Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargem...Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.展开更多
目的探讨小主动脉瓣环（直径≤19mm）患者行St．Jude Medical Regent（SJM Regent）瓣膜置换术后的心功能改变，研究是否存在植入瓣膜与患者不匹配（Prosthesis-Patient Mismatch，PPM）现象．以及是否有行主动脉瓣瓣环扩大术的必要。方...目的探讨小主动脉瓣环（直径≤19mm）患者行St．Jude Medical Regent（SJM Regent）瓣膜置换术后的心功能改变，研究是否存在植入瓣膜与患者不匹配（Prosthesis-Patient Mismatch，PPM）现象．以及是否有行主动脉瓣瓣环扩大术的必要。方法2004年3月-2005年3月，22例主动脉瓣环直径≤19mm患者置换SJM Regent机械瓣，用彩色多普勒超声仪对左心功能进行术前、术后监测．并与22例置换St．Jude Medical Hemodynamic Plus Series（SJMHP）机械瓣及22例置换外径23mm常规机械瓣患者进行对比。结果置换SJM Regent机械瓣膜患者术后的左心功能指标较术前明显好转，左室射血分数、左室缩短分数、瓣膜有效开口面积／体表面积之比（EOA指数）明显上升，左室重量指数及主动脉跨瓣压差也有不同程度降低。左心功能各项指标改善明显好于置换SJMHP机械瓣患者．部分指标接近或好于置换外径23mm瓣膜者。结论对于小主动脉瓣环患者．置换Regent机械瓣后指标已经接近或达到置换外径23mm常规瓣膜者，无PPM现象，大部分患者无须行主动脉瓣瓣环扩大术。展开更多
目的通过观察动态有效瓣口面积指数(effective orifice area index,EOAI)的变化,评价两种扩大瓣环主动脉瓣置换术的中期效果。方法总结30例扩大瓣环的主动脉瓣置换术患者的临床资料和术前、术后早期和中期动态EOAI变化及其他超声心动图...目的通过观察动态有效瓣口面积指数(effective orifice area index,EOAI)的变化,评价两种扩大瓣环主动脉瓣置换术的中期效果。方法总结30例扩大瓣环的主动脉瓣置换术患者的临床资料和术前、术后早期和中期动态EOAI变化及其他超声心动图指标,并和同期常规主动脉瓣置换患者29例的资料进行比较。结果采用Konno法12例,Manougnian 18例,扩大瓣环组早期病死率3.33%,早期心律失常发生率76.3%,低心排血量综合征发生率34.1%。随访21～109个月,随访率100%。Konno亚组和Manougnian亚组3年后左心室质量指数、左心室厚度、平均跨瓣压差比较,差异无统计学意义(P>0.05)。普通瓣膜组与扩大瓣环组术后1年、3年生存率比较,差异无统计学意义(96.5%vs.96.5%,P=0.23;86.2%vs.89.65%,P=0.14)。Manouguian亚组与Konno亚组3年生存率比较,也差异无统计学意义(91.6%vs.88.23%,P>0.05)。扩大瓣环组和普通瓣膜组相比,手术时间,传导束损伤发生率差异有统计学意义(P<0.05)。术后3年时,Manougnian亚组和Konno亚组EOAI值高于普通换瓣组,其中Konno亚组高于Manougnian亚组,差异有统计学意义(P<0.05)。3年随访中和Konno亚组Konno亚组和Manougnian亚组相比,延迟性瓣膜不匹配现象(dalated prosthesis-patient mismatch,DPPM)发生率差异有统计学意义(10.0%vs.26.6%,P<0.05)。结论两种扩大瓣环方式行主动脉瓣置换术在青少年患者中均获得良好的中期效果。从动态EOAI指标观察,Konno法较改良Manougnian法更能达到扩大瓣环直径的效果,DPPM发生率明显降低。Konno法发生DPPM的比例明显低于Manougnian法,Konno法有较大优势,可以作为青少年患者主动脉瓣置换术的首选方法。展开更多
目的探讨成年人小主动脉瓣环者机械瓣膜置换术后的远期疗效，以指导临床实践。方法2003年7月至2005年2月对36例小主动脉瓣环（直径≤19mm）的成年患者行人工机械瓣膜置换术。分别采用改良Manougnian法瓣环扩大后植入23mm CarboMedics机...目的探讨成年人小主动脉瓣环者机械瓣膜置换术后的远期疗效，以指导临床实践。方法2003年7月至2005年2月对36例小主动脉瓣环（直径≤19mm）的成年患者行人工机械瓣膜置换术。分别采用改良Manougnian法瓣环扩大后植入23mm CarboMedics机械瓣膜14例（CM组）；瓣环上主动脉瓣置换法直接植入19 mm CarboMedics Top Hat Supra-Annular Aortic机械瓣膜22例（CMSA组），于术前和术后6年评价两组患者的心功能，超声心动图检测左心室舒张末内径（LVDD）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、收缩期主动脉瓣平均跨瓣压差（PGav）、左心室短轴缩短率（LVFS），计算左心室射血分数。并抽取20例健康成年人的超声心动图数据作为对照组，对三组资料进行对比分析。结果术后6年与术前比较，除CMSA组的IVST[（10．37±2．06）mm比（11．03±2．45）mm]和LVPWT[（10．53±2．18）mm比（11．24±3．09）mm]差异无统计学意义外，CMSA组的心功能分级、LVDD、PGav、LVEF、LVFS和CM组的全部检测指标均较术前有不同程度改善（P〈0．01或〈0．05o术后6年CM组的PGav较CMSA组下降更明显[（9．24±5．93）mmHg（1mmHg=0．133kPa）比（24．30±12．50）mmHg]，差异有统计学意义（P〈0．05）；CM组术后6年各项指标与对照组比较差异无统计学意义，而CMSA组的IVST、LVPWT、PGav与对照组比较差异仍有统计学意义（P〈0．05）。结论成年人小主动脉瓣环者机械瓣膜置换术后远期左心室功能多恢复良好，但行瓣环扩大术应植入较大内径的瓣膜，将有利于左心室形态的逆转。展开更多
文摘Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.
文摘目的探讨小主动脉瓣环（直径≤19mm）患者行St．Jude Medical Regent（SJM Regent）瓣膜置换术后的心功能改变，研究是否存在植入瓣膜与患者不匹配（Prosthesis-Patient Mismatch，PPM）现象．以及是否有行主动脉瓣瓣环扩大术的必要。方法2004年3月-2005年3月，22例主动脉瓣环直径≤19mm患者置换SJM Regent机械瓣，用彩色多普勒超声仪对左心功能进行术前、术后监测．并与22例置换St．Jude Medical Hemodynamic Plus Series（SJMHP）机械瓣及22例置换外径23mm常规机械瓣患者进行对比。结果置换SJM Regent机械瓣膜患者术后的左心功能指标较术前明显好转，左室射血分数、左室缩短分数、瓣膜有效开口面积／体表面积之比（EOA指数）明显上升，左室重量指数及主动脉跨瓣压差也有不同程度降低。左心功能各项指标改善明显好于置换SJMHP机械瓣患者．部分指标接近或好于置换外径23mm瓣膜者。结论对于小主动脉瓣环患者．置换Regent机械瓣后指标已经接近或达到置换外径23mm常规瓣膜者，无PPM现象，大部分患者无须行主动脉瓣瓣环扩大术。
文摘目的探讨成年人小主动脉瓣环者机械瓣膜置换术后的远期疗效，以指导临床实践。方法2003年7月至2005年2月对36例小主动脉瓣环（直径≤19mm）的成年患者行人工机械瓣膜置换术。分别采用改良Manougnian法瓣环扩大后植入23mm CarboMedics机械瓣膜14例（CM组）；瓣环上主动脉瓣置换法直接植入19 mm CarboMedics Top Hat Supra-Annular Aortic机械瓣膜22例（CMSA组），于术前和术后6年评价两组患者的心功能，超声心动图检测左心室舒张末内径（LVDD）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、收缩期主动脉瓣平均跨瓣压差（PGav）、左心室短轴缩短率（LVFS），计算左心室射血分数。并抽取20例健康成年人的超声心动图数据作为对照组，对三组资料进行对比分析。结果术后6年与术前比较，除CMSA组的IVST[（10．37±2．06）mm比（11．03±2．45）mm]和LVPWT[（10．53±2．18）mm比（11．24±3．09）mm]差异无统计学意义外，CMSA组的心功能分级、LVDD、PGav、LVEF、LVFS和CM组的全部检测指标均较术前有不同程度改善（P〈0．01或〈0．05o术后6年CM组的PGav较CMSA组下降更明显[（9．24±5．93）mmHg（1mmHg=0．133kPa）比（24．30±12．50）mmHg]，差异有统计学意义（P〈0．05）；CM组术后6年各项指标与对照组比较差异无统计学意义，而CMSA组的IVST、LVPWT、PGav与对照组比较差异仍有统计学意义（P〈0．05）。结论成年人小主动脉瓣环者机械瓣膜置换术后远期左心室功能多恢复良好，但行瓣环扩大术应植入较大内径的瓣膜，将有利于左心室形态的逆转。
