主动脉瓣病变合并升主动脉扩张主动脉成形术后疗效分析

目的探讨主动脉瓣病变合并升主动脉扩张患者升主动脉成形术后的中期疗效。方法入选主动脉瓣病变合并升主动脉扩张患者34例,在全麻下行主动脉瓣置换同时行升主动脉成形术并对升主动脉应用人工血管外包裹,采用超声心动图测量手术前、出院前及随访（3～60）月的升主动脉直径,以观察升主动脉成形术后的中期疗效。结果围手术期无患者死亡。出院时升主动脉直径较术前减少[（29.4±5.1）mmvs.（46.2±7.2）mm,P〈0.05]。术后随访3～60个月,升主动脉直径（30.3±5.2）mm,较出院时无统计学差异（P〉0.05）。结论对于主动脉瓣病变合并升主动脉扩张的患者,升主动脉成形术同时应用人工血管外包裹的手术中期治疗效果良好。     

保留二叶主动脉瓣的升主动脉置换术疗效分析

目的:评估保留二叶主动脉瓣升主动脉置换术的近期疗效。方法:自2008年2月至2018年5月,来我院手术的主动脉瓣二叶畸形(BAV)合并升主动脉扩张主动脉瓣轻度病变患者共有43例,其中男性17例,女性26例,均行保留主动脉瓣升主动脉置换术,对所有患者随访至2018年12月,随访时间6～129个月,平均(34±4)个月。评估其30 d死亡率,术后主动脉瓣病变进展情况,再次手术率。结果:所有患者围手术期无死亡,住院期间无二次手术,无脑梗死,血栓栓塞并发症,术后痊愈出院。随访到41例,1例患者死于恶性肿瘤,1例患者复查超声心动图显示主动脉瓣关闭不全进展为中度,但患者无胸闷憋气等不适,左心室未扩大,尚需进一步随访,其余患者一般状况均良好,术后复查主动脉瓣返反流及关闭不全情况未再进展。结论:保留主动脉瓣升主动脉置换术对于BAV合并升主动脉扩张瓣膜轻度病变患者是一种安全有效的手术方式,中期随访显示术后患者主动脉瓣病变情况未再进展。     

二叶式主动脉瓣畸形的循证研究

二叶式主动脉瓣畸形是最常见的先天性心脏病,发病率约为0.5%~2%,男女比约为3∶1。其具有多种形态学表型,目前多采用Sievers分型方法。二叶式主动脉瓣畸形患者有更快的主动脉瓣病变进展速度、更高的感染性心内膜风险以及伴发升主动脉扩张甚至导致主动脉夹层的灾难性后果。对于二叶式主动脉瓣畸形的诊断方法以及治疗策略学界已有基本共识。本文就二叶式主动脉瓣畸形及其相关并发症的循证医学证据进行综述。     

二叶式主动脉瓣主动脉扩张机制的研究进展

二叶式主动脉瓣(BAV)是最常见的先天性心脏疾病，BAV主动脉扩张与主动脉不良事件如主动脉瘤、主动脉夹层及破裂的风险增加密切相关，是一种潜在的致命性疾病。BAV主动脉疾病是遗传因素和血流动力学因素不同模式相互作用的结果，机制较为复杂。本文根据近年来BAV在基因遗传学、分子标记物、血流动力学影像标记物方面的研究进展，对其引起主动脉扩张的相关机制进行简要综述。     

风湿性主动脉瓣膜病行主动脉瓣叶拓宽成形术中期随访结果

主动脉瓣膜成形术有很多不确定因素需要进一步探讨,包括什么类型的患者适合成形手术,选择什么材料,术后效果如何等等。该文在1992年9月至2000年12月期间,将自体心包片经戊二醛固定处理后为89例风湿性主动脉瓣关闭不全的青少年施行了主动脉瓣叶拓宽成形术。     

经导管主动脉瓣置换术治疗二叶式主动脉瓣畸形的研究进展

二叶式主动脉瓣(BAV)畸形是主动脉瓣畸形中较为常见的一种瓣膜发育异常.目前,经导管主动脉瓣置换术(TAVR)是治疗中、高风险BAV患者的重要方法,但一些围术期因素仍是影响患者预后的重要因素.我们通过对TAVR治疗BAV畸形的相关研究进行回顾分析,希望为提高患者的预后提供更多方法.     

经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄研究进展

二叶式主动脉瓣是常见的先天性心脏瓣膜畸形,常伴发主动脉瓣狭窄,老年患者通常需主动脉瓣置换术,但手术风险极高。经导管主动脉瓣植入术是治疗有症状的严重主动脉瓣狭窄一种有效的治疗手段。二叶式主动脉瓣由于解剖结构复杂,行经导管主动脉瓣植入术风险高,术后并发症多,在早期被作为经导管主动脉瓣植入术的禁忌证,但随着科技的发展以及经验的积累,经导管主动脉瓣植入术治疗二叶式主动脉瓣患者的有效性以及安全性得到显著提高,现将近期经导管主动脉瓣植入术治疗二叶式主动脉瓣的进展进行介绍。     

经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄中的CT评估

目的 探讨经导管主动脉瓣置换术(TAVR)治疗二叶式主动脉瓣狭窄的临床疗效和术前评估要点.方法 纳入阜外医院2020年1月～2020年12月完成的TAVR患者54例.分析主动脉根部形态学特点、手术有效性及安全性.结果 三组瓣膜选择的oversize(测量瓣环直径/选择瓣环直径-1)为:-0.22±8.62％vs.0.5...     

经导管主动脉瓣置换术在二叶式主动脉瓣狭窄患者中的应用

二叶式主动脉瓣狭窄是经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR) 的相对禁忌证， 其异常的解剖结构和病理特点增加了TAVR 的难度和风险，手术成功率低于三叶瓣患者。但随着手术策略的不断 优化和新一代人工瓣膜的应用，这类患者的TAVR 治疗效果得到改善。本文将对二叶式主动脉瓣狭窄的特点及其 TAVR 治疗策略的进展进行介绍。     

二叶式主动脉瓣的临床重要性

很早以前 ,就已经认识到二叶式主动脉瓣 (简称二叶瓣 )与主动脉瓣狭窄和返流、感染性心内膜炎 ,以及同主动脉在解剖学上的关系。二叶瓣为一种良性病变。如果 2 0岁以前无狭窄 [最大压差 <4 0 mm Hg( 1mm Hg= 0 .1333k Pa) ],或者仅有轻度灌注不足 ,那么在 70岁以前不会发生显著的血流动力学改变。然而 ,大多数病人在 70岁以前就已经死亡 ,或者出现严重的症状需要外科治疗。1　解剖和病理早期病理记载 ,二叶瓣有三个特征 :两叶瓣膜大小不等 ;有一个通常位于大瓣中央的中央脊 ;边缘光滑。这些特征可供与风湿性或其它炎症引起的其中二叶融合…     

二叶主动脉瓣的超声分析

目的 探讨二叶主动脉瓣的超声心动图特征。方法 采用回顾性方法分析了26例先天性二叶主动脉瓣,其中主动脉瓣狭窄17例（有或无主动脉瓣关闭不全）和单纯主动脉瓣关闭不全9例。结果 在主动脉瓣狭窄组、轻度狭窄14例（82％）;二叶主动脉瓣感染性心内膜炎的发生率为42％;主动脉瓣狭窄组与单纯主动脉瓣反流组相比,主动脉瓣增厚钙化有极显性差异（P＜0．00005）,结果表明,二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。结论：二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。二叶主动脉瓣感染性心内膜炎的发生率较高。彩色多普勒二维超声心动图对二叶主动脉瓣的诊断具有重要价值。     

Ascending aorta elasticity in children with isolated bicuspid aortic valve

Background

Aortic dilation is common in children with bicuspid aortic valve (BAV) but aortic complications are infrequent. The aim of this study was to investigate elastic properties of the ascending aorta (AAo) and its relation to AAo size in children with isolated BAV without significant valve dysfunction.

Methods

24 children with isolated BAV and 24 healthy controls with tricuspid aortic valve (TAV) matched by gender, age and body surface area (BSA) were studied. Aortic strain (AS), aortic distensibility (DIS) and aortic stiffness index (SI) were derived from M-mode echocardiography at the AAo together with cuff blood pressure recordings. BAV children with dilated AAo (z score ≥ 2) and non dilated (z score < 2) were compared.

Results

BAV children had larger aortas than controls at the sinuses of Valsalva, sinotubular junction and AAo (p < 0.05). AS was lower in BAV than in controls (10.15 ± 4.93 vs 16.93 ± 5.17 p = 0.000), DIS was lower in BAV than in controls (8.51 ± 3.90 vs 14.37 ± 4.20 p = 0.000) and SI was higher in BAV than in controls (7.19 ± 4.45 vs 4.05 ± 2.33 p = 0.04). There were no significant differences in AS, DIS and SI between children with dilated and non-dilated AAo. AS, DIS and SI were not related to BSA, age or AAo size.

Conclusions

AAo elasticity assessed by transthoracic echocardiography is impaired in BAV children without significant valve dysfunction compared to TAV children. Impaired elasticity seems to be independent from aortic dilation. Measuring aortic elasticity may help to identify children at greater risk for complications as adults.     

Hereditary patterns of bicuspid aortic valve in a hundred families

Background

To study the following characteristics of bicuspid aortic valves (BAVs): 1) the recurrence rate in our population, 2) patterns of hereditary transmission in different BAV morphologies and 3) the aortic dimensions of BAVs in first-degree relatives (FDRs).

Methods

A cross-sectional, prospective study of 100 consecutive families of BAV patients attending a university hospital. The following aortic valve morphologies were analysed and categorised: fusion of the right and left coronary cusps (BAV type A), right and noncoronary cusps (type B) and of the left and noncoronary cusps (type C).

Results

There were 553 subjects studied, 100 cases with a BAV (46.8 ± 15 years, 66% male, type 67% A, 32% B and 1% C; 42% with aortic dilatation), 348 FDRs (44.8% male), and 105 healthy control subjects (50% male). We detected 16 BAVs among 348 FDRs. The recurrence rates were 15% for families, 4.6% for FDRs, 7.05% in men and 2.60% in women. The morphologic concordance in family members was 68.8%. The aortic dimensions in 270 adult FDRs with a tricuspid aortic valve were significantly smaller compared with BAV patients (sinus index diameter 1.60 ± 0.19 cm/m² vs. 1.82 ± 0.29 cm/m², p < 0.001; tubular index diameter 1.51 ± 0.23 cm/m² vs. 2.00 ± 0.45 cm/m², p < 0.001) and similar to 103 control subjects(sinus index diameter 1.60 ± 0.19 cm/m² vs. 1.59 ± 0.17 cm/m², p = 0.600 and tubular index diameter 1.51 ± 0.23 cm/m² vs. 1.53 ± 0.18 cm/m², p = 0.519).

Conclusions

In our population, the BAV recurrence rate in FDRs was low (4.6%). The hereditary transmission of morphologic BAV types seems by chance, and the aortic dimensions in tricuspid FDRs are normal.     

The relationship between serum apelin levels and aortic dilatation in bicuspid aortic valve patients

Objective: The bicuspid aortic valve (BAV) is the most common congenital heart dis‐ease. The process of aortic dilatation is not completely clear in patients with the BAV. Apelin is a peptide found at high levels in vascular endothelial cells which has a role in vascular regulation and cardiovascular function. The aim of this study was to de‐termine the relationship between serum apelin levels and ascending aortic dilatation in adult patients with BAV.
Design: This cross‐sectional study included 62 patients with isolated BAV and to an age, gender, and body mass index‐matched control group of 58 healthy volunteers with tricuspid aortic valve. Transesophageal echocardiography was performed on all patients to determine the type of BAV. Aortic diameters of the aortic root, sinus val‐salva, sinotubular junction, and ascending aorta were evaluated with echocardiogra‐phy. Patients with BAV were divided into two subgroups according to the aortic diameters, as the nondilated BAV group and the dilated BAV group. Serum apelin level was analyzed with ELISA method.
Results: The serum apelin levels of the BAV patients were significantly lower than those of the control group (833.5, 25th‐75th percentile (713.5‐1745) pg/dL vs 1669 (936‐2543) pg/dL; P = 0.006). In the subgroup analysis, serum apelin level was signifi‐cantly different between the nondilated BAV group and the dilated BAV group [977 (790‐2433) pg/dL vs 737 (693‐870) pg/dL, P < 0.05] and between the dilated BAV group and the control group [737 (693‐870) pg/dL vs 1669 (936‐2543) pg/dL, P < 0.001]. In multivariate logistic regression analysis apelin [7.27 (95% CI: 1.73‐30.42), P = 0.007] and age [1.05 (95% CI: 0.99‐1.20), P = 0.049] were determined as inde‐pendent predictors for ascending aortic dilatation.
Conclusion: Low serum apelin level was associated with dilatation of ascending aor‐tic in BAV patients. However, apelin was not relevant to BAV without aortic dilatation.     

先天性二叶式主动脉瓣畸形所致主动脉瓣狭窄的外科治疗体会

目的总结先天性主动脉瓣二叶式畸形所致的主动脉瓣狭窄手术治疗的经验。方法1995年9月至2010年12月福建医科大学附属协和医院心外科共为46例二叶式主动脉瓣畸形所致主动脉瓣狭窄患者实施了瓣膜置换术。对这些患者的手术效果及其影响因素进行回顾性总结。结果术后随访3个月至12年,死亡1例（为猝死）,1例出现与抗凝有关的脑部并发症;心功能Ⅰ级36例,心功能Ⅱ级9例。术后超声心动图测得主动脉瓣跨瓣压差17～51（29．2±11．5）mmHg。结论主动脉瓣置换术是治疗先天性主动脉瓣二叶式畸形所致主动脉瓣的有效疗法,应尽可能选择有效瓣口面积较大的人造瓣膜,这样可以有效降低术后主动脉跨瓣压差,提高手术安全性和远期疗效。     

经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄的术中投照角度预测值分析

目的在二叶式主动脉瓣(BAV)行经导管主动脉瓣置换术(TAVR)中,分析术前多排螺旋CT(MDCT)预测的最佳导丝跨瓣角度、球囊预扩张角度和瓣膜释放角度规律,总结三种投照角度预测值的规律。方法回顾性分析2019年7月至2020年6月在复旦大学附属中山医院因严重症状性重度主动脉瓣狭窄(AS)而行TAVR的BAV患者31例。收集基线资料、术前评估和手术情况。使用MDCT预测TAVR最佳导丝跨瓣角度、球囊预扩张角度和瓣膜释放角度,按照横裂式BAV和纵裂式BAV分组,比较两组之间的差异和规律。结果最佳导丝跨瓣角度,横裂式BAV为右前斜(RAO)8°(18°,3°)、足位(CAU)25°(29°,17°),纵裂式BAV为左前斜(LAO)26°(21°,34°)、头位(CRA)13°(6°,22°),两者差异均有统计学意义(均P<0.001);最佳球囊预扩张角度(显示左冠状动脉开口),横裂式BAV为LAO 11°(9°,26°)、CRA 8°(1°,19°),纵裂式BAV为LAO 36°(30°,39°)、CRA 22°(14°,25°),两者差异均有统计学意义(均P<0.05);最佳球囊预扩张角度(显示右冠状动脉开口),横裂式BAV为LAO 48°(43°,60°)、CRA 26°(3°,29°),纵裂式BAV为LAO 48°(39°,70°)、CRA 25°(22°,33°),两者差异均无统计学意义(P=0.320、P=0.560);最佳瓣膜释放角度,横裂式BAV为RAO 12°(16°,4°)、CAU 25°(28°,19°),纵裂式BAV为LAO 21°(17°,26°)、CRA 3°(-2°,12°),两者差异均有统计学意义(均P<0.001)。结论术前MDCT可预测BAV行TAVR的最佳导丝跨瓣、球囊预扩张和瓣膜释放投照角度,这些角度与BAV为横裂式还是纵裂式相关,存在明显规律。     

超声心动图对主动脉瓣二叶畸形的探讨

目的 探讨超声心动图评估主动脉瓣二叶畸形(BAV)的应用价值.方法 选取我院2012年3月至2014年6月经超声诊断并被临床证实的BAV患者70例(横裂组44例、纵裂组21例、斜裂组5例),并与正常组30例进行比较.测最主动脉窦部及升部内径、室间隔及左室后壁厚度、左心功能及左房横径,观察患者瓣膜有无钙化、狭窄、关闭不全及脱垂.结果 BAV患者部分伴有瓣膜回声增强、增厚、钙化和脱垂,可造成瓣膜狭窄或关闭不全.主动脉升部增宽,纵裂组(39.840±6.361)mm,横裂组(37.480±5.793)mm,高于正常组的(30.270±2.348)mm;室间隔增厚,纵裂组(11.180±1.968)mm,横裂组(11.430±1.912)mm,高于正常组的(9.900±0.403)mm;左房横径增大,纵裂组(37.090±8.203)mm,横裂组(37.950±9.058)mm,高于正常组的(30.330±2.820)mm.结论 超声心动图对诊断BAV有重要价值.BAV可合并主动脉升部增宽、室间隔增厚及左房横径增大,而瓣膜舒张期关闭线形态分类横裂式、纵裂式对心脏结构和功能影响不大.