先天性主动脉瓣脱垂的主动脉瓣成形术

Treatment congenital aortic prolapse by aortic valvuloplasty

目的使用主动脉瓣成形术(AVP)治疗先天性主动脉瓣脱垂的手术经验并对中期结果作出评价.方法该组患者男7例,女3例;年龄14～28岁,平均21.5岁.术前心功能NYHAⅠ级2例,Ⅱ级7例,Ⅲ级1例.超声心动图检查主动脉瓣返流重度6例,中度3例,轻度1例,平均左心室舒张末径(57.4±11)mm,EF平均(56.5±10.5)%.10例患者中单纯主动脉瓣返流者5例,其他伴有VSD、SBE、主动脉瓣下狭窄等.病理:瓣叶脱垂、瓣叶畸形等.手术方法有瓣叶交界处缝合及瓣叶折叠和悬吊.结果术后无早期死亡,术后心包积液1例.所有出院患者随诊8.0～26.4个月,平均1.5 a.术后6个月时心功能NYHAⅠ级7例,Ⅱ级3例;超声心动图示左室舒张末径平均(52.5±8.5)mm、EF平均(58.5±8.5)%,仍存在主动脉瓣轻度返流2例.结论先天性主动脉瓣脱垂的病人使用主动脉瓣成形术(AVP)是一种较好的选择,并具有许多优点,且中期结果良好,但远期结果仍不清楚.

Aortic valvuloplasty may be a better alternative for treatment of congenital aortic prolapse. This retrospective study was conducted to review our preliminary experience in aortic valvuloplasty and evaluate the postoperative results of aortic valvuloplasty in recent years. Seven patients were male and three female. Their ages ranged from 14years to 28 years with a mean of 21.5 years. Preoperatively, 2 patients were in NYHA class Ⅰ, 7 patients in class Ⅱand 1 patients in class Ⅲ.Aortic incompetence was mild in 1 patients, moderate in 3 and severe in 6. Average EF was (56.5±10.5)% and average LVEDd was (57.4±11) mm. Five patients had isolated aortic valve pathology, others had many complications like VSD, SBE or subvalvular aortic stenosis et al. Valve lesion include valve prolapse, bicuspid valve. Some surgical technique were used, depending on the underlying valvular pathology, including commissural plication, leaflet plication, midleaflet excision. There was no operative death and one patient had pericardial effusion. Mean follow-up was 1.5 years. Patients improved as is evident by NYHA functional class postoperatively (7 patients in class Ⅰ, 3 patients in class Ⅱ). Postoperative echocardiography revealed 8 patients normal and only 2 patients had mild aortic incompetence. Average EF was (58.5±8.5)% and average LVEDd was (52.5±8.5) mm. [Conclusions] Aortic valvuloplasty is a better alternative for patients with congenital aortic prolapse with satisfactory intermediate-term results. It has more advantages than valve replacement like minimal morbidity and mortality rates, avoidance of anticoagulant therapy. But long-term results are not clear.