小主动脉瓣环患者机械瓣置换术后中期疗效分析

Intermediate-term Results after Mechanical Valve Replacement in Patients Small Aortic Root

目的观察小主动脉瓣环患者行心瓣膜置换术后中期疗效和心功能恢复情况,探讨小口径瓣膜的使用范围。方法1990年7月至2003年6月共对62例患者施行19号主动脉机械瓣膜置换术(19mm瓣膜组),同时选择62例同期置换21号以上机械瓣膜患者做对照(21mm瓣膜组);术后随访两组患者的临床症状、体征,心电图、超声心动图等指标,采用Kaplan-Meier分析生存曲线计算两组患者的生存率,并进行比较分析。结果19mm瓣膜组中有38例主动脉瓣区仍存在Ⅱ级以上杂音,心电图检查18例有ST段改变,术后11例仍存在胸闷、胸痛症状,术后心功能Ⅱ级33例,Ⅲ级29例;21mm瓣膜组术后心电图检查6例有ST段改变,术后3例有胸闷症状,偶尔有胸痛不适6例,术后心功能Ⅱ级48例,Ⅲ级14例,两组间比较差异有统计学意义(P=0.020)。两组患者术后左心室舒张期末内径、左心室后壁厚度、左心室重量指数、主动脉跨瓣压差等均较术前明显改善(P<0.05),左心室射血分数(LVEF)术后5年与术前比较明显提高(P<0.05),但两组间比较差异无统计学意义(P>0.05)。19mm瓣膜组术后1年、5年生存率分别为93.5%、74.2%;21mm瓣膜组术后1年、5年生存率分别为95.2%、79.0%,两组间比较差异无统计学意义(P=0.231,0.110)。结论小口径主动脉瓣置换术能取得良好的效果和中期生存率。

Objective To observe the intermediate-term outcome and heart function in patients with small aortic root,and to investigate the feasibility of small size prosthesis. Methods From July 1990 to June 2003, 62 patients underwent 19mm aortic valve prosthesis（19mm group）. The results were compaired with other 62 patients receiving larger prosthesis （≥ 21 mm, 21mm group）. Clinical symptoms, signs, electrocardiogram （ECG） and echocardiography （UCG） were followed-up, Kaplan-Meier survival curve was used for analysis. Results In 19mm group, there were 38 patients with ≥ Ⅱ/Ⅵ grade systolic murmur in aortic valve area, 18 patients with ECG ST segment change and 11 patients with chest pain and/or chest distress. Postoperative cardiac function showed that 33 patients with heart function New York Heart Association（NYHA） class Ⅱ and 29 patients with NYHA class Ⅲ. Postoperative ECG showed in 21mm group, 6 patients with ECG ST segment change, 3 patients with chest distress and 6 patients with occasional chest pain and there were 48 patients with NYHA class Ⅱ and 14 patients with NYHA class Ⅲ ,there was statistically difference in heart function between two groups（P=0. 020）. There was a significant regression of left ventrieular end diastolic diameter （LVEDD）, left ventricular wall thickness, mass index, and pressure gradients in both groups （P〈0.05）, and left ventricular ejection fraction （LVEF）had a significant increase in patients 5 years after operation than that before operation（P〈0.05）, and there was no statistically difference in both groups （P〉0.05）. Actual survival at 1,5 years were 93. 5%,74.2% in 19mm group compared with 95.2%, 79.0% in the 21mm valve group, there were no statistically difference in both groups （P= 0. 231,0. 110）. Conclusion Patients with 19mm prosthetic aortic valves can experience a satisfactory improvement and get excellent intermediate-term survival.