Ross术后中远期主动脉瓣反流的危险因素分析

目的 分析影响Ross手术后中、远期主动脉瓣反流的危险因素.方法 自1998年3月至2007年7月,47例主动脉瓣瓣膜疾病病人接受Ross手术,其中男25例,女22例;平均年龄(13.31±5.79)岁.术前诊断风湿性心脏病6例,先天性心脏病41例.病人均采用经胸超声评价主动脉瓣反流情况,采用Logistic:回归分析主动脉瓣反流危险因素.结果 全部病例随访(36.15±22.1)个月,均生存.主动脉窦径及主动脉瓣环直径均较术前明显增加,新主动脉瓣免于轻度以上反流率为82.9%.Logistic回归分析发现,术前主动脉瓣二瓣化畸形、术前主动脉瓣环扩大及病人年龄大于14岁为术后主动脉瓣反流的危险因素.结论 Ross手术治疗主动脉瓣膜疾病安全、有效,主动脉瓣可随机体发育而生长,其中、远期效果满意.年龄大于14岁、术前主动脉瓣环扩大及术前主动脉瓣二瓣化畸形是增加Ross手术后主动脉瓣反流的危险因素.     

Remodeling+Ring(改良Yacoub)技术治疗二叶式主动脉瓣反流合并升主动脉瘤一例

二叶式主动脉瓣患者常合并主动脉扩张,若主动脉瓣质量良好,可行保留主动脉瓣的主动脉根部置换术.本文报道了1例35岁二叶式主动脉瓣反流合并升主动脉瘤男性患者行Remodeling+Ring(改良Yacoub)手术.患者术后第3d复查心脏彩色超声提示主动脉瓣无反流,术后第6d顺利出院.Remodeling+Ring手术保证了...     

自体心包片加高法治疗主动脉瓣脱垂

目的总结用自体心包加高方法矫正主动脉瓣脱垂的临床经验。方法2000年5月至2007年7月,阜外心血管病医院共对17例主动脉瓣脱垂患者施行自体心包片加高手术,其中主动脉右冠瓣脱垂15例,左冠瓣脱垂1例,无冠瓣脱垂1例;主动脉瓣中度反流10例,重度反流7例。取自体心包,用5-0或6-0 Prolene线连续缝合加高脱垂的主动脉瓣。术中经食管超声心动图（TEE）检查提示：主动脉瓣微量至少量反流;对术前、术后超声心动图检查结果进行比较。结果术前、术后超声心动图检查结果比较：术后左心室舒张期末内径较术前明显缩小（38．3±9．6mm vs．47．2±10．3mm,P=0．013）;主动脉瓣收缩期压差（9．8±5．6mmHg vs．10．3±5．3mmHg,P=0．792）,主动脉瓣舒张期压差均较术前有明显缩小（45．7±13．6mmHg vs．78．4±19．9mmHg,P=0．000）。出院前超声心动图检查提示：无明显主动脉瓣反流4例,轻度反流9例,轻至中度反流4例。平均随访32个月（4～74个月）,1例术后4个月因主动脉瓣大量反流行主动脉瓣置换术,其余患者均不需要进行二次手术。结论主动脉瓣瓣叶自体心包加高成形其手术方法简便,对儿童或小主动脉瓣患者是一种良好的手术方式。     

小主动脉瓣环患者主动脉瓣置换术41例

目的总结主动脉瓣环加宽后的主动脉瓣置换术治疗小主动脉瓣环合并主动脉瓣病变患者的临床经验。方法对41例小主动脉瓣环合并主动脉瓣病变患者(瓣环直径为15~21 mm)行主动脉瓣环加宽后的主动脉瓣置换术,主动脉瓣环加宽采用改良N icks法11例,改良M anougn ian法29例,K onno法1例。结果41例患者主动脉瓣环加宽后都可以植入比测量的主动脉瓣环直径大1#或2#的主动脉瓣,无手术死亡。术后所有患者随访4~36个月(13±2个月),无死亡、瓣周漏、二尖瓣反流和主动脉扩张;超声心动图检查示:人工瓣跨瓣峰值压差为9~25mmHg(17±6mmHg),与术前的70~105mmHg(80±15mmHg)比较差别有统计学意义(P<0.01)。结论小主动脉瓣环合并主动脉瓣病变患者,在置换主动脉瓣时先行主动脉瓣环加宽,能使患者在术后获得良好的血流动力学效果,是一种安全、有效的手术术式。     

自体肺动脉瓣移植术治疗先天性主动脉瓣病变

目的　总结自体肺动脉瓣移植手术 (Ross手术 )治疗先天性主动脉瓣病变的疗效。方法　自 1994年 10月至 2 0 0 3年 11月 ,共收治 2 0例先天性主动脉瓣病变患者行Ross手术治疗 ,其中男 15例 ,女 5例 ,平均年龄 2 5岁 ;术前诊断 :主动脉瓣二瓣畸形 12例 ,主动脉瓣叶脱垂 5例 ,瓣叶发育不良 3例 ,合并亚急性细菌性心内膜炎 4例 ,合并室间隔缺损 2例。术前超声心动图检查 (UCG)示所有患者均存在主动脉瓣狭窄或 /并关闭不全 (中重度 )。左心室舒张末内径 (LVDD) (6 0 5 1±11 87)mm ,主动脉瓣跨瓣压差 (2 7 0 4± 6 80 )mmHg。心功能 (NYHA分级 )Ⅱ级 17例 ,Ⅲ级 3例。所有病例均在全麻体外循环中度低温下进行 ,手术分三步进行 :(1)采取自体肺动脉瓣 ;(2 )切除病变的主动脉瓣并移植自体肺动脉瓣于主动脉位 ;(3)利用同种动脉瓣重建右心室流出道。结果　全组患者无手术死亡 ;左心室舒张末内径明显缩小 ,为 (46 38± 9 17)mm (t=3 4 0 0 7,P =0 0 0 0 8) ,术后主动脉跨瓣压差降至正常范围 (6 80± 0 19)mmHg。术后随访 3个月至 9年 ,所有患者的主动脉瓣、肺动脉瓣结构及功能正常。结论　自体肺动脉瓣移植手术是一种临床疗效好的治疗先天性主动脉瓣病变的手术方法 ,近中期效果良好。     

应用自体肺动脉瓣置换主动脉瓣二例

1998年 3月～ 1999年 1月 ,我们对 2例先天性主动脉瓣狭窄患者施行了自体肺动脉瓣置换主动脉瓣、同种肺动脉瓣(HPV)原位右心室流出道重建 (Ross)手术 2例 ,取得了良好的临床效果。1　临床资料与方法1.1　一般资料　 2例中男、女各 1例 ;年龄分别为 12岁和 16岁。均为先天性主动脉瓣狭窄。 1例有心前区疼痛和头晕史。心电图示左心室肥厚 ,ST- T改变。心胸比率 0 .49和 0 .5 6。超声心动图示主动脉瓣中度至重度狭窄 ,均为二瓣化畸形。1.2　手术方法　开胸后测量主、肺动脉瓣环外径 ,分离主、肺动脉间隔至左、右肺动脉分叉处。在主动脉瓣上 …     

超声心动图评价主动脉瓣置换术后左心室收缩功能的改变

目的　利用超声心动图技术分析主动脉瓣高度狭窄患者心瓣膜置换术后的左心室收缩功能和心肌重量的改变。　方法　 74例患者分别于手术前和手术后 1个月接受经胸超声心动图检查 ,根据术前左心室射血分数 (EF)的不同分为两组。A组 :EF>5 0 % ,40例 ;B组 :EF≤ 5 0 % ,34例。　结果　 B组左心室收缩功能于术后明显改善 (P<0 .0 1) ,而 A组 EF轻度下降 (P<0 .0 5 )。两组左心室心肌重量指数术后均明显下降。　结论　主动脉瓣置换术对术前有左心功能不全的主动脉瓣高度狭窄患者术后心功能恢复有很大帮助     

升主动脉成形术中期效果分析

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)砌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.     

无包裹-纵切口升主动脉成形术治疗升主动脉扩张的疗效分析

目的探讨无包裹-纵切口升主动脉成形术治疗升主动脉扩张的临床疗效。方法 2005年9月-2011年5月,对53例主动脉瓣病变伴升主动脉扩张患者行主动脉瓣置换加无包裹-纵切口升主动脉成形术治疗。男41例,女12例;年龄22～75岁,平均52岁。病程1个月～14年。心脏彩色超声多普勒检查示术前升主动脉直径为(45.9±3.3)mm;主动脉瓣三叶瓣40例,主动脉瓣二叶畸形13例。心功能根据纽约心脏病协会(NYHA)分级标准:Ⅱ级19例,Ⅲ级33例,Ⅳ级1例。结果术后发生1例纵隔广泛渗血、3例肺部感染、1例Ⅲ度房室传导阻滞。患者均无升主动脉成形术相关并发症。53例均获随访,随访时间3～68个月,平均15个月。患者均无明显胸闷、心累。末次随访时心功能NYHA分级Ⅰ级22例,Ⅱ级31例。升主动脉直径为(35.2±4.0)mm,与术前比较差异有统计学意义(P=0.000);与术后出院时(34.0±2.5)mm比较差异无统计学意义(P=0.245)。其中,随访时间≥60个月者末次随访时升主动脉直径与术前、术后出院时比较,差异均有统计学意义(P<0.05);主动脉瓣二叶畸形患者末次随访时升主动脉直径与术前比较差异有统计学意义(P<0.05);术前升主动脉直径>50 mm患者末次随访时升主动脉直径与术前比较,差异无统计学意义(P>0.05)。结论无包裹-纵切口升主动脉成形术治疗主动脉瓣病变伴升主动脉轻-中度(直径范围40～50 mm)扩张患者可获得较好早中期疗效,但应严格选择患者,远期效果需进一步随访观察。     

二维和多普勒超声心动图评价同种主动脉瓣膜功能

自 1993年 10月至 1996年 10月 ,我们应用同种主动脉瓣(ＨＡＶ)行原位主动脉瓣置换 2 0例 ,其中 3例行ＲＯＳＳ手术。经二维、脉冲及彩色多普勒超声心动图对置换后的同种主动脉瓣膜解剖形态、生理功能、血流动力学效果研究证明疗效显著 ,现介绍如下。临床资料与方法　本组 2 0例中男 17例 ,女 3例 ;年龄13～ 6 0岁。均为主动脉瓣和主动脉根部病变 ,重度主动脉瓣关闭不全 9例 ,其中细菌性心内膜炎 4例 ,主动脉瓣二叶畸形和脱垂 3例 ,风湿性、巨大主动脉窦瘤各 1例 ;主动脉瓣狭窄并关闭不全 7例 ;重度主动脉瓣狭窄伴钙化 4例。手术在全麻低温…     

3-T magnetic resonance for determination of aortic valve area: A comparison to echocardiography

Objectives. For evaluation of aortic valve area (AVA), transthoracic echocardiography (TTE) is the method of choice. Cardiac magnetic resonance (CMR) at 1.5-Tesla is an alternative. The aim of the study was to check whether quantification of whole range of AVA without severe aortic stenosis is possible and reliable in higher magnetic field strength, and also including a comparison to TTE. Methods. In 3-T CMR phase contrast sequences were assessed above aortic valve and left ventricular output tract. AVA was calculated using the continuity equation. Planimetric analysis of AVA was performed in magnitude images. TTE was used as reference method for graduation of AVA. Results. Totally 48 patients (64 ± 18 years) without severe aortic valve stenosis were prospectively enrolled. In CMR planimetric AVA was 2.5 ± 1.3 cm² and calculated AVA 2.4 ± 1.3 cm², whereas AVA in TTE was 1.9 ± 1.1 cm². Planimetric and calculated AVA in CMR and also AVA in CMR and TTE showed good correlation (r = 0.97, 0.92, respectively). Bland–Altman analysis demonstrated no signs of over- or underestimation. Inter- and intraobserver variabilities were low. Discussion. Determination of AVA using 3-T CMR is possible using direct planimetry and continuity equation. CMR is the alternative first choice method in cases with discrepant or insufficient echocardiographic results.     

Successful valve repair for congenital bicuspid aortic valve and degenerated prolapsed mitral valve

A 54-year-old man with congenital bicuspid aortic valve underwent simultaneous valve repair for aortic and mitral regurgitation. Surgical technique consisted of plication of redundant aortic valve repair and mitral annuloplasty with chordal replacement. One-year follow-up transthoracic echocardiography showed no valve regurgitation. Valve repair for both bicuspid aortic valve and mitral valve regurgitation should be the first option in this subset of patients.     

A quadricuspid aortic valve diagnosed by transesophageal echocardiography: Report of a case

A quadricuspid aortic valve is a very rare anomaly which may cause aortic regurgitation in adulthood. We describe herein the case of a 54-year-old man with aortic regurgitation in whom a quadricuspid aortic valve was diagnosed, not through transthoracic investigation, but by transesophageal echocardiography (TEE). TEE also indicated that the right coronary ostium was located in a lower position. Subsequent aortic valve replacement was successfully performed, at which time the diagnosis was confirmed. Thus, TEE played an important role in identifying the anatomy of the aortic valve and the location of the coronary ostium.     

Balloon aortic valvuloplasty: Treatment of rapid deployment aortic valve replacement complicated by a paravalvular leak

The Edwards Intuity Elite valve system was designed to facilitate minimally invasive surgery and streamline complex aortic valve replacements and has since gained more popularity. Despite the superior results shown with rapid deployment aortic valve replacement (RDAVR) utilizing this valve system, paravalvular leaks (PVL), as a complication, remains a concern. Currently, there is no universally agreed single treatment option. A 53‐year‐old male with a history of well‐controlled diabetes mellitus and hypertension presented to the emergency room with a 1‐month history of angina, syncope on exertion and dyspnea. On further workup, he was found to have severe aortic stenosis in the setting of a bicuspid aortic valve, with non‐obstructive coronary artery disease. He proceeded to urgent RDAVR with a 23 mm Edwards Intuity Valve. Six months post‐RDAVR he re‐presented with dyspnea on exertion and near syncopal episodes. Postoperative transthoracic and transesophageal echocardiography revealed moderate to severe PVL posterior to the prosthetic aortic valve. Balloon valvuloplasty with a 25 mm True Balloon was performed. Resolution of the PVL was confirmed postprocedure both by angiography and echocardiography. The patient was followed for 1 year and remained symptom‐free with evidence of mild PVL on surveillance echocardiography. In conclusion, multiple treatment options for RDAVR complicated by PVL exist; however mid to long‐term outcome data are lacking. We presented one such case successfully treated with balloon aortic valvuloplasty.     

The value of transesophageal echocardiography during cardiac surgery

The intraoperative use of two-dimensional transesophageal echocardiography has proved effective in the evaluation of left ventricular function after heart operations, in the assessment of adequacy of valve replacement or repair techniques, and in the detection of intracardiac air bubbles before discontinuation of cardiopulmonary bypass. We report here a patient in whom the presence of a tumor mass in the left leaflet of the aortic valve, which was missed at preoperative transthoracic echocardiogram and would have most likely been the cause of systemic embolization, was diagnosed by two-dimensional transesophageal echocardiographic monitoring. We hope that this experience may support the use of two-dimensional transesophageal echocardiography during cardiac surgery.     

Severely calcified bicuspid aortic valve stenosis after valve-sparing root replacement: A word of caution

A 58-year-old man was admitted for reoperation for severe aortic stenosis in a previously preserved bicuspid aortic valve (BAV). He had undergone valve-sparing root replacement (VSSR) for dilated aortic root 6 years ago. Transesophageal echocardiography following VSSR showed good valve function with no aortic incompetence. However, the BAV became stenotic causing shortness of breath. At reoperation, the preserved BAV was noted to be fibrotic and calcified and had a fixed rigid small orifice. It was replaced with a biological valve plus root enlargement. Macroscopic finding showed thickening of the cusps and nodular calcification. Microscopic examination revealed severe nodular calcification.     

Left coronary ostial obstruction after aortic valve replacement with a supra-annular aortic valve

We report a rare case of left coronary ostial obstruction after aortic valve replacement with a Top Hat supra-annular aortic valve, which was diagnosed with intraoperative transesophageal echocardiography and successfully treated with an unplanned coronary bypass. The patient was a 76-year-old woman (height 143 cm, weight 44 kg) with aortic stenosis and regurgitation. A 19-mm Top Hat valve was implanted in the supra-annular position because of a small aortic annulus. There was a possibility that the high profile of this prosthesis might block the left coronary ostium. There may be a problem with the use of this prosthesis in patients with small and rigid aortic roots with little compliance. Although the Top Hat valve has a great advantage for small aortic annuli, care in its use should be taken due to possible interference with the coronary ostia. (Jpn J Thorac Cardiovasc Surg 2006; 54:199-202)     

Surgically treated aortic root aneurysm following aortic valve replacement

A 65-year-old man with aortic regurgitation underwent aortic valve replacement with a St. Jude Medical prosthetic valve about 6 years ago. At that time, the aortic root was slightly dilated at about 40 mm in diameter and the ascending aorta was within the normal range. This year, the man was diagnosed with an aortic root aneurysm in regular follow-up echocardiography. Chest-enhanced computed tomography and chest aortography at our hospital demonstrated a pear-like aortic root aneurysm about 60 mm in diameter. Elective operation for the aortic root aneurysm was conducted September 29, 1999, based on the Bentall procedure. Composite graft replacement with coronary reconstruction was conducted using a 28-mm Hemashield prosthetic graft and a 23-mm St. Jude Medical prosthetic valve under cardiopulmonary bypass. An 8-mm Hemashield graft was interposed on the left main coronary artery and the right coronary artery was directly anastomosed using a Carrel patch method. The postoperative course was uneventful and post-operative examination demonstrated good surgical results. Histological findings of the aortic aneurysm wall showed cystic medial necrosis. Surgical cases of aortic root aneurysm after aortic valve replacement are rare, but serious complications with the possibility of rupture or dissection warrant surgical intervention.     

Intraoperative right coronary artery obstruction due to aortic root prosthesis mismatch after aortic valve replacement—A case report

Iatrogenic intraoperative coronary artery ostial occlusion is quite rare and a dangerous complication of aortic valve replacement. Intraoperative vigilance and prompt intervention are required to manage this fatal complication. A case report of a 48‐year‐old female with normal coronaries who underwent aortic valve replacement and had right ventricle distension is described here. It seemed that the cause which led to right coronary ostial obstruction was due to prosthesis aortic root mismatch and it required bypass with a vein graft. Computed tomographic angiography of aortic root showed abutting of right coronary ostium by the aortic valve prosthesis     

Rapid-deployment aortic valve replacement after aortic root replacement: A safe alternative to redo root replacement

Reoperative aortic root replacement, following prior biologic or mechanical valved conduit aortic root prosthesis, presents a technical challenge. The rapid-deployment aortic valve prosthesis is an approved alternative to traditional bioprosthetic aortic valve replacement. We present three clinical cases in which rapid-deployment aortic valve prostheses were utilized in lieu of reoperative full aortic root replacement. All three patients recovered uneventfully. The rapid-deployment valve insertion in a prior surgical aortic root prosthesis is a safe option to avoid reoperative full aortic root replacement.