44例小主动脉瓣环患者应用17mm St Jude Regent机械瓣术后早中期疗效分析

Early and mid-term results after 17mm St Jude Regent mechanical valve replacement in 44 patients with small aortic root

目的分析我院的44例小主动脉瓣环(直径≤17mm)患者行St Jude Medica Regent瓣膜置换术后心功能等改变,探讨是否存在植入瓣膜与患者不匹配现象。方法2007年10月至2009年3月,我院有44例小主动脉瓣环(直径≦17mm)患者,置换17mm St Jude Medica Regent机械瓣膜组;随机选择同期44例直径为21mm患者,置换21mm St Jude机械瓣膜组。术后随访两组患者的临床症状、体征,心电图、超声心电图等指标,采用SPSS13.0统计软件进行比较分析。结果17mm St Jude Medica Regent机械瓣膜组中,心电图检查8例有ST段改变,术后3例仍存在胸闷症状,偶尔有胸痛不适3例;术后心功能Ⅱ级8例、Ⅲ级4例。21mm St Jude机械瓣膜组术后心电图检查6例有ST段改变,2例有胸闷症状,偶尔有胸痛不适2例;术后心功能Ⅱ级11例,Ⅲ级2例,两组间比较差异无统计学意义(P=0.32)。两组患者术后左心室舒张期末内径、左心室后壁厚度、左心室重量指数、主动脉跨瓣压差等均较术前明显改善(P<0.05),左心室射血分数(LVEF)术后6～12月与术前比较明显提高(P<0.05),但两组间比较差异无统计学意义((P>0.05)。结论对于体重较轻(≤60kg)、体表面积较小(≤1.6cm2)的小主动脉瓣环患者,置换17mm St Jude Medical Regent机械瓣后,能取得较好的效果,部分指标已经接近或达到置换外径21mm St Jude机械瓣膜组,无明显PPM现象,无须行主动脉瓣环扩大术。

Objective To analyze the changes in the cardiac function after St.Jude regent mechanical valve replacement and assess the prosthesis-patient matching.Methods From October 2007 to March 2009,44 patients received implantation of 17 mm St.Jude aortic prostheses in our hospital.The patients were followed up for clinical symptoms,signs,electrocardiogram （ECG）,echocardiogram and cardiac functions,and the results were compared with those of randomly selected 44 patients receiving 21 mm St.Jude aortic prostheses.Results In 17 mm St Jude Medica Regent valve group,8 patients presented with ECG ST segment changes,3 complained of chest tightness,3 had occasional chest pain and discomfort,and 8 had grade II and 4 grade III cardiac function.In 21 mm St Jude Medical Regent valve group,6 patients had ECG ST segment changes,2 complained of chest tightness,2 reported occasional chest pain and discomfort,11 had grade II and 2 grade III cardiac function.No significant differences were found in these indices between the two groups（P=0.32）.Compared with those before operation,the two groups showed significant improvements in the left ventricular end-diastolic diameter,left ventricular posterior wall thickness,left ventricular mass index,and aortic pressure gradient （P0.05）.A significant increase in the left ventricular ejection fraction occurred 6-12 months after operation,but without statistical difference between the two groups （P0.05）.Conclusions For underweight patients （60 kg） and those with small body surface area （1.6 cm2）,17 mm St.Jude Medical Regent valve prosthesis may produce good therapeutic effect,and some indices are even close to those after placement of 21 mm St.Jude Medical Regent valve prosthesis.No obvious prosthesis-patient mismatch occurs after the placement of the 17 mm valve prosthesis and aortic valve ring expansion is not necessary.