自体肺动脉瓣移植术在治疗主动脉瓣病变中的应用

Clinical experience of Ross procedure treating patient with aortic disease

目的:总结我院自体肺动脉瓣移植术的临床经验。方法:1994年10月-2005年1月,共完成自体肺动脉瓣移植术42例;术前诊断:先心病、主动脉瓣病变39例,亚急性细菌性心内膜炎合并主动脉瓣关闭不全1例,主动脉瓣人工机械瓣置换术后心内膜炎合并瓣周漏1例,老年退行性病变1例,为重度主动脉瓣狭窄。全组患者术前UCG示主动脉瓣病变,狭窄和/或关闭不全(中重度),主动脉瓣环径(2.45±0.31)cm;肺动脉瓣发育正常,功能良好,肺动脉瓣环径(2.34±0.21)cm;术前心功能2.12级。所有病例均在全麻中度低温体外循环下进行,手术分三步进行:(1)采取自体肺动脉瓣;(2)切除病变的主动脉瓣并移植自体肺动脉瓣于主动脉位,采用主动脉根部移植法;(3)利用同种动脉瓣重建右室流出道。结果:全组患者无手术死亡;术后主动脉平均跨瓣压差在正常范围(6.11±0.12)mmHg,左室舒张末径明显缩小(P<0.01),LVEF0.49±0.23,心功能I^II级。38例患者接受随访,随访1个月~10年,心功能I级,主动脉瓣、肺动脉瓣均功能良好,末见瓣膜狭窄或关闭不全。1例早期手术患者术后6个月出现同种瓣心内膜炎再次手术死亡,另1例患者术后不明原因突发心脏骤停,复苏后应用体外人工膜肺支持一周后心脏功能明显好转,后因经费问题家属要求自动出院。结论:自体肺动脉瓣移植术是一种临床疗效好的治疗主动脉瓣病变的手术方法。

Objective To summarize all cases of Ross procedure performed in Anzhen Hospital. Methods From October 1994 to January 2005, 42 cases of Ross procedure were performed. Thirtynine were diagnosed congenital heart disease and aortic valve disease （AS/or AI）, one case of SBE complicated with aortic incompetence, one case of SBE with peri-valve leakage after aortic mechanical valve replacement, one case of aged degenerated aortic valve disease, aortic stenosis. UCG showed aortic disease, AS and/or AI（moderate to severe）, aortic valve annulus diameter of （2.45±0.31）cm, normal pulmonary valve, its annulus diameter of （2.34±0.21）cm, NYHA of class 2.12. All cases were performed under CPB and moderate hypothermia with the following procedures, taking off autopulmonary arteryvalve, removing dysfunctional aortic valve and auto-transplantation of pulmonary valve on aortic root and putting a homograft on right ventricular outflow tract. Results The operative mortality was 0. The aortic valve function was normal. The mean pressure gradients was （6. 11±0. 12） mmHg. I.VDD was decreased significantly （P〈0. 01）. LVEF was 0.49±0.23. The heart function （NYHA） was in class Ⅰ～Ⅱ（NYHA）. All cases were followed up from 1 year to 10 years and the heart function was in class Ⅰ （NYHA）, aortic and pulmonary valve function was very well. Conclusion Ross procedure is a kind of effective alterative operation treating the patients with aortic valve disease.