Ross手术治疗先天性主动脉瓣膜疾病

Ross procedure for surgical treatment of the congenital aortic valve disease

目的 总结 Ross手术治疗先天性主动脉瓣膜疾病的临床经验和手术结果。 方法 自 1998年 3月至2 0 0 2年 7月 ,16例主动脉瓣膜疾病患者 (平均年龄 14 .0± 9.9岁 )接受 Ross手术 ,即自体肺动脉瓣移植术。诊断为主动脉瓣二瓣化畸形 ,主动脉瓣狭窄 9例 ,主动脉瓣发育不良呈穹隆状狭窄 2例 ;主动脉瓣脱垂 5例 ,其中合并室间隔缺损和动脉导管未闭各 1例。 结果 无手术死亡 ,全部患者治愈出院。随访 1～ 4 8个月 ,平均 30± 13个月 ,无远期死亡 ,无瓣膜相关并发症。所有患者心功能 级。超声心动图提示主动脉瓣及同种肺动脉瓣功能良好 ,仅 1例患者主动脉瓣有极少量反流 ;所有患者主动脉瓣跨瓣压差 2 .1± 0 .8mm Hg(1k Pa=7.5 mm Hg) ,左心室流出道及主动脉瓣环随着年龄的生长而增长 ,平均瓣环直径较术后增加 4 .0± 2 .1mm。 结论 Ross手术治疗主动脉瓣膜疾病安全 ,效果好 ,随机体发育而生长 ,可适于某些主动脉瓣瓣膜疾病 ,尤其适于小儿及年轻患者。

Objective To review the clinical experience and result of Ross operation in surgical repair for the congenital aortic valve disease. Methods From March 1998 to July 2002, 16 patients (mean age 14.0± 9.9 years) underwent Ross procedure for congenital aortic valve disease. Among them, 13 patients were younger than 16 years. The diagnosis included bicuspid aortic valve and aortic stenosis in 9, simple aortic stenosis shaped like arched roof in 2, prolapse of aortic valve and aortic insufficiency in 5. Among them, one associated with ventricular septal defect and another with patent ductus arterious. All patients underwent Ross procedure under cardiopulmonary bypass. Results There were no operative death, all patients were discharged uneventfully. Follow-up from 1-48 months (mean 30±13 months), no late deaths, and no valve-related events were observed during the period. The cardiac function was in NYHA class Ⅰ for all patients. The result of echocardiography showed that the function of the aortic valve and the pulmonary homograft valve was well; the hemodynamic of the pulmonary autograft were normal with an average mean gradient of 2.1±0.8 mmHg, and one patients with trivial insufficiency. Serial measurement of the left ventricular outflow tract and aortic root showed that the diameters were increased with patients growing -up,the diameter of the autografts increased 4.0±2.1mm than that of postoperation immediately. The outcomes were satisfactory. Conclusions Ross operation is a safe, effective procedure. It can be used for kinds of congenital aortic valve disease with the advantage of real potential for growth, especially in children and young patients.