小儿主动脉瓣关闭不全主动脉瓣成形术的探讨

目的：总结为28例主动脉瓣中、重度关闭不全(AI)小儿行主动脉瓣成形术(AVP)的经验。方法：对28例AI患儿行主动脉瓣成形术，包括主动脉瓣折叠、悬吊、穿孔修补及窦管交界环缩等成形手术。结果：全组无死亡，随访期间15例术前中度关闭不全患中14例转为≤轻度关闭不全，1例不变；术前13例重度关闭不全中，12例转为≤轻度关闭不全中1例转为中度关闭不全，并且行主动脉瓣置换术。结论：对主动脉瓣关闭不全的患儿，无论其关闭不全程度如何均应首选主动脉瓣成形术。     

主动脉瓣成形术在主动脉瓣关闭不全外科治疗中的近期效果分析

目的 分析主动脉瓣成形术(AVP)治疗主动脉瓣关闭不全(AI)的近期效果.方法 回顾性分析2018年1月至2020年12月选取的29例因主动脉瓣关闭不全在阜外华中心血管病医院行主动脉瓣成形术的患者为成形组,并随机收集同期30例因主动脉瓣关闭不全行主动脉瓣置换术的患者作为对照(置换组),出院后通过门诊复查和电话进行随访,...     

室间隔缺损合并主动脉瓣关闭不全的外科治疗

室间隔缺损合并主动脉瓣关闭不全为一综合病征，其发生机制有其独特的解剖学和病理生理学特征。本院９年来共手术治疗这种综合征９例，均获良好效果，其中４例仅施行单纯室间隔缺损修补术，５例同时施行主动脉瓣成形术。有１例因合并风湿性二尖瓣病变及脾功能亢进，同期施行二尖瓣替换术及巨脾摘除术。并发症及手术死亡。随诊４个月至８年，均恢复良好，８例心功能为Ⅰ级，１例为Ⅱ级，心脏均较术前明显缩小。本文对这一综合征的临床特点、发病机制和手术技术进行了讨论。     

经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全

【摘要】 目的 探讨Venus-A支架瓣膜行经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全患者的可行性。方法 回顾性调阅2018年12月至2019年12月在阜外医院接受经股动脉经导管主动脉瓣置换术的15例单纯主动脉瓣关闭不全患者的床资料。其中男性12例, 女性3例,年龄68—83岁,平均年龄(74.65±5.52)岁。患者术前均有左心功能不全症状,且术前心脏超声诊断均为单纯主动脉瓣重度返流。结果 患者行经股动脉经导管主动脉瓣置换术。所有病例成功植入Venus-A支架瓣膜。全组病例无死亡。出院前对患者进行临床评估和超声心动图检查。术中行瓣中瓣治疗3例,少量瓣周返流2例。其余病人均无明显瓣周返流,并且顺利出院。结论 经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全患者是可行的,术后早期结果满意。     

小儿主动脉瓣关闭不全伴室间隔缺损的外科治疗

报告手术治疗17例小儿主动脉瓣关闭不全伴室间隔缺损(室缺)的外科治疗.其中肺动脉瓣下型空缺10例,膜周型室缺7例.术式为主动脉瓣折叠整形和空缺修补.随访1～4年,扇超复查发现主动脉瓣轻至中度返流2例,轻微返流8例.除1例有Ⅰ°舒张期杂音外.均无心脏杂音.认为:对小儿先天性心脏病主动脉瓣关闭不全手术应首选主动脉瓣整形,但必须掌握整形的方法,防止主动脉瓣撕脱.     

左心室功能对主动脉瓣关闭不全手术预后的影响

作者观察５０例单纯主动脉瓣关闭不全手术疗效并进行远期随访。结果显示术后死亡及远期心功能差者术前心室多严重扩大，收缩功能下降，术后心功能良好者术前心室多为轻～中度扩大，收缩功能较好。术前心室功能是决定手术疗效的重要因素，左室收缩期内径是预测手术疗效的有效指标。     

主动脉瓣脱垂与关闭不全的外科治疗（附56例报告）

用主动脉成形术治疗主动脉瓣脱垂与关闭不全患者５６例，无手术死亡者。术后平均随访２５．６个月，心功能Ｉ级５０例，Ⅱ级６例；７例仍有舒张期杂音者术后３年无变化。认为其手术的关键是主动脉瓣成形效果，并主张积极处理轻度主动脉瓣脱垂与关闭不全。     

升主动脉瘤合并主动脉瓣关闭不全的外科治疗

目的：回顾性总结自１９９１年１２月至１９９９年５月期间,３３例升主动脉瘤伴主动脉瓣关闭不全外科治疗的经验。方法：３３例升主动脉瘤中,１例为真性动脉瘤。３２例为夹层动脉瘤。夹层动脉瘤按ＤｅＢａｋｅｙ分型法,Ｉ型８例,ＩＩ型２４例,均伴主动脉关闭不全,均行Ｂｅｎｔａｌｌ手术,１０例合并二、三尖瓣关闭不全,做二、三尖瓣整形手术。１例合并冠心病,做内乳动脉与前降支搭桥术,结果：手术死亡率为６．０％（２／３３）,２例分别死于感染性心内膜为和吻合不可控制性渗血,２例有严重脑部并发症,随访时间１～５５个月,远期死亡２例,均系错迷窒息死亡,其余２９例心功能明显改善,眩动脉瘤无复发。结论：（１）升主动脉瘤合并主动脉瓣关闭不全行Ｂｅｎｔａｌｌ手术,采用良好的心肌保护方法,注意吻合技术防止出血,可以取得良好的手术效果。（２）对Ｄ     

心室间隔缺损合并主动脉瓣关闭不全的外科矫治

目的：探讨心室间隔缺损（ＶＳＤ）合并主动脉瓣关闭不全（ＡＩ）的外科矫治方法。　　方法：总结１０６例ＶＳＤ合并ＡＩ的外科治疗经验。主要有干下型ＶＳＤ６６例（６２．３％ ）,膜周部ＶＳＤ２２ 例（２０．８％ ）。主动脉瓣以单叶右冠状动脉瓣脱垂为主（７８例占７３．６％ ）;本组单纯ＶＳＤ修补１４ 例;主动脉瓣成形７５例,主动脉成形主要采用脱垂瓣叶折叠悬吊法和中心型折叠法;主动脉瓣置换１７例。　　结果：手术死亡１ 例。出院检查脉压差均恢复正常。心胸比率以及左心室舒张末径均有明显缩小。ＶＳＤ修补术后无残余分流。　　结论：强调早期治疗,防止ＡＩ的进一步发展。主动脉瓣成形是首选方法     

升主动脉夹层并发主动脉瓣关闭不全3例外科治疗

主动脉夹层多由主动脉内膜突然撕裂,血液冲入主动脉壁,分开其中层形成夹层血肿所致,过去也称为主动脉夹层动脉瘤,主动脉夹层并发主动脉关闭不全,临床上较为少见,本文报告3例并就其外科治疗进行分析.     

经导管主动脉瓣置换的动物实验方法

目的:建立经导管主动脉瓣置换（transcatheter aortic valve replacement,TAVR）的动物实验方法,确定适合于TAVR的实验动物模型及主动脉根部造影的最佳投照体位。方法:选用健康绵羊15只（体质量40～45 kg）,于颈中、下1/3处到胸骨上窝区间,通过超声心动图和血管超声分别测量绵羊主动脉瓣环直径和颈总动脉直径。分离绵羊颈总动脉,于直视下测量其直径。穿刺颈总动脉,送入猪尾巴导管,行左心室造影,确定主动脉根部最佳投照体位并进行影像学分析。行颈总动脉横切口,依次置入20F和24F介入式大动脉支架（主动脉覆膜支架）输送鞘,观察能否顺利通过。分别在置入前后,经胸超声心动图（TTE）测量主动脉瓣有效瓣口面积（effective orifice area,EOA）、返流百分比、心率,经心导管测量主动脉收缩压（aortic systolic pressure,ASP）、主动脉舒张压（diastolic aorticpressure,DAP）、平均主动脉压（mean aortic pressure,MAP）、左心室收缩压（left ventricular systolic pressure,LVSP）、左室舒张末压（left ventricular end diastolic pressure,LVEDP）。结果:用超声心动图测得收缩期主动脉瓣环直径为（24.98±2.41）mm,舒张期主动脉瓣环直径为（19.82±2.14）mm。用血管超声测得颈中、下1/3处颈总动脉直径为（5.61±0.50）mm,颈总动脉胸廓入口处直径为（9.16±0.84）mm。解剖直视下测得的颈中、下1/3处颈总动脉直径为（5.90±0.64）mm。15只绵羊均可经颈总动脉成功置入20F输送鞘,13只绵羊可成功置入24F输送鞘。造影结果显示,右前斜位2.5°±3°、头足位7.1°±6°,可清楚显示绵羊左、右冠脉的开口及主动脉根部的解剖形态。术后存活绵羊（14只）主动脉瓣的EOA、返流百分比、心率、ASP、DAP、MAP、LVSP、LVEDP与术前测量值差异均无统计学意义。结论:经绵羊颈总动脉可建立逆行TAVR实验模型,右前斜位2.5°±3°、头足位7.1°±6°,可获得良好的主动脉根部影像,满足应用介入瓣膜输送系统进行TAVR动物实验研究的需要。     

Asymptomatic chronic traumatic aortic valve perforation with severe aortic regurgitation

Here, we present a young asymptomatic male patient incidentally diagnosed to have aortic regurgitation (AR). The patient had a history of a blunt trauma to the thorax two years back but did never have any symptoms. Transthoracic echocardiography showed a moderately dilated left ventricle with normal systolic function and severe AR with normal nondilated aortic root and tri-leaflet aortic valve. To diagnose the etiology of the AR, a transesophageal echocardiogram (TEE) was done, which revealed a perforation in the nonadjacent leaflet (NAL) and confirmed severe AR with two AR jets being clearly visualized, one through the point of incomplete coaptation and other one through the perforated area in the NAL. The patient was treated with aortic valve replacement and was doing well on follow-up.     

Timing of surgery in chronic aortic regurgitation

When deciding on therapy for aortic regurgitation (AR), it is imperative to distinguish between acute and chronic AR. Symptoms and echocardiographic findings are essential in distinguishing acute from chronic AR and in assessing the severity. Vasodilators have been shown to be helpful in treating patients with chronic severe AR. The timing of aortic valve replacement in chronic severe AR remains controversial. Symptoms, left ventricular function, and response to exercise have been shown to be the most important prognostic indicators.     

The valve‐in‐valve technique: Transcatheter treatment of aortic bioprothesis malposition

Percutaneous aortic valve replacement is an emerging alternative to palliative medical therapy for nonsurgical patients with severe aortic valve stenosis. The impossibility of repositioning of the current transcatheter prosthesis in case of suboptimal placement is the main limit of these devices. Here, we report on a case of an 84‐year‐old woman successfully treated with implantation of two 18‐Fr CoreValve® prosthesis (CoreValve®, Irvine, California), because of the suboptimal deployment of the first one, analyzing the procedural technique and the immediate and short‐term clinical and hemodynamic results. © 2009 Wiley‐Liss, Inc.     

Quantification of acute aortic regurgitation by color Doppler flow in an experimental animal model

Color Doppler flow studies were performed on ten anesthetized open-chest dogs. Acute aortic regurgitation was created in the dogs by a special valve-spreading catheter. The magnitude of valvular regurgitation was determined by aortic electromagnetic flow recordings of regurgitant fraction. Arbitrarily-designated grades of aortic regurgitation: mild (4%-10%), moderate (11%-30%), and severe ( greater than 30%) were assigned on the basis of electromagnetic flow. We attempted to obtain studies of varying degrees of AR in each animal. Mean regurgitant fraction for the three grades were 6.8 +/- 0.6% (n = 11), 22.0 +/- 2.4% (n = 7), and 40.4 +/- 2.5 (n = 20), respectively (each P less than 0.05). By color Doppler flow assessment, the ratio of regurgitant jet height to the left ventricular dimension at the junction of the left ventricular outflow tract and the aortic annulus (JH/LVOH) was measured in each study. AR was classified by Doppler as grade I (mild), 1%-24%; II (moderate), 25%-64%; and III (severe), greater than or equal to 65% jet height/left ventricular outflow tract height. Color Doppler flow correlated well with flowmeter assessment of regurgitant fraction. Color Doppler flow tests had a calculated sensitivity of 88%, specificity of 83%, and predictive value of 85% for significant (moderate + severe) aortic regurgitation. Our data support the concept that this method of color Doppler flow assessment provides a quantitative noninvasive evaluation of aortic regurgitation.     

Percutaneous aortic valve replacement for severe aortic regurgitation in degenerated bioprosthesis: the first valve in valve procedure using the Corevalve Revalving system.

Percutaneous valve replacement for severe aortic stenosis has shown to be an alternative treatment option for non-surgical candidates. We report on the first successful valve in valve procedure in an 80-year-old patient with a severe regurgitation of a degenerated aortic bioprosthesis using the Corevalve Revalving system.     

Rare or unusual causes of chronic, isolated, pure aortic regurgitation

Six patients undergoing aortic valve replacement had rare or unusual causes of isolated, pure aortic regurgitation. Two patients had congenitally bicuspid aortic valves with a false commissure (raphe) displaced to the aortic wall ("tethered bicuspid aortic valve"), two had floppy aortic valves, one had a congenital quadricuspid valve, and one had radiation-induced valve damage.     

Progression of valvar aortic stenosis: a long-term retrospective study

Aortic valve stenosis is a potentially serious condition. Progression from mild to severe aortic stenosis is well-recognized but there are few data as to the likely rate of progression. Clinical outcome and cardiac catheterization data were reviewed for 65 patients with valvar aortic stenosis. Each patient had been investigated by cardiac catheterization on at least two occasions, the interval between studies ranging between 1 and 17 years (mean 7 years). In 60 cases the aortic valve gradient had increased, from a median of 10 mmHg (range 0-60) to a median of 52 mmHg (range 15-120). The mean rate of increase of gradient was 6.5 mmHg per year, and was significantly faster in patients in whom there was aortic valve calcification or aortic regurgitation present at the first catheter study (P less than 0.02). This study shows that progression of aortic stenosis may be very rapid, and correlates with valve calcification and regurgitation. If cardiac surgery is proposed for co-existing coronary or mitral valve disease in patients with mild or moderate aortic valve gradients, then aortic valve replacement should be considered at that time.