自体肺动脉瓣移植替换主动脉瓣术的超声心动图评价

Echocardiographic assessment on Ross procedure of pulmonary autograft valve in place of aortic valve

目的 评价自体肺动脉瓣移植替换主动脉瓣术 (Ross术 )的主动脉瓣位自体肺动脉瓣和肺动脉瓣位同种异体肺动脉瓣的功能 ,自体肺动脉瓣根部内径在体循环环境中的变化。方法 1 5例Ross术患者 ,术前记录超声心动图 ,术后定期随访并记录超声心动图。多普勒方法评价主动脉瓣位自体肺动脉瓣、肺动脉瓣位同种异体肺动脉瓣有无反流、狭窄以及严重程度。比较自体肺动脉瓣瓣环及窦部的最大直径的变化。结果 随访时间为 6～ 1 8个月 ,平均 (8.1± 2 .5)月。主动脉瓣位自体肺动脉瓣及肺动脉瓣位同种异体肺动脉瓣均无中度至重度反流。最近的随访中 ,前者 1例轻至中度反流 ,3例轻度反流 ;后者 1例轻至中度反流 ,4例轻度反流 ;两者均无狭窄。出院时及最近随访主动脉瓣位自体肺动脉瓣瓣环内径无显著变化 ,而窦部内径明显增加。结论 Ross术近期效果满意。自体肺动脉瓣窦部内径早期扩张以适应体循环高压力环境 ,瓣环内径变化较小。

Objective To estimate pulmonary autograft v alve in the aortic position and pulmonary homograft valve function after the Ross procedure and to assess the changes in the pulmonary autograft root size as it was subjected to systemic pressure. Methods Echocardiographic follow-up data were evaluated in 15 patients who underwent the Ross procedure. Pulmonary autograft valve in the aortic position and pulmonary homograft valve function were estimated.The autograft annulus and sinus dimensions were measured and compared with at discharge and recent follow-up.Results The mean follow-up period was ( 8.1-± 2.5-)months (range 6-18 months).All pulmonary autograft valve and homograft valve had no stenosis,no moderate and severe regurgitation. At recent follow-up, 3 patients with mild regurgitation and 1 patient with mild-moderate were found in the pulmonary autograft valve. Four patients with mild and 1 patient with mild-moderate were found in the pulmonary homograft valve.No significant difference was noted between the values over time in autograft annulus.In contrast,there was a significant increase in autograft sinus. Conclusions Ross procedure showed excellent results.The autograft annulus size has a minimal change over time.In contrast, the autograft sinus showed an obvious increase in size over time.