主动脉根部正常的二叶式主动脉瓣(BAV)狭窄伴升主动脉瘤样扩张的手术治疗

The operative approach to the bicuspid aortic valve(BAV) with aortic valve stenosis and dilation of the ascending aorta

目的 对二叶式主动脉瓣（bicuspid aortic valve,BAV）狭窄伴升主动脉瘤样扩张患者进行回顾性分析,探讨其发病特点及手术方式的选择.方法 回顾分析复旦大学附属中山医院自2004年6月至2012年8月治疗的60例BAV狭窄合并升主动脉瘤样扩张患者行升主动脉瓣替换加主动脉替换（aortic valve replacement,AVR）术的资料.采用超声心动图测量主动脉根部内径、升主动脉内径及射血分数（ejection fraction,EF）值,部分患者行CT检查,对术前、术后及随访数据进行比较.结果 手术死亡3例（5％）,出院的57名患者随访到53例,随访率92.9％.随访时间平均（20.3±18.6）个月,所有患者均行超声心动图检查.超声心动图测量主动脉根部内径为28～47 mm,平均（38.2±4.1） mm,较术前差异无统计学意义（P＞0.05）,升主动脉内径为26～35mm,平均（31±2）mm;EF为0.49～0.71,平均0.6±0.2,无出院后死亡病例.结论 BAV狭窄伴升主动脉瘤样扩张患者,如其主动脉窦管部内径仍在正常范围内,可考虑行AVR加升主动脉替换术,该手术操作简单,手术风险降低,术后近期效果较好,远期疗效与Bentall术相近.

Objective To summarize the clinical characteristics and assess the surgical outcomes for the bicuspid aortic valve （BAV） patients with aortic valve stenosis and dilation of the ascending aorta by retrospective analysis. Methods During Jun. ,2014 and Aug. ,2012,60 BAV patients with aortic valve stenosis and dilation of the ascending aorta and without dilation of aortic root were performed with the composite aortic valve replacement （AVR） and ascending aorta replacement procedure. The data of aortic diameters at aortic root and ascending aorta and ejection fraction （EF） were acquared with echocardiography and some of them underwent CT scanning. Results Three hospital deaths occurred （5 %） ,53 of the other 57 patients were successfully followed up, with the follow-up rate of 92.9% and the average follow-up time of （20.3 ±18.6） months,all patients were examined by echoeardiography. The average data of aortic diameter at aortic root was （38.2± 4. 1 ）mm, while there was no statistical difference compared with preoperative dimension （P〉0.05）. The average diameter of ascending aorta was （31 ± 2） mm, and the average EF was 0.6± 0.2. No death occurred after discharge. Conclusions The BAV patients with aortic valve stenosis and dilation of the ascending aorta,if the aortal root dimension is normal, can be performed with separate valve and graft replacement, which can be achieved with simple operative procedure and low risk, while get excellent short-time outcomes. It also can obtain comparable long-time outcomes with the Bentall procedure.