小主动脉瓣环者行瓣膜置换手术后远期疗效随访  

Long-term results after mechanical valve replacement in patients with small aortic root

作　　者：张春曦[1] 罗兆榴[1] 吴戴红[1] 

机构地区：[1]广州市第一人民医院心胸外科,510180

出　　处：《国际医药卫生导报》2011年第16期1995-1997,共3页International Medicine and Health Guidance News

摘　　要：目的探讨小主动脉瓣环者接受机械瓣膜置换术后的远期疗效。方法2003年7月-2005年12月间，对36例成人小主动脉瓣环值径≤19mm）者行人工机械瓣膜置换术，其中主动脉瓣置换25例，主动脉瓣、二尖瓣双瓣置换11例。主动脉瓣置换采用改良Manougnian法瓣环扩大后植．A．23mmCarboMedics瓣14例（CM组、采用瓣环上瓣膜置换法植入19mmCarboMedicsTopHatSupra—AnnularAortic瓣22例（CMSA组），分析两组术前和术后第6年的临床及超声心动图资料。结果与术前比较，术后第6年两组患者的心功能明显改善，左心室的射血分数、短轴缩短率明显上升，舒张末内径、主动脉跨瓣压差明显降低，CM组的室间隔厚度、左心室后壁厚度明显缩小，差异具有显著性（P〈0．05、组问比较，CM组的主动脉跨瓣压差较CMSA组降低更加明显（P〈0．05），而室间隔厚度和左心室后壁厚度的均数值也小于CMSA组，已达健康成年人水平。结论小主动脉瓣环者机械瓣膜置换术后远期左心室功能恢复良好，行瓣环扩大而植入较大内径瓣膜者，更有利于左心室形态的逆转。Objective To evaluate the long-term effect after mechanical valve replacement in adult pa- tients with small aortic root, and guide clinical practice. Methods From July 2003 to December 2005, 36 patients with small aortic root （diameter ~〈 19 mm） received aortic prostheses; among which 25 cases underwent aortic valve replacement alone, and the other received mitral valve replacement besides aortic valve replacement. 23mm CarboMedics valve were implantated in 14 patients（CM group） by using of Manougnian＇s annulus enlarging technique; 22 patients received implantation of 19mmCarboMedics Top Hat Supra-Annular valve（CMSA group）. All of patients were followed up with echocardiography and cardiac functions Pre-operation ang 6th Year post-operation. Results Comparing with those before operation, cardiac function（NYHA） improved obviously, Left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） increased significantly, left ventricular end-diastolic diameter（LVDD）and pres- sure gradients across aortic valve（PGav） decreased obviously. Comparison Between groups, PGav , interventricular septal thickness（IVST）and left ventricular posterior wall thickness（LVPWT）of CM group reduced more obvious than CMSA group, has reached healthy aduh level. Conclusion The long-term effect after surgery is satisfied in adult patients with small aortic root, especially in left ventricular function. Implant ing a larger prosthesis is more beneficial for left ventricular morphology reversal.

关 键 词：小主动脉瓣环 主动脉瓣置换 主动脉瓣环扩大 左心室功能 左心室形态 

分 类 号：R654.2[医药卫生—外科学]