细小主动脉根部换瓣时扩大瓣环的方法

METHODS FOR ENLARGEMENT OF THE SMALL AORTIC ANNULUS DURING VALVE REPLACEMENT

本院自1979年7月至1991年4月,对10例细小主动脉根部患者,做了扩大瓣环主动脉瓣替换术,采用了3种术式:Nicks氏手术3例(2例死亡),Konno氏手术1例(死亡),Manouguian氏手术6例(无死亡)。本文讨论了手术适应证并对3种术式进行了比较。

Aortic valve replacement (AVR) of small aortic root is a difficult problem which is met in the clinic occasionally. From July 1979 to April 1991, 10 patients underwent AVR with enlargement of the small aortic annulus by three modes of operation. The Nicks's procedure was done in 3 patients (2 died), the Konno's procedure in 1 (died) and the Manouguian's procedure in 6 (None died). The survivors were discharged in good condition. The heart function (NYHA) of 4 patients was improved from class Ⅲ to class Ⅱ after operation, the other 2 was from class Ⅳ to class Ⅱ-Ⅲ. The cardiacthoracic ratio was down from 0. 61 to 0.57 about 1 week after operation. The aortic inner diameter by echocardiography was enlarged from 22. 6 to 25. 7 mm after operation. Follow-up showed no late death and complication in 4-27 months (mean 12.5 months). The heart function was improved further. The results of our limited data suggest that: (1) the 21-23 size mechanical prosthetic aortic valve should be selected for most of the adults; (2) the possibility of small aortic root should be considered if the aortic diameter is<22mm by echocardiography preoperatively; (3) among the three modes, Manouguian's procedure is the rational management of AVR with enlargement of small aortic annular, and the best material forenlarging the aortic annulus is autologous pericardium.