升主动脉成形术中期效果分析  

Unsupported reduction ascending aortoplasty： midterm follow-up and analysis

作　　者：谢涌泉[1] 胡盛寿[1] 许建屏[1] 孙立忠[1] 宋云虎[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院外科,北京100037

出　　处：《中华胸心血管外科杂志》2009年第3期145-147,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的分析升主动脉成形术治疗主动脉瓣病变伴升主动脉扩张病人的中期随访结果并总结其临床经验。方法1996年10月至2007年4月对54例主动脉瓣病变伴升主动脉扩张的病人行主动脉瓣膜置换和升主动脉成形术，术后随访13～96个月，平均（23±16）个月。分别于术前、出院前及术后随访中，通过心脏超声检查测量升主动脉直径。结果围术期死亡2例。术前升主动脉直径（45．77±6．02）mm与出院前升主动脉直径（34．67±4．81）mm二者比较差异有统计学意义（P〈0．01）。术后随访升主动脉直径（37．65±6．35）mm与术前及术后出院前比较差异亦均有统计学意义（P〈0．01）。单纯主动脉瓣狭窄的基础病变和术后出院前升主动脉直径大于40mm是升主动脉再扩张的独立风险因素。结论升主动脉成形术中未用人工血管包裹治疗主动脉瓣病变伴升主动脉扩张或者升主动脉瘤的中期疗效欠佳。单纯主动脉瓣狭窄是这种术式的适应证，成形术必须将主动脉直径减至40mm以下，以减少远期再扩张。Objective Reduction ascending aortoplasty is an alternative procedure to the replacement of the ascending aorta in case of ascending aorta dilation. However, its appheabihty is still under debate. This retrospective study was designed to evaluate the midterm follow-up of unsupported ascending reduction aortoplasty for dilatation of the ascending aorta in patients with aortic valve disease. Methods From October , 1996 to April ,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution. The diameter of the ascending aorta was measured before and early after surgery and then later between 13 and 96 months [ mean （ 23 ± 16 ） months ] postoperatively using echocatthography. Results Two patients were dead with thean overall perioporative mortality rate was of 3.7%. The reduction acrtoplasty decreased the diameter of the aorta from （45.77 ± 6.02 ） mm preoperatively to （34.67 ± 4.81 ） mm early after surgery （ P 〈 0.01 ）. During follow-up, the diameter of aorta increased from （ 34.67 ± 4.81 ）mm early after surgery to （37.65 ± 6.35） n-an after a mean follow-up of （23± 16） months （P〈0.01）, including the diameters are greater than 〉 45 mm within 5 patients. Aortic stenosis and an early postoperative diameter greater than 40 mm are independent risk factors for redilatation. Conclusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortop/asty for dilatation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate follow-up or even reoperation. The patients of aortic stenesis is the suitable indication for RAA, and it is necessary to reduce the diameter of aorta to be less than 40 mm to prevent redilatation.

关 键 词：心脏外科手术 主动脉 主动脉瓣 心脏瓣膜假体植人 主动脉成形术 

分 类 号：R686[医药卫生—骨科学]