Aortic valve regurgitation:assessment with dual source computed tomography

目的:以经胸心脏超声(transthoracic echocardiography,TTE)为对照,观察双源CT(dual source CT,DSCT)对主动脉瓣反流(aortic valve regurgitation,AR)的诊断价值.方法:79例行DSCT及TTE检查,其中34例为AR患者,45例为正常对照组.DSCT面积法测量舒张期最大反流面积(regurgitant orifice area,ROA),以TTE测量值为对照,同时测量左室功能指标.结果:DSCT在34例患者中发现32例有AR,45例正常人中有1例AR(敏感性94％,特异性98％,阳性预测值97％,阴性预测值96％).ROA CT测量值(0.49±0.40) cm2和TTE反流轻中重分级指标具有明显相关性(r＝0.79,P＜0.01),通过受试者相关曲线分析,用ROA 0.21 cm2作为区分轻度和中重度反流的指标,ROA 0.71 cm2作为区分轻中度和重度关闭不全的指标.CT测量值和TTE测量值在舒张末期容积(r=0.82,P＜0.01)、收缩末期容积(r=0.87,P＜0.01)和射血分数(ejection fraction,EF)(r＝0.86,P＜0.01)均具有明显相关性.结论:DSCT能够对AR患者ROA、EF准确评价,因此DSCT能够对AR患者术前提供全面、细致的评估.     

超声心动图在经导管主动脉瓣置入术中的作用

目的探讨超声心动图在经导管主动脉瓣置入术前、术中及术后的作用。方法 59例三叶式主动脉瓣重度狭窄或反流患者行经导管主动脉瓣置入术,术前经胸超声心动图评估主动脉瓣狭窄或反流程度、测量主动脉根部内径,评估心功能,术中介入操作前经食管超声心动图再次测量主动脉根部内径;介入过程中引导瓣膜植入、监测并发症,术后即刻评估置入瓣膜效果和经胸超声心动图随访人工瓣膜功能、左室收缩功能、左室质量指数等。结果 59例三叶式主动脉瓣患者中重度主动脉狭窄49例,单纯中-重度主动脉瓣反流10例。术前经胸超声心动图(TTE)所测的主动脉瓣环径与经食管超声心动图(TEE)测值比较(22.4±2.3mm vs.24.8±2.1mm)差异有统计学意义(P<0.05),其余主动脉根部内径(主动脉窦部内径、主动脉窦管交界处内径、主动脉窦部高度,左室流出道内径,升主动脉内径)测值间比较差异均无统计学意义。术中1例患者右冠状动脉开口堵塞,经导管主动脉瓣植入术(TAVI)置入失败转入心外科开胸手术,其余患者均成功置入瓣膜。术后即刻评估瓣周漏微量或无占67%,轻度占31%,中度仅占2%。术后1周及术后3月主动脉瓣口前向血流速度、最大压差、平均压差较术前均明显降低。术后1周左室质量指数较术前明显降低,术后3月进一步降低。术后1周左室射血分数(EF)有所恢复,术后3月恢复正常。结论超声心动图检查在TAVI治疗中不可或缺,在术前评估、术中监测及术后随访中均起着非常重要的临床作用。     

主动脉根及其比邻结构关系的外科意义

目的:测量主动脉根部不同高度的口径大小,并观察主动脉窦与邻近结构的关系。方法:用30例正常成人甲醛固定心脏标本,测量了主动脉根部不同高度的口径和主动脉瓣的大小,观察主动脉窦与邻近结构的关系。结果:主动脉根部的4个高度口径大小,主动脉窦中部(sinus)>主动脉窦管结合部上1 cm(STJ1)主动脉窦结合处(STJ0)>主动脉窦瓣环基底(base)。经方差检验,P<0.05,说明主动脉根部4个高度口径大小的差别具有高度统计意义。主动脉瓣高,瓣附着缘长和瓣游离缘长的测量结果,右冠瓣稍大于左冠瓣和无冠瓣,经方差分析检验,P>0.05,说明无统计意义。二尖瓣前瓣中轴线与主动脉窦的关系,其中二尖瓣前瓣中轴线86.6％位于左冠状动脉窦与无冠状动脉窦之间。右心房主动脉隆凸与主动脉窦的关系,右心房主动脉窦凸由无冠状动脉窦形成者占73.3％,由无冠状动脉窦和右冠状动脉窦共同形成者占26.7％。左右肺动脉瓣交界点与主动脉窦的关系,左、右肺动脉窦交界点对向左、右冠状动脉窦之间者占80％。结论:根据测量主动脉根部各高度口径大小的结果Sinus>STJ1>STJ0>Base(P<0.05)。主动脉瓣的测量结果,3个半月瓣的大小相近,无统计意义(P>0.05)。测量结果有助于心外科手术的开展。     

应用心脏彩超评价经导管主动脉瓣植入术对老年主动脉瓣狭窄患者的影响

[目的]研究心脏彩超评价经导管主动脉瓣植入术(TAVI)对老年主动脉瓣狭窄患者的价值。[方法]选取我院2016年1月至2018年2月收治入院行TAVI的老年主动脉狭窄患者34例,分析患者基线资料和手术结果,比较术前与术后4周、术后12周心脏彩超各指标的结果。[结果]34例患者均顺利完成TAVI,无患者死亡;比较患者术前经胸超声心动图(TTE)、术中经食管超声心动图(TEE),主动脉瓣环内径、主动脉窦部内径、主动脉窦部高度、左室流出道内径和左室射血分数(LVEF)等指标测量值,差异无统计学意义(P>0.05);患者左室舒张末期内径在术前与术后4周、术后12周之间比较,差异无统计学意义(P>0.05),患者左室收缩末期内径、峰值跨瓣压差、平均跨瓣压差、LVEF和有效瓣口面积在术前与术后4周、术后12周之间比较,差异有统计学意义(P<0.05)。[结论]TAVI治疗老年严重主动脉瓣狭窄患者,疗效显著,在术前、术中和术后应用心脏彩超检查及随访具有重要意义。     

经食管实时三维超声心动图对主动脉瓣环形态的可视化定量研究

目的应用经食管实时三维超声心动图(RT 3DTEE)及其定量分析软件对主动脉瓣环进行可视化三维重建和定量分析,以期为主动脉疾病的外科及介入治疗提供更加客观、准确的依据。方法 70例行RT 3DTEE检查的患者,采集主动脉根部实时三维全容积图像,应用QLAB 7.0瓣环定量分析软件对收缩末期及舒张末期主动脉瓣环进行三维可视化重建,并测量主动脉瓣环相关参数,包括主动脉瓣环高度(H)、三维环周长(C3D)、投影平面中二维环周长(C2D)、瓣环在投影平面内的面积(A2D)以及二维环周长与三维环周长之比(C2D/C3D)。结果主动脉瓣环的三维形态与患者的瓣叶数目相关,三叶式主动脉瓣环呈三叉皇冠状,二叶式和四叶式主动脉瓣其瓣环分别呈二叉、四叉皇冠状;主动脉瓣环投影形态呈多态性,可呈椭圆形、类三角形和不规则形。主动脉瓣环参数收缩期和舒张期测值差异无统计学意义(P均>0.05)。结论 RT 3DTEE及瓣环定量分析软件能真实重建主动脉瓣环立体解剖形态,并实现瓣环定量描述。     

二代双源CT的MinDose技术与超声心动图在主动脉瓣病变术前评估中的对比研究

【摘要】 背景 准确评价冠状动脉、主动脉瓣环直径(aortic valve annulus diameter,AVAD)以及左心射血分数(left ventricular effective fraction,LVEF)对于主动脉置换手术策略的制定具有非常重要的意义。本研究中探讨双源CT的低辐射剂量MinDose技术在主动脉瓣置换术前的临床应用价值。方法 回顾性分析40例欲行换瓣治疗的主动脉瓣病变病人,所有病人均接受双源CT以及超声心动图检查。经胸超声采用二维及四维方法获取病人左室射血分数。所有病人于舒张末期测量主动脉瓣环直径。对照组为33 名非主动脉瓣狭窄成年人,DSCT检查采用常规回顾性心电门控扫描。结果 40例病人MD-DSCT 检查评价冠状动脉均获得良好效果,所有CT成像能够清晰显示瓣叶钙化、脱垂等形态学改变。所有病人的LVEF-MinDose-DSCT与LVEF-2D-TTE有较强的相关性(r=0.87,P<0.01),与LVEF-4D-TTE有更强的相关性(r=0.90,P<0.01)。AVVD-MinDose-DSCT与AVVD-2D-TTE有较强的相关性(r=0.90, P<0.01)。与标准后门控对照组相比,有效辐射剂量能明显减低63.54%。 结论 MinDose-DSCT可以于术前一站式评价主动脉瓣狭窄病人的冠状动脉病变、AVVD以及LVEF。     

主动脉瓣疾病病因类型及变迁分析

目的:探讨本地区主动脉瓣病变的病因特征和时代变迁,为主动脉瓣病变的诊治提供依据。方法:回顾分析我院不同时代的主动脉瓣置换术患者的临床资料,分析其病因特征,比较其时代差异。分别以主动脉瓣狭窄、主动脉瓣关闭不全、主动脉瓣狭窄合并关闭不全3组分析,具体病因包括风湿性、二叶式主动脉、退行性主动脉瓣、主动脉根部扩张、感染性心内膜炎、少见及未确定等6类病因。结果:风湿性、二叶式主动脉瓣、主动脉根部扩张以及退行性主动脉瓣病变是主要的病因类型,其中单纯主动脉瓣狭窄以风湿性(43例,占59.7%)及二叶瓣17例(23.6%)病因为主,单纯主动脉瓣关闭不全以根部扩张(38例,占43.2%)为主,主动脉瓣狭窄合并关闭不全则以风湿性(70例,占88.5%)为主。随着社会进步和人口老龄化,风湿性病因所占比例大幅下降,主动脉根部扩张导致的主动脉关闭不全有较大幅度的上升,退行性主动脉瓣有所上升,二叶式主动脉瓣、感染性心内膜炎所致瓣膜损害变化不明显。结论:主动脉瓣病因构成的改变及其特征对主动脉瓣临床诊治和医疗策略制定具有指导意义。     

据灌注情况决定主动脉瓣置换与否的中期效果

目的分析用主动脉根部灌注心脏停搏液能否让心脏停跳来决定是否行主动脉瓣置换的方法的中期效果。方法选取我院2004年5月～2008年4月二尖瓣中度以上狭窄伴主动脉瓣轻度返流患者,在术中根据主动脉根部灌注心脏停搏液能否使心脏停跳来决定是否作主动脉瓣置换,收集到心脏停跳未行主动脉瓣置换患者共54例,同期收集术前不合并主动脉瓣返流直接行二尖瓣置换患者49例,随访两组患者左室舒末直径、心功能、射血分数、二次手术率等指标。结果两组患者的术前条件差异无统计学意义(P>0.05),随访(4.86±0.92)年,随访时间差异无统计学意义(P>0.05),两组患者术后左室舒末直径、升主动脉直径、心功能、射血分数和再次手术行主动脉瓣置换率等各项指标差异均无统计学意义(P>0.05)。结论对于术前主动脉瓣轻度返流的患者,如果主动脉根部灌注心脏停搏液能够使心脏停跳,可以不行主动脉瓣置换。     

先天性主动脉瓣二叶畸形的外科治疗

目的 总结先天性主动脉瓣二叶畸形患者的临床特点及外科治疗经验.方法 回顾性分析2008年1月-2010年12月我科行外科手术治疗的先天性主动脉瓣二叶畸形患者34例,年龄23-78(51.0±12.4)岁,其中男性28例(82.3%),女性6例(17.6%).单纯主动脉瓣狭窄10例(29.4%),主动脉瓣狭窄伴关闭不全19例(55.8%),单纯主动脉瓣关闭不全5例(14.7%).合并主动脉根部扩张30例(88.2%),合并感染性心内膜炎6例(17.6%).行单纯主动脉瓣置换术32例,行Bentall 术1例,主动脉瓣置换+ 升主动脉置换术1例.其中21例植入机械瓣,13例植入生物瓣.结果 无死亡及其他严重并发症.术后超声心动图示升主动脉内径((45.4±5.9)mm vs(40.9±6.5)mm,P<0.05)及左室舒张末内径(LVEDD)((56.9±15.5)mm vs 年44.3±9.0)mm,P<0.05)较术前明显减小.结论 先天性主动脉瓣二叶畸形合并主动脉根部扩张要根据病情行不同方式手术.     

先天性二叶式主动脉瓣畸形的外科治疗

目的: 探讨先天性二叶化主动脉瓣畸形的临床特点?围术期处理以及手术疗效?方法:回顾性分析2007年1月~2010年1月在本院心胸外科接受二叶式主动脉瓣膜手术患者52例?气管插管静脉复合麻醉下常规建立体外循环,切除病变的主动脉瓣叶,替换人工机械瓣或行主动脉瓣成形术?其中主动脉瓣置换术34例,双瓣膜置换7例;主动脉瓣膜成形术6例;同时行主动脉窦瘤破裂修补术1例,室间隔缺损修补术5例,冠状动脉旁路移植术2例?6例主动脉根部扩张并发主动脉瘤形成的患者中行主动脉根部成形术4例,Bentall手术2例?结果:术后早期死亡4例(占7.7%),其中2例死于心功能不全,1例死于尖端扭转型室性心律失常,1例死于多脏器功能衰竭?随访时间4个月~3年,随访患者心功能改善明显,临床症状好转?结论:先天性主动脉瓣二叶化畸形可致主动脉瓣狭窄和(或)关闭不全,出现心功能衰竭?心前区疼痛?体位性晕厥?感染性心内膜炎时应尽早行手术治疗?症状不明显的患者应定期复查超声心动图,主动脉瓣置换术是常用的手术方法?     

双源CT术前评估胸主动脉夹层破口的对照研究

目的：探讨双源CT（DSCT）对胸主动脉夹层动脉瘤（TAD）破口术前评估的准确性.方法：选取2008-01/10间初诊疑似TAD的连续139例患者,DSCT检查结果与其他影像学检查对照,包括数字减影血管造影术（DSA）、经胸壁超声心动图（TTE）、64排螺旋CT（MDCT）和磁共振（MRI）.结果：TAD确诊97例.DSCT,DSA,TTE,MDCT和MRI分别检查112,72,94,60,6例,诊断TAD的灵敏度（Se）分别为100%,100%,95%（P〈0.05）,93%（P〈0.05）和100%,与DSCT比较,差异有统计学意义.DSCT,DSA,TTE和MDCT诊断TAD破口的Se分别为98%,98%,46%（P〈0.05）和87%（P〈0.05）,与DSCT比较,差异有统计学意义.结论：DSCT术前诊断TAD破口准确性高,宜作为首选的影像学检查方法.     

Aortic valve annulus and sinus-tube joint diameters in normal adults of Chinese Han ethnic group

Background The anatomic value of the aortic root is important for aortic valve repair. This study was to determine the normal diameters of the aortic valve annulus （AVA） and sinus-tube joint （STJ） in the healthy adults of Chinese Han ethnic group, and to provide a morphological foundation for potential clinical application.
Methods Echocardiography was performed in 326 normal subjects, who were divided into 5 groups according to their age. The diameters of the AVA and STJ were measured in the parasternal long-axis view, and normalized to body surface area （BSA）. They were averaged for each age group and for each gender. Differences were then determined between the normalized diameters for each age group and for both genders. Pearson＇s product-moment correlation coefficient was used to determine the differences between AVA and STJ diameters. It was also used to determine any positive or negative correlations between the above two variables and age. BSA, weight, and height.
Results The diameters of the AVA and STJ of Han nationality patients increased with an increase in age, BSA, weight, and height. The correlation coefficient between AVA diameter and BSA was 0.4944 （P 〈0.0001）, between AVA diameter and age, 0.1138 （P〈0.05）, between AVA diameter and weight, 0.4521 （P〈0.001）, and between AVA diameter and height, 0.4713 （P 〈0.001）. The correlation coefficient between STJ diameter and BSA was 0.3910 （P 〈0.0001）, between STJ diameter and age, 0.3667 （P 〈0.0001）, between STJ diameter and weight, 0.4586 （P 〈0.0001）, and between STJ diameter and height, 0.3736 （P 〈0.0001）. The difference between the above two diameters was statistically significant at 2.42±2.45 mm （paired t-test; t=-17.25; P 〈0.0001）. AVA and STJ diameters were similar in both genders of each group when indexed to BSA.
Conclusions The diameters of the AVA and STJ of adults of Chinese Han ethnic group increase with age, BSA, weight, and height. The diameters of the AVA and the STJ are     

Comparison of low-dose sequences of dual-source CT and echocardiography for preoperative evaluation of aortic valve disease

Background Accurate evaluation of coronary artery,aortic valve annulus diameter （AVAD）,and cardiac function in patients with aortic valve disease is of great significance for surgical strategy.In this study,we explored the preoperative evaluation of low-dose sequence （MinDose sequence） scan of dual-source CT （DSCT） for those patients.Methods Forty patients suspected for aortic valve disease （the experimental group） underwent MinDose sequence of DSCT to observe coronary artery,AVAD,and left ventricular ejection fraction （LVEF）.Another 33 subjects suspected for coronary artery disease （the control group） underwent conventional retrospective electrocardiographically-gated sequence of DSCT.Two-dimensional transthoracic echocardiography （2D-TTE） and four-dimensional transthoracic echocardiography （4D-TTE） were applied in the experimental group to measure AVAD and LVEF and compared with MinDose-DSCT.Results There was a strong correlation between LVEFs measured by 2D-TTE and MinDose-DSCT （r=0.87,P ＜0.01）,as well as between 4D-TTE and MinDose-DSCT （r=0.90,P ＜0.01）.AVAD measured by MinDose-DSCT was in good agreement with corresponding measurements by 2D-TTE （r=0.90,P ＜0.01）.The effective dose in the experimental group was 63.54％ lower than that in the control group.Conclusions MinDose sequence of DSCT with a low radiation dose serving as a one-stop preoperative evaluation makes effective assessment of the coronary artery,AVAD,and LVEF for patients with aortic valve disease.     

Application of transesophageal echocardiography to aortic embolic stroke

目的：应用TEE及经胸壁超声心动图（TTE）在探查心脏及主动脉弓潜在性栓塞源（PES）的相对价值,并进一步了解主动脉弓动脉粥样硬化（AAA）在缺血性中风中的作用。方法：所有患进行了TTE及TEE检查;同时对所有患进行了颈动脉实时超声,TCD,CT检查,部分患进行了DSA及MRI等检查。AAA分为三级：轻度、中度、重度或活动性动脉粥样硬化斑声。结果：①TTE不能发现主动脉弓病变;②在TEE检查中：31例（63％）在主动脉弓发现有动脉粥样硬化性病变。其中7例（14.1％）呈轻度病理性改变,9例（18.4％）呈中度病理性改变,15例（30.6％）呈重度病理性改变,该15例中11例患无明显的颈内动脉及心脏疾患,其主动脉弓斑块可能是其脑栓塞的主要原因;两比较,TEE对心脏及主动脉弓的PES的发现率为48.98％,而TTE仅为18.4％;33例患伴有颈内动脉动脉粥样硬化（ICAA）改变;9例患伴有心脏疾病;高龄及ICAA组AAA的发病率明显增高。结论：TEE是目前探查主动脉弓及心脏PES的一个较好的检查手段。主动脉弓动脉粥样硬化在缺血性中风中非常常见,AAA在缺血性脑血管病的病因学中是一个应该值得重视的潜在栓塞源。     

Effect of pulmonary autograft transplantation in the surgical treatment of aortic valve disease

Background Aortic root replacement with pulmonary autograft （Ross procedure） has the advantages of good haemodynamics and growth potential without the need for anticoagulation. In this study, we reviewed our experience of the Ross procedure for patients with aortic valve disease. Methods From October 1994 to January 2005, 42 Ross procedures were performed in our centre. There were 30 males and 12 females. The mean age was 28＋15 years （range, 5-56 years）. Congenital heart disease （CHD） with aortic valve stenosis （AS） and/or aortic valve insufficiency （AI） in 40 cases including one associated with ventricular septal defect （VSD）, degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis （SBE） with AI in 1 were studied. The diagnosis was made by ultracardiography （UCG） in all patients. The mean aortic valve annulus diameter （AVD） was （2.45±0.31） cm and pulmonary valve annulus diameter （MPVD） was （2.34±0.21） cm. All patients had normal pulmonary valves. The New York Heart Association （NYHA） function class was Ⅱ in 36 cases and Ⅲin 6 cases. The operation was performed under moderate hypothermic cardiopulmonary bypass （CPB） with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft. Results There was no early hospital mortality. Postoperative UCG showed normal aortic valve function in all our patients. The mean gradient across the aortic valve was （6.11±0.12） mmHg. The left ventricular diastole diameter （LVDD） decreased significantly from （62±5） mm to （56±3） mm （P 〈0.001）. The mean postoperative left ventricular ejective fraction （LVEF） was 0.49±0.23. All patients were in NYHA class Ⅰ-Ⅱ. Follow-up was completed in 38 cases for a mean period of 3.2 years （range 1-10 years）. All survivors were in NYHA class Ⅰ with normal neo-aortic and pulmonary valve function. One patient died after secondary operation due to homograft fungal endocarditis 1 year af     

Congenital quadricuspid aortic valve: analysis of 11 surgical cases

Background  Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR). The diagnosis and treatment of the disease were reported in 11 cases.

Methods  Eleven patients (nine men and two women, mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated. Medical records, echocardiograms and surgical treatment were reviewed.

Results  In accordance with the Hurwitz and Roberts classification, the patients were classified as type A (n=2), type B (n=7), type F (n=1) and type G (n=1). Three patients were associated with other heart diseases, including infective endocarditis and mitral prolaps, left superior vena cava, aortic aneurysm. All had aortic regurgitation (AR) except two with aortic stenosis (AS), detected by color-flow Doppler echocardiography. The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography. All patients underwent successful aortic valve replacement.

Conclusion  Quadricuspid aortic valve is a rare cause of aortic insufficiency, while echocardiography plays an important role in diagnosing the disease. Aortic valve replacement is the major therapy for the disease.

     

One-year results of transcatheter aortic valve implantation as an alternative treatment for severe aortic stenosis in high-risk patients

BackgroundAortic valve replacement (AVR) remains the gold standard treatment for symptomatic severe aortic stenosis (AS). For the past 10 years, transcatheter aortic valve implantation (TAVI) has been applied in patients with high surgical mortality and morbidity risks. The preliminary results of our TAVI patients are presented in this study.MethodsTen high-risk patients with severe AS, for AVR, were referred and accepted for TAVI in the 6 month period from May 2010 to October 2010. The patient age, logistic EuroSCORE, femoral arterial diameter, aorta annulus size, aorta valve area (AVA), mean aortic pressure gradient (MPG), as well as coronary angiography results were all collected. Six patients were treated via the transapical approach in March 2010, whereas the other four were treated with the transfemoral approach, according to their femoral artery diameter and arterial quality. This study focuses on the immediate, 1 month, 3 month, and 1 year results of TAVI.ResultsThe average age of the 10 patients receiving TAVI was 81.5 years. The mean calculated EuroSCORE was 28.3 ± 7.9%. The mean AVA was 0.61 ± 0.19 cm². The MPG was 48 ± 16 mmHg. The surgical technical success achieved 100%. There was no reported moderate to severe postoperative paravalvular aortic regurgitation, permanent complete atrioventricular block, major access site complication, or embolic stroke. Chronic renal failure, which necessitated permanent hemodialysis, developed in 10% of the patients. One acute myocardial infarction and one case of pneumonia developed postoperatively. The AVA was increased by 251%, whereas the MPG was decreased by 80% at the 3 month follow-up. The 30-day mortality rate was 10%. The all-cause 1-year mortality rate was 20%.ConclusionThis new technique and device requires greater caution and needs more practice to accumulate sufficient experience. The studied patients were very fragile, due to old age and multiple comorbidities. Our results are similar to findings of multicenter trials. With careful patient screening and selection, TAVI can be a promising treatment for high-risk severe AS patients.     

Aortic root replacement

Objective To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications, methods, and surg ical techniques.Methods Between January 1994 and August 1999, a group of 231 consecutive patients underw ent aortic root replacement at our hospital, with 13 being treated on an emergen cy basis. There were 189 men and 42 women, ranging in age from 14 to 69 years. The diameter of the aneurysm varied from 4.5 to 11 cm. Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type Ⅰ aortic dis section, and the remaining 21 were diagnosed as having DeBakey type Ⅱ aortic di ssection. Aortic valve regurgitation occurred in all cases. Aortic root replac ement was performed with composite valved graft in 229 patients, and in 2 patien ts the aortic valve was preserved.Results The hospital mortality rate was 3.03% (7 patients). Early complications includ ed re-exploration for bleeding in 6 patients, pericardial effusion in 9, as wel l as cerebral infarction, pleural effusion, and pneumothorax in 2 patients each . One hundred and seventy-five patients (78.12%) were followed up, with a mea n follow-up time of 15.7±13.1 months (range, 2 weeks to 65 months). One pat ient died from lower-limb embolism and renal dysfunction 3 months postoperative ly. Three patients died from postoperative anticoagulation accidents. The preo perative and postoperative left ventricular end-diastolic diameters were s ignificantly different (68.1±9.4 mm, range 54 to 112 mm; vs 54.8±8.2 mm , range 38 to 88 mm; P&lt;0.001).Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient s hould undergo surgery as soon as possible if the general conditions permit. Aor tic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm.