小瓣环主动脉瓣置换并主动脉瓣环扩大术的近中期结果

Early and mid-term results of aortic valve replacement with patch enlargement of the hypoplastic aortic annulus

目的:评价主动脉瓣环扩大成形术,在小主动脉瓣环的主动脉瓣置换术(AVR)中临床应用的近中期结果。方法:2002年1月至2007年5月,共25例小主动脉瓣环患者行AVR术,男性22例,女性3例,年龄7～64岁,平均(45±12.5)岁。术前主动脉瓣环径(18.12±1.93)mm,跨瓣压差(82±12)mmHg(1mmHg=0.133kPa)。心功能(HYHA分级):Ⅱ级20例、Ⅲ级4例及Ⅳ级1例。采用中、低温体外循环下行主动脉瓣环扩大并AVR术。Nicks法20例,Manouguian法5例。置换机械瓣18例,生物瓣5例,自体肺动脉瓣移植至主动脉瓣(Ross手术)2例。结果:死亡1例,为Ross手术后出现低心排出量综合征,出现病死率4%。其余24例住院(10±2)d。主动脉瓣环径扩大至(23.7±1.5)mm,跨瓣压差为(22±7)mmHg,与术前相比P<0.05。出院患者随访平均(24±10)个月,人工瓣和自体肺动脉瓣功能良好。心功能(HYHA分级):Ⅰ～Ⅱ级。结论:小瓣环主动脉瓣置换加瓣环扩大术近中期结果良好,远期结果有待进一步随访。

Objective：To introduce the experiences and report the early and mid-term results of aortic valve replaeement （AVR） with patch enlargement for the hypoplastic aortic annulus. Method： From January 2002 to May 2007,25 patients underwent patch enlargement for hypoplastic aortic annulus, Male 22, Femal 3, age from 7 to 64 years old,average（ 45 ± 12.5）years old. The eehoeardiography （UCG） showed： aortic annulus diameter： （18.12 ±1.93） mm, Cardiac function in New York Heart Assoeiation（NYHA） ： 20 eases in class Ⅱ , 4 cases in class Ⅲ , 1 ease in elass IV. Operative procedure including Nicks and Manouguian ways were performed underwent mild hypothermic cardiopulmonary bypass（CPB） in al patients, 20 cases in Nicks and 5 eases in Manouguian procedure . All patients were accepted AVR including mechanical prosthetic in 18 eases, tissue prosthetic in 5 eases and Ross procedure in 2 eases. Result：AVR with patch enlargement for the hypoplastic aortic annulus in all patients, operative mortality was 4% （1/25）. One patient underwent Ross procedure was died of post-operative low cardiac output. Hospital stays were （10 ±2） days. Post-operative UCG showed： aortic annulus diameter was（23.7 ± 1.5） ram, gradient across aortic valve was （22 ± 7） mm Hg, （ P 〈 0.05）. All the patients were followed-up, average（24 ± 10） months, 24 eases were survival during follow-up periods, and their cardiac funetions in NYHA were class Ⅰ -Ⅱ . Prosthetic aortic valve and pulmonary autograft valves＇ function were normal. Conclusion： Aortie valve replacement with aortic annulus enlargement procedure is a safety and effective alternative for aortic valve disease combined with the hypoplastic aortic annulus. The early and mld-term results are excellent.