瓣膜修复在反流性主动脉瓣二叶畸形患者中应用的近中期结果  

Short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves

作　　者：张步升 戴黄栋 方亮[1] 谢晓奕[2] 李伟[1] 孔烨[1] ZHANG Busheng;DAI Huangdong;FANG Liang;XIE Xiaoyi;LI Wei;KONG Ye(Department of Cardiac Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai,200030,P.R.China;Department of Ultrasound,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai,200030,P.R.China)

机构地区：[1]上海市胸科医院上海交通大学附属胸科医院心外科,上海200030 [2]上海市胸科医院上海交通大学附属胸科医院超声科,上海200030

出　　处：《中国胸心血管外科临床杂志》2021年第12期1436-1440,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市胸科医院基础研究院内培育项目(2020YNJCM09)。

摘　　要：目的评价瓣膜修复技术在反流性主动脉瓣二叶畸形(BAV)患者中应用的近中期临床结果。方法回顾性分析2016年9月至2020年1月期间,在我院行瓣膜修复术的27例反流性BAV患者临床资料,其中男24例、女3例,平均年龄20~68(38.5±14.6)岁。27例患者病理分型均为Seviers 1型。左右冠瓣融合23例,右冠瓣和无冠瓣融合4例。心脏彩色超声:主动脉瓣中度反流3例、中重度18例、重度6例。主动脉瓣环(27.9±3.4)mm,主动脉窦部最大径(39.9±7.6)mm,左心室舒张末期内径(62.7±6.5)mm,左心室舒张末期容积(197.9±53.6)mL。结果 27例患者全部获得随访。随访时间12~51(24.2±12.5)个月,末次随访时患者全部存活,无主动脉瓣再次手术。患者心功能较术前明显改善(P<0.05);随访心脏彩色超声提示:主动脉瓣无反流11例、轻度反流13例、中度反流3例,无重度反流患者。与术前相比,左心室舒张末期内径及容积均明显缩小(P<0.05)。结论瓣膜修复技术应用于反流性BAV患者中是安全有效的,具有良好的近中期结果。Objective To evaluate the short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves(BAV). Methods The clinical data of 27 consecutive patients with insufficient BAV undergoing valve repair in Shanghai Chest Hospital from September 2016 to January 2020 were retrospectively reviewed. There were 24 males and 3 females with a mean age of 38.5±14.6 years(range: 20-68 years). BAV of all patients was type 1 in Seviers’ classification. There were 23 patients with left-right fusion and 4 patients with right-noncoronary fusion. There was aortic regurgitation in the patients measured by the echocardiogram, including moderate regurgitation in 3 patients, moderatesevere in 18 patients, and severe in 6 patients. The diameter of aortic annular base was 27.9±3.4 mm, and the largest diameter of aortic sinus was 39.9±7.6 mm. Left ventricular end diastolic diameter was 62.7±6.5 mm, and the volume was197.9±53.6 mL. Results All 27 patients completed the follow-up, and the mean time was 24.2±12.5 months(range: 12-51 months). No patient died or required aortic valve-related reoperation during the follow-up. The cardiac function of the patients significantly improved postoperatively(P<0.05). By echocardiography, 11 patients had no aortic regurgitation, 13 had mild aortic regurgitation, and 3 had moderate aortic regurgitation, and no patient had severe aortic regurgitation.Postoperative left ventricular end diastolic diameter and volume decreased, compared to preoperative ones(P<0.05).Conclusion In patients with insufficient BAV, valve repair is safe and effective, and has excellent short and mid-term outcomes.

关 键 词：主动脉瓣二叶畸形 主动脉瓣反流 瓣膜修复 主动脉瓣环成形 手术 

分 类 号：R654.2[医药卫生—外科学]