Ross手术治疗主动脉瓣膜病变中期随访结果

Midterm Results of Ross Procedure for Aortic Valve Disease

目的:观察Ross手术治疗主动脉瓣膜病变的中期临床结果。方法:1998年3月至2003年11月我院完成的24例Ross手术病例,其中男性13例,女性11例,年龄3～34岁,平均(13.96±5.76)岁,所有患者均以主动脉病变为主,其中主动脉瓣二叶化畸形12例,手术在体外循环下进行,取自体肺动脉移植于主动脉瓣位,并行冠状动脉原位移植,同种肺动脉瓣移植于肺动脉瓣位。所有患者均用多普勒彩色超声心动图进行评估。结果:随访所有患者,随访时间4～78个月,平均(34.2±20.1)个月,均存活,没有感染、栓塞和再次手术。自体肺动脉瓣(新主动脉瓣)平均流速为(1.46±0.49)m/s,中度反流2例,重度反流1例。同种肺动脉瓣(新肺动脉瓣)平均流速为(1.73±0.99)m/s,1例跨瓣压差超过80mmHg(1mmHg=0.133kPa),2例中度反流。结论:Ross手术治疗主动脉瓣膜病变获得较好的中期疗效,尤其对不适合瓣膜成形和瓣膜置换术的儿童型主动脉瓣膜病变是一个很好的选择。

Objective ：To study the early and midterm rcsuhs of Ross procedure for aortic valve disease. Methods：Twenty-four cases of Ross procedures were performed in Fuwai Hospital between March 1998 and November 2003. Thirteen of them were males with the mean age of 13.96 ± 5.76 years. All the patients mainly had aortic valve disease, and twelve of them had deformities of bicuspid aortic valves, Aortic root replacement was carried out using pulmonary autngrafts. The basic techniques were supra-annular implanting, three continual sutures and coronary artery re-implanting. The right ventricular outflow track was recnnstructed with hnmografts. All patients were followed up and underwent eehocardiography. Resuhs：The mean cardiopulmonary bypass duration was 179, 2 ± 25.8 min and aortic clamping duration was 136. 0 ± 19, 0 min. There were no operative deaths. Only one patient suffered aortic subvalvular abscess, All patients were followed up, with the mean follow-up duration of 34.2 ± 20, 1 months. There were no late deaths, infection, embolism or re-operation, The mean flow speed passing by the neo-aortic valves was 1.46 ± 0. 49 m/s. Moderate rcgurgitatinn occurred in two anti severe regurgitation in one. In homografting group, moderate regurgitation occurred in two and severe stenosis in one, Conclusion： Excellent long-term survival rate and good hemodynamic effects can be achieved by Ross procedure for aortic valve disease,