17-mm Regent瓣治疗狭小主动脉瓣环患者术后临床观察

Clinical investigation of aortic valve replacement with 17-mm St. Jude Medical prostheses for a small aortic rootClinical investigation of aortic valve replacement with 17-ram St. Jude Medical prostheses for a small aortic root

目的评价17-mmRegent瓣置换主动瓣术后心功能、跨主动脉瓣压差变化。方法选择2008年7月至2010年7月住院的主动脉瓣环狭小的患者7例，均为女性，年龄49-65（54．0±10．8）岁，平均体表面积（BSA）（1．42±0．32）m2，心功能（NYHA）Ⅲ级5例、Ⅱ级2例，平均射血分数（EF）（0．45±0．12）。均在体外循环下用17-mm Regent（St．Jude Medical）瓣置换主动脉瓣，瓣环尺寸使用厂家的测瓣器测量，术前和术后心脏功能用超声方法进行评估。结果围手术期无死亡。术后心功功（NYHA）Ⅰ级4例、Ⅱ级3例。跨瓣压差较术前明显降低，平均（16．0±4．2）mmHg。结论17-mmRegent（St．Jude Medical）瓣对狭小主动脉瓣环患者是较好的选择，它能避免扩大主动脉瓣环所带来的困难和风险，而且未发现人瓣不匹配现象（PPM）。

Objective To estimate the change of heart function and transvalvular pressure gradient for aortic valve replacement with 17-mm Regent （St.Jude Medical） prostheses. Methods From July 2008 to July 2010, 7 women aged 49 to 65 years older [mean age （54.0±10.8） years], with a mean body surface area （BSA） of （1.42±0.32）m2 and a mean ejection fraction of （EF）（0.45±0.12）, underwent aortic valve replacement with a 17- mm Regent （St.Jude Medical） prosthesis under cardiopulmonary bypass. The aortic valve annular size determined using valve gage. The results of preoperative and postoperative echoeardiography were evaluated. Results No pa- tients died perioperation. The NYHA functional class improved to class I in 4. Transvalvular pressure gradient was significantly lower in postoperative than that in preoperative [（68±26）mm Hg vs （16.0±4.2）mm Hg]. Conclusion The 17-ram SJM valve is the optimal choice in these patients with small aortic roots of less than 19 ram. This is because it can avoid risk and difficulty of aortic annular enlargement, and no PPM is found.