自体肺动脉瓣移植术治疗主动脉瓣病变10例

Clinical experiences of Ross procedure treating aortic valve disease

目的 :总结本院心外科自体肺动脉瓣移植术 (Ross手术 )的临床应用情况。方法 :2 0 0 2年 1月 10日至2 0 0 2年 8月 31日 ,本院心外科共完成Ross手术 10例 ;术前诊断 :先心病 ,主动脉瓣病变 9例 ,老年退行性病变 1例 ,UCG示主动脉瓣病变 ,狭窄或 /并关闭不全 (中重度 ) ,术前心功能 (NYHA)Ⅱ级 7例 ,Ⅲ级 3例 ;所有病例均在全麻体外循环中度低温下进行 ,手术分三步进行 :①采取自体肺动脉瓣 ;②切除病变的主动脉瓣并移植自体肺动脉瓣于主动脉位 ,采用主动脉根部移植法 ;③利用同种异体肺动脉瓣重建右室流出道。结果 :全组患者无手术死亡 ;术后主动脉瓣跨瓣压差在正常范围 ((7.0 7± 0 .96 )mmHg) ,LVDD明显缩小 (P <0 .0 0 1) ,LVEF :0 .5 5± 0 .19,心功能Ⅱ级。随访 1周～ 8个月 ,心功能Ⅰ～Ⅱ级 ,主动脉瓣、肺动脉瓣均功能良好。结论 :Ross是一种临床疗效好的治疗主动脉瓣病变的手术方法。

Aim:To summarize cases of auto transplantation of pulmonary valve (Ross procedure) performed in Anzhen Hospital.Methods:Ten cases diagnosed as congenital heart disease(CHD)(aortic disease: 9 cases; aged degenerated aortic valve disease: 1 case) were performed Ross procedure in Anzhen Hospital from Jan. 2002 to July 2002; UCG showed aortic value disease, AS and/or AI(moderate to severe), heart function(NYHA): Class Ⅱ: 7 cases; Class Ⅲ: 3 cases; all cases were performed under CPB and moderate hypothermia, the operation procedures were:a)taking off auto pulmonary artery valve; b)removing dysfunctional aortic valve and auto transplantation of pulmonary valve on aortic root; c)putting a homograft in right ventricular outflow tract.Result:The mortality was during the stay at hospital, aortic valve function were all normal, the grade pressure across aortic valve was in normal limitation ((7.07±0.96) mmHg), LVDD decreased significantly( P <0.001), LVEF: 0.55±0.19, heart function (NYHA) were in class Ⅱ.One week to 7 months follow up showed that heart function was in Class Ⅰ～Ⅱ(NYHA), aortic and pulmonary valve function were very good.Conclusion: Ross procedure is effective for aortic valve disease.