Manouguian法瓣环增宽加主动脉瓣置换术治疗成人小主动脉瓣环

Aortic Valve Replacement in Adult Patients with Enlargement of the Small Aortic Annuli

目的总结成人主动脉瓣狭窄伴小主动脉瓣环行瓣环增宽并替换主动脉瓣的经验。方法 12例病人行主动脉瓣环增宽并替换主动脉瓣。手术径路均采用Manouguian法：将主动脉斜切口下延伸,经无冠瓣与左冠瓣交界处向下,垂直切开瓣环至二尖瓣基部。采用绦纶片内衬自体心包片作为增宽材料,替换23 mm或25 mm主动脉瓣;同期行二尖瓣替换4例。结果 1例同期行二尖瓣置换者因严重低心排死于手术当晚;1例术后第7 d因心包填塞经剑突下引流后痊愈;肺部感染并发呼吸功能不全1例,经气管切开及呼吸机支持1周后痊愈;1例主动脉根部明胶海绵物填充后感染于术后12 d再次开胸清除腐烂明胶海绵,并留管冲洗引流而愈。本组术后住院13~20 d,平均（16.2±1.5）d;11例患者均获随访,时间5~84个月,平均（36.7±21.2）个月,心功能恢复至Ⅰ级5例,Ⅱ级6例,无远期死亡。结论对大多数小主动脉瓣环,采用Manouguian术式简单易行,不需切开二尖瓣基部,已能满足替换23 mm或25 mm瓣膜,增宽材料易得,效果可靠。

Objective To summary the experiences of aortic valve replacement in adult patients with enlargement of the small aortic annuli.Methods 12 patients underwent aortic valve replacement with small aortic annulus enlargement by the methods of Manouguian.The standard aortotomy incision was extended into the left valve and the noncoronary valve commissure,through the aortic annulus,and just into the anterior leaflet of the mitral valve.And the diameter of the small aortic annulus was enlarged with a pericardium extralining Docron patch.23mm or 25mm valves were implanted in adults.Results One patient with AVR and MVR died of low cardiac output syndrome.There were 3 cases of postoperative complication included one acute pericardial tamponade,one respiratory failure,one infection of gelatin sponge at the aortic root,and were all cured.Conclusion The Manouguian method of enlarged diameter of small aortic annulus with a pericardium extralining Docron patch is in practical value.