主动脉瓣病变合并升主动脉扩张的外科治疗

Surgical treatment for patients with aortic valve disease and ascending aorta dilatation

目的探讨主动脉瓣病变合并升主动脉扩张的外科处理方式。方法按照主动脉瓣瓣叶情况和外科处理方式将患者分组,利用心脏彩超随访测量不同方式处理后的升主动脉变化情况。结果三叶主动脉瓣行单纯置换瓣膜者的升主动脉年平均减少0.471 mm,同期行升主动脉成形者的升主动脉年平均减少0.27 mm;二叶主动脉瓣患者单纯置换瓣膜者其升主动脉年平均增加2.28 mm,同期行成主动脉成形者其升主动脉年平均增加2.923 mm。结论二叶主动脉瓣患者术后升主动脉扩张明显。二叶主动脉瓣患者术前升主动脉>40 mm宜进行置换手术,三叶主动脉瓣患者应谨慎同期处理升主动脉。

Objective To explore the surgical treatment for patients with aortic valve disease and ascending aorta dilatation. Methods The patients were divided into two groups according to the condition of aortic valve leaflet and surgical treatment. The changes of ascending aorta after different treatment were measured by echoeardiography. Results Among tricuspid aortic valve patients, diam- eter of ascending aorta in patients with simple aortic valve replacement decreased by 0.471 mm aver- agely per year, while diameter of ascending aorta in patients with the concomitant ascending aorta an- gioplasty decreased 0.27 mm averagely per year. Among bicuspid aortic valve patients, diameter of ascending aorta in patients with simple aortic valve replacement increased by 2.28 mm averagely per year, while diameter of ascending aorta in patients with the concomitant ascending aorta augioplasty increased 2. 923 mm averagely per year. Conclusion The patients with bicuspid aortic valve are more likely to develop ascending aorta dilatation after the operation of the aortic valve. Patients with bicuspid aortic valve should undergo ascending aorta replacement when aorta diameters are more than 40 mm. Patients with tricuspid aortic valve undergoing surgery must be very cautious.