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目的 研究左心室功能受损低压力阶差主动脉瓣狭窄程度的简便评估方法,探讨该类患者行主动脉瓣置换术的临床指征及疗效.方法 回顾性分析201 1年1月至2014年5月我院21例左心室功能受损低压力阶差主动脉瓣狭窄患者外科治疗的临床资料,其中男15例、女6例,年龄41～66 (54.6±10.7)岁.主动脉瓣平均跨瓣压差＜40 mm Hg,左心室射血分数(left ventricular ejection fraction,LVEF) ＜50％.结果 对多巴酚丁胺试验有反应的20例患者均行主动脉瓣置换术,术中见主动脉瓣二叶瓣畸形11例,退行性改变5例,风湿性心脏病4例,同期行心房颤动射频消融术3例、升主动脉置换术1例、冠状动脉旁路移植术2例、二尖瓣成形术1例.1例并发多脏器衰竭术后第4d死亡,其余患者康复出院.术后随访3～37个月,心功能分级(NYHA)多数改善为Ⅰ或Ⅱ级.术后3个月超声心动图复查示人工瓣膜功能状态良好,LVEF由术前的35.7％±8.2％提高至49.4％±7.2％.1例患者术后11个月不明原因猝死.结论 对多巴酚丁胺超声负荷试验显示为真性重度主动脉瓣狭窄且左心室具备收缩储备能力的患者行主动脉瓣置换术后,梗阻解除,左心室后负荷明显下降,左心室功能也随之好转,术后LVEF及生活质量明显改善.“,”Objectives To investigate simple assess method of the degree of low transvalvular gradient aortic stenosis patients with impaired left ventricular function and to investigate aortic valve replacement indications,short and mid-term outcome of this kind of patients.Methods We retrospectively analyzed the clinical data of 21 low-gradient patients with impaired left ventricular function in our hospital from January 2011 through May 2014.There were 15 males and 6 females aged 41-66 (54.6±10.7) years with mean aortic transvalvular gradient less than 40 mm Hg and left ventricular ejection fraction (LVEF) less than 50％.Results In response to dobutamine echocardiography stress test,20 patients underwent aortic valve replacement.The result of intraoperative pathology showed 11 patients were with bicuspid aortic valve malformation,4 patients with degenerative changes,4 patients with rheumatic disease.During the same period,3 patients underwent atrial fibrillation ablation,1 patient with ascending aorta replacement,2 patients with coronary artery bypass grafting,1 patient with mitral valvuloplasty.One patient died of multiple organ failure on the fourth day after operation.The remaining patients recovered.The patients were followed up for 3 to 37 months after operation.Heart function of majority improved to grade Ⅰ or Ⅱ in 3 months after surgery.The result of echocardiogram showed prosthetic valve function was good and LVEF increased (preoperative 35.7％±8.2％ vs.postoperative 49.4％±7.2％).One patient suffered sudden death of unknown cause in the 1 1th months after operation.Conclusions For patients whose dobutamine echocardiography stress test displayed with true severe aortic stenosis and left ventricular contractile reserve capacity,after aortic valve replacement and relief of the obstruction,the left ventricular afterload decreases significantly,the left ventricular function also improves,LVEF and the quality of life improve significantly after operation.