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。

Using Self-Pericardial Patch Heightening to Treat Aortic Valve Prolapse

Objective To summarize the clinical experiences of using self-pericardial patch heightening to treat aortic valve prolapse. Methods From May 2000 to July 2007, seventeen patients with aortic valve prolapse were treated by self-pericardial patch heightening. Fifteen cases had right coronary cusp prolapse, one had left coronary cusp prolapse, and one had no coronary cusp proplapse. There were 10 cases with moderate aortic regurgitation and 7 with severe regurgitation. Autologous pericardium was continuously sutured on the proplapsed cusp by 5-0 or 6-0 Prolene suture. The transesophageal echocardiography（TEE） showed that there was few or mild aortic regurgitation during operation. Preoperative and postoperative echocardiography results were compared. Results The comparison between preoperative and postoperative echocardiography results showed that postoperative left ventricular end-diastolic diameter reduced obviously （ 38. 3 ±9. 6 mm vs. 47. 2 ±10. 3 mm, P = 0. 013） ; postoperative aortic valve systolic pressure difference reduced（9.8±5.6 mm Hg vs. 10.3±5.3 mm Hg,P=0. 792） ; postoperative aortic valve diastolic pressure difference reduced obviously（45.7± 13.6 mmHg vs. 78.4 ± 19.9 mm Hg, P = 0. 000）. Echocardiographic examination before discharge showed that 4 cases had no obvious aortic regurgitation, 9 had mild aortic regurgitation and 4 had moderate aortic regurgitation. The average follow-up time was 32 months（4-74 months）. One case underwent aortic valve replacement because of severe aortic regurgitation 4 months later after the operation, and the rest needed no second operation. Conclusion Using self-pericardial patch heightening to treat aortic valve prolapse is a simple operative method, and it is good for young patients or small aortic annulus.