Reimplantation技术在二叶式主动脉瓣合并主动脉根部瘤中的应用  

Application of reimplantation in the treatment of bicuspid aortic valve with aortic root aneurysm

作　　者：龚湘峰 牛昊 秦超毅[1] 宋海波[2] 蒙炜[1] 武忠[1] 郭应强[1] 胡佳[1] 张尔永[1] 肖正华[1] GONG Xiangfeng;NIU Hao;QIN Chaoyi;SONG Haibo;MENG Wei;WU Zhong;GUO Yingqiang;HU Jia;ZHANG Eryong;XIAO Zhenghua(Department of Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院心脏大血管外科,成都610041 [2]四川大学华西医院麻醉科,成都610041

出　　处：《中国胸心血管外科临床杂志》2022年第10期1347-1353,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省科技计划项目(2019YJ0046);四川大学华西医院学科卓越发展1·3·5工程临床研究孵化项目(2019HXFH027)。

摘　　要：目的评估保留主动脉瓣的根部再植(reimplantation)技术在治疗主动脉瓣二叶式畸形(bicuspid aortic valve,BAV)合并主动脉根部瘤患者中的早期临床效果。方法回顾性分析2019年11月—2021年5月在四川大学华西医院采用reimplantation技术修复主动脉根部[直径45~63(52.68±5.55)mm]25例BAV患者的临床资料,其中男22例、女3例,年龄15~65(50.00±13.10)岁,体表面积(1.79±0.23)m^(2)。结果术中确认BAV病理分型:0型3例,Ⅰ型22例。瓣叶修复采用瓣叶中央折叠12例,融合嵴关闭缝合2例。术后瓣叶对合高度(0.78±0.15)cm,有效高度(1.27±0.19)cm。术中主动脉瓣最大流速(1.65±0.42)m/s,主动脉瓣平均压差(5.46±3.05)mm Hg,主动脉瓣环直径(21.32±0.95)mm。体外循环时间(225.84±35.34)min,主动脉阻断时间(189.60±26.51)min。住院时间(11.64±3.07)d,ICU停留时间(2.64±0.99)d,机械通气时间(1.48±0.87)d。随访时间(17.20±4.70)个月,25例患者无死亡及重大并发症发生。患者随访时心功能较术前明显改善(P≤0.05);彩色超声提示主动脉瓣无反流12例、微量反流10例、轻度反流3例且均为中央型,无中度及以上反流患者。与术前相比,随访时主动脉根部直径、左心室舒张末期内径及容积均明显缩小(P≤0.05),主动脉瓣最大流速(1.54±0.36)m/s,主动脉瓣平均压差(5.17±2.38)mm Hg。结论Reimplantation技术对于高选择性的BAV患者有良好的临床效果,能够有效避免术后长期抗凝,但术后主动脉瓣最大流速略微增快,可能与BAV本身构型有关,但相对瓣膜置换效果仍然值得肯定。Objective To evaluate the early clinical effect of reimplantation in the treatment of bicuspid aortic valve(BAV)with aortic root aneurysm.Methods The clinical data of 25 patients with BAV and aortic root aneurysm[mean diameter:45-63(52.68±5.55)mm]undergoing reimplantation in West China Hospital from November 2019 to May 2021 were retrospectively reviewed.There were 22 males and 3 females.The mean age was 15-65(50.00±13.10)years and body surface area was 1.79±0.23 m^(2).Results The pathological classification of BAV malformation was confirmed during the operation:Type 0 in 3 patients and Type 1 in 22 patients.There were 12 patients undergoing cusp central plication,and 2 patients were sutured with a closed fusion crest.Postoperative valve leaflet coaptation height was0.78±0.15 cm,and effective height was 1.27±0.19 cm.In operation,maximum aortic valve flow velocity was 1.65±0.42 m/s,pressure difference was 5.46±3.05 mm Hg,and aortic valve annulus diameter was 21.32±0.95 mm.Cardiopulmonary bypass time was 225.84±35.34 min,and aortic block time was 189.60±26.51 min.In-hospital time was 11.64±3.07 d,ICU stay time was 2.64±0.99 d,and mechanical ventilation time was 1.48±0.87 d.The follow-up time was 17.20±4.70 months,and no death or major complications occurred during the follow-up in all patients.The cardiac function of the patients significantly improved postoperatively(P≤0.05).Echocardiography suggested that 12 patients had no aortic regurgitation,10 minor aortic regurgitation,3 mild aortic regurgitation,and no patients with moderate or more severe regurgitation.The diameter of the aortic sinus,left ventricular end-diastolic diameter and volume decreased during the follow-up,compared to preoperative ones(P≤0.05).The maximum flow velocity of the aortic valve was 1.54±0.36 m/s,and the pressure difference was 5.17±2.38 mm Hg during the follow-up.Conclusion Reimplantation technology has a good clinical effect for highly selective BAV patients.It can effectively avoid long-term postoperative anticoagu

关 键 词：二叶式主动脉瓣 主动脉根部瘤 根部再植术 主动脉瓣反流 

分 类 号：R541.1[医药卫生—心血管疾病]