人工主动脉瓣膜功能障碍二次置换术临床报道及思考

Clinical Report and Consideration of Secondary Replacement of Artificial Aortic Valve Dysfunction

目的分析人工主动脉瓣膜功能障碍二次置换术临床报道及思考。方法挑选2010年1月—2016年12月期间收治的9例主动脉瓣膜置换术后主动脉瓣膜功能障碍患者进行研究。分析患者手术相关情况、TEE所见与术后随访情况。结果其中7例实施了二次AVR术,术后TEE检查及随访显示取得了良好的治疗效果,消除了瓣膜反流、狭窄等症状,降低了跨主动脉瓣峰速、跨瓣平均压差,提高了有效瓣口面积指数,显著改善了运动耐力和患者的生活质量。结论术后患者未出现明显的术后并发症,二次AVR术具有较高的安全性。对于部分高龄、高危、存在体外循环手术禁忌的患者,TAVI、瓣中瓣等技术提供了可选择的替代治疗途径。

Objective To analyze the clinical report and consideration of secondary replacement for prosthetic aortic valve dysfunction.Methods 9 cases of patients with aortic valve dysfunction after aortic valve replacement from January 2010 to December 2016 were selected for study.The operation-related conditions,TEE findings and postoperative followup were analyzed.Results 7 cases underwent the second AVR,and the TEE examination and follow-up showed that the treatment effect was good,the symptoms such as valve regurgitation and stenosis were eliminated,the peak velocity and average pressure difference of the cross aortic valve were reduced,the effective valve area index was improved,the exercise tolerance and the quality of life of the patients were significantly improved.Conclusion There are no obvious postoperative complications in patients after operation,and secondary AVR operation has high safety.For some elderly,high-risk and taboo patients undergoing extracorporeal circulation surgery,TAVI,mid-valve and other technologies provide alternative treatment approaches.