), 非侵入性地推导出计算 vft 所需的变量。在本报告中, 我们详细介绍了这一方法, 并回顾了我们迄今的调查结果。

访问受限。请登录或开始试用以查看此内容。

方案

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

克莱门特·扎布洛基退伍军人事务医疗中心机构审查委员会批准了这些协议。由于在我们机构接受心脏手术的所有患者中, 通常都会使用侵入性心脏监测和 tee, 因此放弃了书面知情同意。对 tee 有相对或绝对禁忌症的患者、正在接受重复中位胸骨切开术或急诊手术的患者以及有心房或室性心律失常的患者被排除在参与之外。

1. 麻醉

  1. 为每位患者提供静脉注射咪唑安定 (1 至3毫克) 和芬太尼 (50 至150微克), 以便在手术前进行有意识的镇静。
  2. 使用局部麻醉 (皮下1% 利多卡因) 插入静脉和径向动脉导管。用针刺测试局部麻醉的质量。
  3. 确保患者使用鼻腔插管 (2 至 4 lmmin) 获得补充氧气。
  4. 在无菌条件下, 通过右或左颈内静脉, 在适当临床适应症的超声指导下, 使用局部麻醉 (皮下1% 利多卡因) 放置中心静脉或肺动脉导管。
  5. 使用静脉注射芬太尼 (5 mcgkg)、异丙酚 (1 至 2mgskg) 和罗库溴铵 (0.1 mg kg) 进行麻醉。在空气-氧混合物、芬太尼 (1 至 2μgg h) 和滴定的 rocuronium (0.05 mg kg) 中使用吸入的异氟醚 (潮末浓度为 1%) 保持麻醉, 以使用神经肌肉监测生效。
  6. 用胃管吸胃。
  7. 将超声波果冻放在患者的下咽中。前抬起下颌, 用温和的压力将 tee 探针推进食道, 以克服低刺肌的抵抗力。

2. 经食管超声心动图

  1. 根据美国超声心动图学会心血管麻醉师指南42对每个患者进行全面的 tee 检查。
  2. 在二尖瓣的尖端之间放置一个脉冲波多普勒样本量, 以记录中食管四室 tee 成像平面中的反二尖瓣血流速度 (图 1)。
  3. 识别经二尖瓣血流速度的早期 lv 充盈和心房收缩血流波形, 并使用 超声心动图设备的集成软件包 (图 1)。
  4. 计算心房充盈分数 (β) 为心房与总 lv 填充的比率:
    figure-protocol-1
  5. 测量收缩期中段主动脉瓣长轴主动脉瓣正下方的 lv 流出道的最大直径 (图 2a)。
  6. 计算 lv 流出道的面积, 假设圆形几何为/4 的乘积和直径的平方 (见上面的步骤 2.5)。
  7. 获得深经胃长轴 tee 视图, 并在 lv 流出道远端放置一个脉冲波多普勒样本体积, 以记录与测量直径相同水平的血流速度包络 (图 2b) (见上文步骤 2.5);利用超声心动图设备的软件包集成该波形的面积, 以获得 vti。
  8. 将 lv 流出轨迹的所产生的速度时间积分 (vti) 乘以流出轨迹的区域 (图 2b), 以获得行程体积 (sv)。
  9. 记录食管中双轴和 lv 长轴 tee 成像平面的视频剪辑, 分别为 42。请务必在每次录制中包括几个心脏周期。
  10. 目视检查慢动作图像的视频剪辑 (见步骤2.9 上文) 后, 心电图 t 波选择二尖瓣小叶的最大开口。
  11. 使用超声心动图设备的 "卡尺" 功能测量二尖瓣 (图 3a和3A) 之间的距离。
  12. 计算二尖瓣直径 (d) 为主要 (经共体前-后部-内侧) 和次要 (前后) 长度的平均值。
  13. 使用公式计算 vft:
    figure-protocol-2
  14. 在结束时进行所有定量超声心动图测量, 一式三份。

3. 实验设计

  1. 确定10例冠状动脉下正常术前 lv 射血分数患者的 vft、左旋舒张功能指标和稳态情况下血流动力学, 前30分钟和体外循环 (cpb) 后15、30和60分钟手术来检验 cpb 瞬时降低 vft 39 的假设。
  2. 测试主动脉瓣狭窄产生的 lv 压力过载肥大减少 vft 的假设, 方法是检查 (在一组8例接受主动脉瓣置换术的患者中) 严重主动脉狭窄, 并将观察结果与另一组8人进行比较经冠状动脉手术治疗的 lv 壁厚正常 40例。在 cpb 前30分钟的稳态条件下测量 vft、lv 舒张功能、血流动力学和舒张终壁厚度。
  3. 试验8例主动脉瓣狭窄和中度主动脉功能不全患者中进入 lv 的舒张血流量异常对经二尖瓣 lv 充盈效率的假设, 而8例主动脉狭窄患者没有返流瓣膜38. 测量 vft 和上述其他参数 (步骤 3.2)。
  4. 测试老年与7只八旬老人 (82±2岁) 使用 vft 量化的 lv 灌装效率下降的假设, 而在7个年轻患者 (55±6岁) 中接受冠状动脉手术的情况是 41年。确保两组患者术前都有正常的 lv 射血分数。测量 vft 和上述其他参数 (步骤 3.2)。

4. 统计

  1. 将数据显示为平均值±标准偏差。
  2. 使用方差分析 (anova) 评估数据, 然后使用邦费罗尼修改学生的t测试。
  3. 采用线性回归分析确定 vft 与舒张终后壁厚度之间以及 vft 与年龄之间的关系。
  4. 当 p & lt; 0.05 时拒绝零假设。

访问受限。请登录或开始试用以查看此内容。

结果

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

目前的技术使我们能够在各种临床条件下可靠地测量心脏手术期间的 vft, 方法是从标准 tee 成像平面上的血流和尺寸记录中获得每个决定因素。在食管中段四室视图的二尖瓣小叶尖端放置脉冲波多普勒样本体积, 得到计算心房充盈分数所需的反式二尖瓣血流速度剖面 (β;图 1)。行程体积是使用连续性方程 (lv 流出轨迹的速度时间积分, 血流速度波形乘以流出轨迹的面积) 确定的, lv 流出轨迹直径是在中道 lv 长轴视图中测量的 (图 2a), 而通过流出道的血液流动是在深胃经胃短轴成像平面 (图 2A) 中确定的。最后, 将二尖瓣平均直径计算为在食管中双轴和 lv 长轴平面测量的主要轴和小轴直径的平均值 (分别为图 3 a 和 3A)。vft 的测量与观察者内部和观察者之间的变异性分别为5% 和7% 有关, 类...

访问受限。请登录或开始试用以查看此内容。

讨论

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

目前的结果表明, vft 可以可靠地测量心脏手术期间使用这里描述的 tee 技术。以前对 vft 的描述在有意识的受试者中使用了经胸超声心动图, 但当胸部打开时, 这种方法无法使用。我们使用术中 tee 来确定心脏手术麻醉患者的 vft, 在此期间, 由于缺血再灌注损伤或手术干预, lv 充盈动力学的变化经常会发生。我们的研究结果表明, vft 测量反映了瞬态 cb 诱导的松弛型舒张功能障碍、主动脉瓣疾病和衰老所产生的 lv 填充效率的变化。目前在心脏手术中计算 vft 的技术需要在稳态血流动力学条件下提供高质量的 tee 图像和视频剪辑, 以确保精确测量二尖瓣和 lv 流出道尺寸和血液流动 (图 1、图 2和图 3)。并非所有患者都会有最佳的成像窗口, 因为心脏的离轴旋转或心脏几何的病理变化。尽管有这些潜在的局限性, 有经验的术中超声心动图医生应该能够很容易地获得必要的中食管四室, 中食管双管, 中食管 lv 长轴, 和深胃长轴意见在全面 tee 考试

访问受限。请登录或开始试用以查看此内容。

披露

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

根据这项工作, 提交人没有相互竞争的经济利益或其他利益冲突。

致谢

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

这些材料是在威斯康星州密尔沃基克莱门特·扎布洛基退伍军人事务中心开展的工作和使用这些设施的结果。

访问受限。请登录或开始试用以查看此内容。

材料

本文使用的材料清单
姓名公司目录编号评论
超声心动图机飞利浦超声，博索尔，WAiE33
经食管超声心动图探头飞利浦超声，博索尔，WAX7-2t
统计软件AnalystSoft，Walnut，CAStatPlus：mac Pro

参考文献

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,
  1. Collier, E., Hertzberg, J., Shandas, R. Regression analysis for vortex ring characteristics during left ventricular filling. Biomedical Sciences Instrumentation. 38 (2), 307-311 (2002).
  2. Kheradvar, A., Gharib, M. Influence of ventricular pressure drop on mitral annulus dynamics through the process of vortex ring formation. Annals of Biomedical Engineering. 35 (12), 2050-2064 (2007).
  3. Gharib, M., Rambod, E., Shariff, K. A universal time scale for vortex ring formation. Journal of Fluid Mechanics. 360 (1), 121-140 (1998).
  4. Krueger, P. S., Gharib, M. The significance of vortex ring formation to the impulse and thrust of a starting jet. Physics of Fluids. 15 (5), 1271-1281 (2003).
  5. Reul, H., Talukder, N., Muller, W. Fluid mechanics of the natural mitral valve. Journal of Biomechanics. 14 (5), 361-372 (1981).
  6. Kim, W. Y., et al. Two-dimensional mitral flow velocity profiles in pig models using epicardial Doppler echocardiography. Journal of the American College of Cardiology. 24 (2), 532-545 (1994).
  7. Kilner, P. J., et al. Asymmetic redirection of flow through the heart. Nature. 404 (6779), 759-761 (2000).
  8. Gharib, M., Rambod, E., Kheradvar, A., Sahn, D. J., Dabiri, J. O. Optimal vortex formation as an index of cardiac health. Proceedings of the National Academy of Sciences USA. 103 (16), 6305-6308 (2006).
  9. Rodriguez Munoz, D., et al. Intracardiac flow visualization: current status and future directions. European Heart Journal Cardiovascular Imaging. 14 (11), 1029-1038 (2013).
  10. Martinez-Legazpi, P., et al. Contribution of the diastolic vortex ring to left ventricular filling. Journal of the American College of Cardiology. 64 (16), 1711-1721 (2014).
  11. Dabiri, J. O., Gharib, M. The role of optimal vortex formation in biological fluid transport. Proceedings of the Royal Society B. 272 (1572), 1557-1560 (2003).
  12. Kheradvar, A., Gharib, M. On mitral valve dynamics and its connection to early diastolic flow. Annals of Biomedical Engineering. 37 (1), 1-13 (2009).
  13. Linden, P. F., Turner, J. S. The formation of "optimal" vortex rings, and the efficiency of propulsion devices. Journal of Fluid Mechanics. 427 (1), 61-72 (2001).
  14. Domenichini, F., Pedrizzetti, G., Baccani, B. Three-dimensional filling flow into a model left ventricle. Journal of Fluid Mechanics. 539 (1), 179-198 (2005).
  15. Sengupta, P. P., et al. Left ventricular isovolumic flow sequence during sinus and paced rhythms: new insights from use of high-resolution Doppler and ultrasonic digital particle imaging velocimetry. Journal of the American College of Cardiology. 49 (8), 899-908 (2007).
  16. Rodriguez Munoz, D., et al. Flow mapping inside a left ventricular aneurysm: a potential tool to demonstrate thrombogenicity. Echocardiography. 31 (1), E10-E12 (2014).
  17. Son, J. W., et al. Abnormal left ventricular vortex flow patterns in association with left ventricular apical thrombus formation in patients with anterior myocardial infarction: a quantitative analysis by contrast echocardiography. Circulation Journal. 76 (11), 2640-2646 (2012).
  18. Kheradvar, A., Falahatpisheh, A. The effects of dynamic saddle annulus and leaflet length on trans-mitral flow pattern and leaflet stress of a bileaflet bioprosthetic mitral valve. The Journal of Heart Valve Disease. 21 (2), 225-233 (2012).
  19. Kheradvar, A., Assadi, R., Falahatpisheh, A., Sengupta, P. P. Assessment of trans-mitral vortex formation in patients with diastolic dysfunction. Journal of the American Society of Echocardiography. 25 (2), 220-227 (2012).
  20. Chen, R., et al. Assessment of left ventricular hemodynamics and function of patients with uremia by vortex formation using vector flow mapping. Echocardiography. 29 (9), 1081-1090 (2012).
  21. Hendabadi, S., et al. Topology of blood transport in the human left ventricle by novel processing of Doppler echocardiography. Annals of Biomedical Engineering. 41 (12), 2603-2616 (2013).
  22. Sengupta, P. P., Pedrizetti, G., Narula, J. Multiplaner visualization of blood flow using echocardiographic particle imaging velocimetry. Journal of the American College of Cardiology Cardiovascular Imaging. 5 (5), 566-569 (2012).
  23. Sengupta, P. P., et al. Emerging trends in CV flow visualization. Journal of the American College of Cardiology Cardiovascular Imaging. 5 (3), 305-316 (2012).
  24. Hong, G. R., Kim, M., Pedrizzetti, G., Vannan, M. A. Current clinical application of intracardiac flow analysis using echocardiography. Journal of Cardiovascular Ultrasound. 21 (4), 155-162 (2013).
  25. Kheradvar, A., Milano, M., Gharib, M. Correlation between vortex ring formation and mitral annulus dynamics during ventricular rapid filling. American Society for Artificial Internal Organs Journal. 53 (1), 8-16 (2007).
  26. Hong, G. R., et al. Characterization and quantification of vortex flow in the human left ventricle by contrast echocardiography using vector particle image velocimetry. Journal of the American College of Cardiology Cardiovascular Imaging. 1 (6), 705-717 (2008).
  27. Zhang, H., et al. The evolution of intraventricular vortex during ejection studied by using vector flow mapping. Echocardiography. 30 (1), 27-36 (2013).
  28. Nogami, Y., et al. Abnormal early diastolic intraventricular flow 'kinetic energy index' assessed by vector flow mapping in patients with elevated filling pressure. European Heart Journal Cardiovascular Imaging. 14 (3), 253-260 (2013).
  29. Zhang, H., et al. The left ventricular intracavity vortex during the isovolumic contraction period as detected by vector flow mapping. Echocardiography. 29 (5), 579-587 (2012).
  30. Poh, K. K., et al. Left ventricular filling dynamics in heart failure: echocardiographic measurement and utilities of vortex formation time. European Heart Journal Cardiovascular Imaging. 13 (5), 385-393 (2012).
  31. Belohlavek, M. Vortex formation time: an emerging echocardiographic index of left ventricular filling efficiency? European Heart Journal Cardiovascular Imaging. 13 (5), 367-369 (2012).
  32. Dabiri, J. O., Gharib, M. Starting flow through nozzles with temporally variable exit diameter. Journal of Fluid Mechanics. 538 (1), 111-136 (2005).
  33. Jiamsripong, P., et al. Impact of acute moderate elevation in left ventricular afterload on diastolic trans-mitral flow efficiency: analysis by vortex formation time. Journal of the American Society of Echocardiography. 22 (4), 427-431 (2009).
  34. Belohlavek, M., et al. Patients with Alzheimer disease have altered trans-mitral flow: echocardiographic analysis of the vortex formation time. Journal of Ultrasound in Medicine. 28 (11), 1493-1500 (2009).
  35. Pedrizzetti, G., Domenichini, F., Tonti, G. On the left ventricular vortex reversal after mitral valve replacement. Annals of Biomedical Engineering. 38 (3), 769-773 (2010).
  36. Martinez-Legazpi, P., et al. Stasis mapping using ultrasound: a prospective study in acute myocardial infarction. Journal of the American College of Cardiology Cardiovascular Imaging. 11 (3), 514-515 (2018).
  37. Harfi, T. T., et al. The E-wave propagation index (EPI): a novel echocardiographic parameter for prediction of left ventricular thrombus. Derivation from computational fluid dynamic modeling and validation on human subjects. International Journal of Cardiology. 227 (1), 662-667 (2017).
  38. Pagel, P. S., Boettcher, B. T., De Vry, D. J., Freed, J. K., Iqbal, Z. Moderate aortic valvular insufficiency invalidates vortex formation time as an index of left ventricular filling efficiency in patients with severe degenerative calcific aortic stenosis undergoing aortic valve replacement. Journal of Cardiothoracic and Vascular Anesthesia. 30 (5), 1260-1265 (2016).
  39. Pagel, P. S., Gandhi, S. D., Iqbal, Z., Hudetz, J. A. Cardiopulmonary bypass transiently inhibits intraventricular vortex ring formation in patients undergoing coronary artery bypass graft surgery. Journal of Cardiothoracic and Vascular Anesthesia. 26 (3), 376-380 (2012).
  40. Pagel, P. S., Hudetz, J. A. Chronic pressure-overload hypertrophy attenuates vortex formation time in patients with severe aortic stenosis and preserved left ventricular systolic function undergoing aortic valve replacement. Journal of Cardiothoracic and Vascular Anesthesia. 27 (4), 660-664 (2013).
  41. Pagel, P. S., Dye, L., Boettcher, B. T., Freed, J. K. Advanced age attenuates left ventricular filling efficiency quantified using vortex formation time: a study of octogenarians with normal left ventricular systolic function undergoing coronary artery surgery. Journal of Cardiothoracic and Vascular Anesthesia. 32 (4), 1775-1779 (2018).
  42. Shanewise, J. S., et al. ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Journal of the American Society of Echocardiography. 12 (10), 884-900 (1999).
  43. Gaspar, T., et al. Three-dimensional imaging of the left ventricular outflow tract: impact on aortic valve area estimation by the continuity equation. Journal of the American Society of Echocardiography. 25 (7), 749-757 (2012).
  44. Karamnov, S., Burbano-Vera, N., Huang, C. C., Fox, J. A., Shernan, S. A. Echocardiographic assessment of mitral stenosis orifice area: a comparison of a novel three-dimensional method versus conventional techniques. Anesthesia and Analgesia. 125 (3), 774-780 (2017).
  45. Pagel, P. S., Kampine, J. P., Schmeling, W. T., Warltier, D. C. Comparison of end-systolic pressure-length relations and preload recruitable stroke work as indices of myocardial contractility in the conscious and anesthetized, chronically instrumented dog. Anesthesiology. 73 (2), 278-290 (1990).
  46. Pagel, P. S., Kampine, J. P., Schmeling, W. T., Warltier, D. C. Alteration of left ventricular diastolic function by desflurane, isoflurane, and halothane in the chronically instrumented dog with autonomic nervous system blockade. Anesthesiology. 74 (6), 1103-1114 (1991).
  47. De Hert, S. G., Rodrigus, I. E., Haenen, L. R., De Mulder, P. A., Gillebert, T. C. Recovery of systolic and diastolic left ventricular function early after cardiopulmonary bypass. Anesthesiology. 85 (5), 1063-1075 (1996).
  48. Gorcsan, J., Diana, P., Lee, J., Katz, W. E., Hattler, B. G. Reversible diastolic dysfunction after successful coronary artery bypass surgery. Assessment by transesophageal Doppler echocardiography. Chest. 106 (5), 1364-1369 (1994).
  49. Djaiani, G. N., et al. Mitral flow propagation velocity identifies patients with abnormal diastolic function during coronary artery bypass graft surgery. Anesthesia and Analgesia. 95 (3), 524-530 (2002).
  50. Casthely, P. A., et al. Left ventricular diastolic function after coronary artery bypass grafting: a correlative study with three different myocardial protection techniques. Journal of Thoracic and Cardiovascular Surgery. 114 (2), 254-260 (1997).
  51. Tulner, S. A., et al. Perioperative assessment of left ventricular function by pressure-volume loops using the conductance catheter method. Anesthesia and Analgesia. 97 (4), 950-957 (2003).
  52. Firstenberg, M. S., et al. Relationship between early diastolic intraventricular pressure gradients, an index of elastic recoil, and improvements in systolic and diastolic function. Circulation. 104 (12 Suppl 1), I330-I335 (2001).
  53. Cooke, J., Hertzberg, J., Boardman, M., Shandas, R. Characterizing vortex ring behavior during ventricular filling with Doppler echocardiography: an in vitro study. Annals of Biomedical Engineering. 32 (2), 245-256 (2004).
  54. Grossman, W., Jones, D., McLaurin, L. P. Wall stress and patterns of hypertrophy in the human left ventricle. Journal of Clinical Investigation. 56 (1), 56-64 (1975).
  55. Hess, O. M., et al. Diastolic function and myocardial structure in patients with myocardial hypertrophy. Special reference to normalized viscoelastic data. Circulation. 63 (2), 360-371 (1981).
  56. Hess, O. M., et al. Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacement. Circulation. 69 (5), 855-865 (1984).
  57. Sandstede, J. J. W., et al. Cardiac systolic rotation and contraction before and after valve replacement for aortic stenosis: a myocardial tagging study using MR imaging. American Journal of Roentgenology. 178 (4), 953-958 (2002).
  58. Stuber, M., et al. Alterations in the local myocardial motion pattern in patients suffering from pressure overload due to aortic stenosis. Circulation. 100 (4), 361-368 (1999).
  59. Nagel, E., et al. Cardiac rotation and relaxation in patients with aortic valve stenosis. European Heart Journal. 21 (7), 582-589 (2000).
  60. Rakowski, H., et al. Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography: from the Investigators of Consensus on Diastolic Dysfunction by Echocardiography. Journal of the American Society of Echocardiography. 9 (5), 736-760 (1996).
  61. Homeyer, P., Oxorn, D. C. Aortic regurgitation: echocardiographic diagnosis. Anesthesia and Analgesia. 122 (1), 37-42 (2016).
  62. Landzberg, J. S., et al. Etiology of the Austin Flint murmur. Journal of the American College of Cardiology. 20 (2), 408-413 (1992).
  63. Flint, A. On cardiac murmurs. American Journal of Medical Sciences. 91 (1), 27(1886).
  64. Botvinick, E. H., Schiller, N. B., Wickramasekaran, R., Klausner, S. C., Gertz, E. Echocardiographic demonstration of early mitral valve closure in severe aortic insufficiency. Its clinical implications. Circulation. 51 (5), 836-847 (1975).
  65. Mann, T., McLaurin, L., Grossman, W., Craige, E. Assessing the hemodynamic severity of acute aortic regurgitation due to infective endocarditis. New England Journal of Medicine. 293 (3), 108-113 (1975).
  66. Borlaug, B. A., et al. Longitudinal changes in left ventricular stiffness: a community-based study. Circulation Heart Failure. 6 (5), 944-952 (2013).
  67. Wong, J., et al. Age-related changes in intraventricular kinetic energy: a physiological or pathological adaptation? American Journal of Physiology Heart Circulatory Physiology. 310 (6), H747-H755 (2016).
  68. Carrick-Ranson, G., et al. Effect of healthy aging on left ventricular relaxation and diastolic suction. American Journal of Physiology Heart Circulatory Physiology. 303 (3), H315-H322 (2012).
  69. Iskandrian, A. S., Hakki, A. H. Age-related changes in left ventricular diastolic performance. American Heart Journal. 112 (1), 75-78 (1986).
  70. Schulman, S. P., et al. Age-related decline in left ventricular filling at rest and exercise. American Journal of Physiology. 263 (6 Pt 2), H1932-H1938 (1992).
  71. Stork, M., et al. Age-related hemodynamic changes during diastole: a combined M-mode and Doppler echo study. Internal Journal of Cardiovascular Imaging. 6 (1), 23-30 (1991).
  72. Sanders, D., Dudley, M., Groban, L. Diastolic dysfunction, cardiovascular aging, and the anesthesiologist. Anesthesiology Clinics. 27 (3), 497-517 (2009).

访问受限。请登录或开始试用以查看此内容。

重印与许可

申请许可以重复使用本 JoVE 文章的文本或图表

申请许可

标签

相关文章