应用ROSS手术治疗儿童主动脉瓣病变的研究

Ross procedure for aortic valve disease in children

目的评价应用Ross手术治疗儿童主动脉瓣病变的效果。方法回顾性分析1994年1月～2005年1月Ross手术治疗儿童主动脉瓣病变26例,其中男18例,女8例,平均年龄(12.4±5.3)岁。主动脉瓣赘生物7例,主动脉瓣二瓣叶畸形9例,主动脉瓣叶脱垂6例,瓣叶发育不良3例,主动脉瓣成形术后再发主动脉瓣关闭不全1例。所有患儿均采用自体带瓣肺动脉行主动脉根部替换,均应用同种肺动脉带瓣管道重建右室流出道。结果本组26例无手术死亡,1例术后大出血而2次开胸止血。在2例12年、24例(24.5±3.8)个月的随访期间,1例术后1年同种肺动脉瓣感染致感染性心内膜炎再次手术时死亡。25例血流动力学优良,23例无主动脉瓣反流,2例仅存在轻微主动脉瓣反流;4例有同种异体肺动脉瓣轻度反流,1年后左室舒张末径从术前的(65.24±12.7)mm显著缩小到(49±8.23)mm(P<0.05)。结论应用Ross手术治疗儿童主动脉瓣病变可取得较好的围术期及近中期效果。

Objective To evaluate the efficacy of Ross procedure in the treatment of aortic valve disease in children. Methods Ross procedures in 26 children with aortic valve disease were reviewed. There were 18 boys and 8 girls with a mean age of （12. 4 ± 5. 3）yrs. Among them, 7 suffered from endocarditic aortic valve insufficiency, and 9 from congenital bicuspid aortic valve disease, 6 from prolapsed aortic valve, 3 from hypoplastic aortic valve, and 1 from aortic insufficiency after aortic valve repair procedure. Pulmonary homograft was used to reconstruct the right ventricle outflow tract. Results There was no peri-operative death. One patient required re-operation due to hemorrhage. At follow-ups, we found that one patient developed pulmonary homograft endocarditis and died during the redo procedure 1 year after the initial operation. The remaining 25 patients were hemodynamically stable. Among them, 23 had no aortic valve insufficiency, 2 had mild aortic valve insufficiency and 4 had mild pulmonary homograft insufficiency. One year after the procedure, the left ventricle end-diastolic diameter decreased from （65.24± 12. 7）mm to （49 ± 8. 23）mm （P〈0. 05）. Conclusions Ross procedure produces good mid-term result in children with aortic valve diseases.