个体模具化测量自体心包主动脉瓣成形技术

The aortic valve reconstruction with autologons pericardium by individual sizing technique

目的 探讨总结我院近年来使用个体化模具自体心包主动脉瓣成形手术的治疗效果。方法 常规正中开胸，游离心包置入0.6%戊二醛浸泡10 min，冲洗后备用。常规建立体外循环，去除病变瓣膜，使用模具测瓣器分别测量3个主动脉瓣环交界－交界之间的弧形大小。分别使用模具裁剪相应大小的心包片。使用强生4-0 prolene线连续缝合新制成的主动脉瓣叶，相邻心包瓣叶重新4-0 prolene线加毡片固定到主动脉壁外侧。二叶或四叶畸形患者重新构建主动脉瓣环走向。主动脉窦部有扩张或二叶畸形但不需要人工血管置换者在窦管结合部进行外侧毡条环缩固定。结果 2015年10月以来共进行个体模具化测量自体心包主动脉瓣成形技术27例，年龄27-60岁，男9例，女18例。术前主动脉瓣狭窄7例，主动脉瓣关闭不全20例。其中主动脉瓣二叶畸形3例，四叶畸形1例。主动脉阻断时间平均（104±25）min。术后食管超声心动图显示自体心包主动脉瓣叶对合良好，无明显反流，正向流速平均压差（8.5±3.2）mmHg（1 mmHg＝0.133 kPa）。早期1例主动脉瓣退行性变狭窄合并关闭不全患者，保留二个瓣叶仅行自体心包单瓣叶成形术，术后仍有主动脉瓣中度反流，进行再次主动脉瓣置换。所有患者均顺利恢复出院，阿司匹林抗凝随访6个月。术后随访3-13个月，患者心脏功能和主动脉瓣功能稳定，无主动脉瓣明显反流或正向流速增快。结论 这种个体化模具测量自体心包主动脉瓣成形技术操作相对简单，初步临床治疗效果满意，值得深入研究和长期随访。

Objective To conclude the preliminary results of aortic valve repair with autopericardium. Methods After routine median sternotomy the pericardium was isolated and immersed into the 0.6% glutaraldehyde immersion for 10 minutes, then rinsed off before use. Conventional extracorporeal circulation was established and diseased aortic valves were removed. The curves lengths between three measured with the specific sizers. The corresponding size of the pericardial patchs was used to cut the new aortic leaflets. The continuous Johnson Prolene 4-0 sutures were used to fixed the new aortic valve leaf- lets to the anulus. Another new 4-0 prolene suture were used to fix the new three commissures outside the aortic wall with mat. The new mat stripes were used to fix the sinus in condition with the aortic sinus dilation or bileaflets malformation. Results Since 2015 October total 27 patients received aortic valve repair with autologous pericardium. The age was in the range of 27 to 60 years old including 18 female and 9 male. There were 7 cases diagnosed as aortic valve stenosis and 20 cases aortic insufficiency. And there were 3 cases bileaflets aortic valve deformity. The mean bypass time is （ 104 ± 25 ） rains. Postoperative esophageal ultrasound showed good coaptation of the aortic valve without significant regurgitation. The mean transvalve gradient was （8.5 ± 3.2）mmHg（ 1 mmHg = 0. 133 kPa）. In the early stage one case diagnosed with aortic valve stenosis and regurgitation received monocusp repaired with autologous pericardial leave. But there was still moderate aortic regurgitation and had to receive the aortic valve replacement. All patients recovered well and were treated with Aspirin for 6 months. The followed up lasted for 3 to 13 months. Mean aortic occlusion time was （104 ± 25 ） minutes. The patients were followed up for 3 - 13 months, the cardiac function and aortic valve function were stable, and no gradient increased. Conclusion It is relatively simple to perform the aortic valve repair with individual autologous pericardial sizer technique and the primary clinic results are satisfactory. It is worthy of further study and long-term follow-up.