Congenital quadricuspid aortic valve: report of nine surgical cases.

We report the clinicopathologic characteristics of the congenital quadricuspid aortic valve necessitating surgery. Among 616 patients for whom we performed an aortic valve operation over the past 20 years, nine patients (1.46%) (five men and four women, mean age 60 years) with quadricuspid aortic valve were encountered. All had aortic regurgitation (AR) except one with aortic stenosis and mild regurgitation (ASr). All were free of cardiac anomaly including that of the coronary arterial system. Macroscopically, severe calcification of the valve was seen in the one case of ASr. Fenestration of the cusp was seen in five cases of AR. Infective endocarditis was not seen. Histological study disclosed fibrous thickening and myxoid degeneration in the AR cases. In accordance with the Hurwitz and Roberts classification, four valves were type b (three equal-sized cusps and one smaller cusp), two valves were type a (four equal-sized cusps), two valves were type d (one large, two intermediate, and one small cusp), and one valve was type g (four unequal-sized cusps). Valve repair failed in one patient and was converted to valve replacement during the operation. All patients underwent successful aortic valve replacement (AVR).     

Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease

Aortic valve disease is usually treated by prosthetic valve replacement. We have performed aortic valve plasty (AVP) using glutaraldehyde-treated autologous pericardium. AVP was performed for 88 patients from April 2007 through August 2009. Sixty-five patients had aortic stenosis, and 23 patients had aortic regurgitation (AR). Twenty-one patients showed bicuspid aortic valves, and one patient showed quadricuspid valve. There were 43 males and 45 females. Their mean age was 70.6±10.5 years old. First, diseased leaflets excised. Then, the distance between each commissure was measured. The new leaflet were trimmed with an original template from a glutaraldehyde-treated autologous pericardium sample. Finally, the annular margin of the pericardial leaflet was running sutured to each annulus. There was no operative mortality or embolic event. Postoperative echocardiography revealed a mean peak pressure gradient (PG) of 19.0±9.1 mmHg one week after surgery. Thirty-two patients had echocardiography one year after surgery. The peak PG became 12.9±5.8 mmHg. Ten patients showed no AR, 20 patients showed trivial AR, and two patients showed mild AR. Freedom from reoperation is 100% at three years follow-up.     

Midterm results of conservative repair of the incompetent bicuspid aortic valve

AIM: Repair of the bicuspid aortic valve is not generally considered the treatment of choice. Our success with this procedure leads us to report our immediate and mid-term RESULTS: METHODS: From August 1993 to December 2000, 19 patients with aortic regurgitation due to congenital aortic valve underwent aortic valve repair (17 men and 2 women with a mean age of 42+/-17 years; range, 16 to 70 years). The mean preoperative aortic regurgitation grade was 3.1+/-0.8 on a scale of 1 to 4. Mean preoperative New York Heart Association functional class was 1.9+/-0.8. Fourteen patients had pure aortic regurgitation, 2 also had infectious endocarditis, 1 had angina pectoris, and 2 had an ascending aortic aneurysm. RESULTS: There was 1 hospital death (5.2%), and 1 patient required re-operation due to recurrent infectious endocarditis. Mean aortic regurgitation grade at discharge was 1.1+/-0.9, and functional class was 1.1+/-0.2. All patients were followed for a mean duration of 40+/-23 months (range, 0.5 to 84 months). There was 1 late death, and two patients required aortic valve replacement. The 5-year survival rate was 90+/-7%. The 1- and 5-year re-operation-free rates were 87+/-12% and 76+/-23%. CONCLUSIONS: Bicuspid aortic valve repair is a safe procedure with good early postoperative RESULTS: However midterm results are not satisfactory. Re-operation is a promising alternative and progress aortic regurgitation were complications. Bicuspid aortic valve repair to valve replacement that requires additional study to individualize treatment.     

四叶式主动脉瓣畸形的诊断及外科治疗

目的 总结四叶式主动脉瓣畸形的超声心动图诊断并探讨外科治疗.方法 回顾分析上海市心血管病研究所2004年1月至2007年5月超声心动图资料,总结四叶式主动脉瓣膜病例的超声诊断特点.观察23例四叶式主动脉瓣四叶分布形态、回声、启闭及血流动力学情况.并总结分析手术治疗的9例病人的资料.结果 在92656例心脏超声检查中,共检出四叶式主动脉瓣膜畸形23例,检出率为0.248‰.年龄19～83岁,平均(50.3±18.8)岁;男11例,女12例.23例中22例合并不同程度主动脉瓣膜反流,仅1例主动脉瓣膜功能正常.其中9例行主动脉瓣膜置换手术,术中发现A型8例,F型1例.结论 四叶式主动脉瓣膜畸形是非常少见的先天性心脏畸形,多数由超声心动图检查发现,实时三维超声心动图对可疑病例可明确诊断.四叶式主动脉瓣膜畸形主要并发主动脉瓣膜反流,严重者应手术治疗.     

Surgical pathology of aortic valve disease. A study based on 602 specimens

A consecutive series of 602 surgically excised aortic valves was evaluated by means of macroscopic and histological study. Pure aortic stenosis was diagnosed in 140 patients, pure incompetence in 254 and combined dysfunction in 208. Of the cases with pure aortic stenosis, 38% were rheumatic, 34% were calcified bicuspid valves and 23% showed dystrophic calcification. Half the patients with pure aortic regurgitation showed aortic root dilatation. Most cases of combined aortic stenosis and regurgitation were the sequelae of rheumatic fever. A male prevalence was detectable in each group (mean male: female ratio = 2.6), and was highest in infective endocarditis and aortic root dilatation. Infective endocarditis was a frequent complication of congenitally bicuspid valves. In conclusion, rheumatic disease is still a frequent cause for surgical replacement of the aortic valve. At least half the explanted aortic valves have degenerative or congenital diseases which are often the site of a superimposed infective endocarditis.     

Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium

Objective

We had previously reported the short-term results of the aortic valve neocuspidization (AVNeo) procedure. We have now evaluated the midterm results with the longest follow-up of 118 months.

Bicuspid aortic valve.

The bicuspid aortic valve is a common congenital cardiac anomaly, having an incidence in the general population of 0.9% to 2.0% and a frequency of 54% in all patients aged >15 years with valvular aortic stenosis. In most cases it remains undetected until infective endocarditis or calcification supervenes. The bicuspid aortic valve may function normally throughout life, may develop progressive calcification and stenosis or may develop regurgitation with or without infection. The association of the bicuspid aortic valve with dissection of the aorta is also common. The recognition of the bicuspid valve in patients with aortic valve disease remains an important challenge to the clinician, whereas preoperative knowledge of valve morphology would be helpful in planning the surgery. Antibiotic prophylaxis is also recommended in such patients, since these valves are likely to become the most important intrinsic cardiac predisposition for infective endocarditis with the virtual disappearance of rheumatic fever in developed countries.     

Open commissurotomy for critical isolated aortic stenosis in neonates

BACKGROUND: The optimal management of critical aortic stenosis in early infancy remains controversial. The aim of this study was to assess the early and late outcomes following open surgical valvotomy for critical aortic stenosis in neonates and to provide a framework of data against which current results of other treatment approaches can be evaluated. METHODS: Eighteen consecutive neonates (mean age 9.2 days, range 1 to 26 days) undergoing an open valvotomy for critical isolated aortic stenosis (the standard treatment for this condition in our unit) between 1984 and 2000 were studied. The mean aortic valve gradient was 79.4 mm Hg. Twelve neonates received prostaglandins and 10 received inotropic agents preoperatively. Follow-up was complete (mean 8.1 years, range 1 month to 15 years). RESULTS: There was no operative mortality. At discharge, the mean aortic valve gradient was 37.2 mm Hg, with 6 patients having mild and 2 having moderate aortic regurgitation. Six patients required a reoperation; 3 of these had an aortic valve replacement at 9 to 11 years of age. Kaplan-Meier 5- and 10-year freedoms from any aortic reoperation or reintervention were 85 and 55%, respectively; 5- and 10-year freedoms from aortic valve replacement were 100 and 79%, respectively. A 14-year-old boy died from endocarditis 4 years following an aortic valve replacement in another unit. Kaplan-Meier 10-year survival was 100%. All survivors are in New York Heart Association I class and are leading normal lives. Their mean aortic valve gradient is 34.5 mm Hg, and none has significant aortic regurgitation. CONCLUSIONS: Open valvotomy for critical aortic stenosis in neonates carries a low operative risk and provides lengthy freedom from recurrent stenosis or regurgitation. Reoperations are inevitable, but aortic valve replacement can be delayed until the implantation of an adult-sized prosthesis is possible. Late survival is excellent. We consider open surgical valvotomy to be the treatment of choice for critical neonatal aortic stenosis.     

Outcome of aortic valve repair in children with congenital aortic valve insufficiency

OBJECTIVE: Surgical aortic valvotomy has a long history of providing excellent palliation for aortic stenosis in infancy and childhood. The fate of aortic valve repairs for dominant aortic regurgitation in this same age group is considerably less clear. METHODS: From 1990 to 2000, a total of 21 patients underwent aortic valve repair for aortic regurgitation at our institution. Seventeen patients were younger than 17 years at the time of repair (3-17 years, mean 8.1 +/- 3.7 years). Of these 17 children, 6 (35%) had bicuspid valves and 11 (65%) had tricuspid valves. Type of repair varied with valve type, but repair generally consisted of commissure resuspension, partial commissure closure, triangular resection of redundant leaflets, or some combination. RESULTS: There were no deaths. Follow-up ranged from 1 to 11 years (mean 5.3 +/- 2.4 years). At present 3 of 17 (17.6%) have mild aortic regurgitation according to echocardiography and 6 (35.2%) have moderate aortic regurgitation. In 8 of 17 cases (47.1%) the repair clearly failed, requiring reoperation from 0.5 to 73 months after the original operation (mean 18.9 months). Reoperation consisted of 6 Ross procedures and 2 mechanical aortic valve replacements. There were no deaths at the secondary operation. CONCLUSION: Aortic valve repair in children with a dominant feature of aortic insufficiency tended to fail progressively and at a high rate. Leaflet thickening was associated with higher risk of repair failure in this series. The threshold for aortic valve replacement should remain low.     

Quadricuspid aortic valve associated with rapidly progressive aortic stenosis during chronic hemodialysis; report of a case

A 70-year-old man was referred to our department for surgical treatment for aortic valve stenosis. He was diagnosed with aortic regurgitation 30 years ago, but he was asymptomatic at that time. Ten years ago, chronic hemodialysis was instituted for diabetic nephropathy. In recent years, he became aware of nocturnal dyspnea and echocardiography revealed moderate aortic stenosis. After that, the symptom was getting worse and surgical treatment was indicated. We performed aortic valve replacement. Intraoperatively, we noticed his aortic valve was quadricuspid. The postoperative course was uneventful and he was discharged without complications. Quadricuspid aortic valve is rare congenital anomaly and patients are often operated on for aortic regurgitation. Our case is indicated for valve replacement because of aortic stenosis. In addition, there are a few reports of quadricuspid aortic valve associated with hemodialysis. We consider hemodialysis is one of the cause of rapid progression of aortic stenosis in this patient.     

Congenital aortic and truncal valve reconstruction using the Ozaki technique: Short-term clinical results

ObjectivesAortic valve reconstruction (AVRec) with neocuspidization or the Ozaki procedure with complete cusp replacement for aortic valve disease has excellent mid-term results in adults. Limited results of AVRec in pediatric patients have been reported. We report our early outcomes of the Ozaki procedure for congenital aortic and truncal valve disease.MethodsA retrospective analysis was performed on all 57 patients with congenital aortic and truncal valve disease who had a 3-leaflet Ozaki procedure at a single institution from August 2015 to February 2019. Outcome measures included mortality, surgical or catheter-based reinterventions, and echocardiographic measurements.ResultsTwenty-four patients had aortic regurgitation (AR), 6 had aortic stenosis (AS), and 27 patients had AS/AR. Two patients had quadricuspid valves, 26 had tricuspid, 20 had bicuspid, and 9 had unicusp aortic valves. Four patients had truncus arteriosus. Thirty-four patients had previous aortic valve repairs and 5 had replacements. Preoperative echocardiography mean annular diameter was 20.90 ± 4.98 cm and peak gradient for patients with AS/AR was 53.62 ± 22.20 mm Hg. Autologous, Photofix, and CardioCel bovine pericardia were used in 20, 35, and 2 patients. Eight patients required aortic root enlargement and 20 had sinus enlargement. Fifty-one patients had concomitant procedures. Median intensive care unit and hospital length of stay were 1.87 and 6.38 days. There were no hospital mortalities or early conversions to valve replacement. At discharge, 98% of patients had mild or less regurgitation and peak aortic gradient was 16.9 ± 9.5 mm Hg. Two patients underwent aortic valve replacement. At median follow-up of 8.1 months, 96% and 91% of patients had less than moderate regurgitation and stenosis, respectively.ConclusionsThe AVRec procedure has acceptable short-term results and should be considered for valve reconstruction in pediatric patients with congenital aortic and truncal valve disease. Longer-term follow-up is necessary to determine the optimal patch material and late valve function and continued annular growth.     

Early and mid-term results of isolated aortic valve neocuspidization in patients with aortic stenosis

Objectives

This study aimed to elucidate the surgical outcome of aortic valve neocuspidization (AVNeo) in patients with aortic stenosis (AS).

Methods

From December 2010 to June 2017, we performed AVNeo for aortic valve pathologies in 144 patients. Of them, we evaluated 57 patients with AS who underwent AVNeo. Their mean age was 77.5?±?8.8 years. Fifty-five patients had AS from degenerative changes, 1 from pericardium endocarditis, and 1 from prosthetic valve endocarditis. Forty patients had a tricuspid aortic valve, 1 had a unicuspid valve, 14 had a bicuspid valve, 1 had a quadricuspid valve, and 1 had postoperative aortic valve replacement (AVR). Preoperative echocardiography revealed an average peak pressure gradient of 89?±?32.9 mmHg and a mean pressure gradient of 52?±?18.8 mmHg. The surgical procedure complies with the 3 cuspid suturing to the aortic annulus with the glutaraldehyde-treated pericardium.

Results

There were no conversions to AVR. There were 2 noncardiac-related deaths owing to liver failure and sepsis. Postoperative echocardiography showed an average peak pressure gradient of 22?±?10.7 mmHg 1 week after the procedure and 19.2?±?9.7 mmHg 20 months after the procedure. Two patients underwent reoperation owing to infective endocarditis and recurrent aortic regurgitation. The mean follow-up period was 30.4?±?20.8 months. The freedom from reoperation rates was 98.1 and 95.3% at 12 and 81 months of follow-up, respectively.

Conclusions

AVNeo is suitable for patients with AS considering its early and mid-term outcomes. Verification of long-term outcomes and reliability is necessary.

     

先天性主动脉瓣二叶化畸形的外科治疗

目的　探讨先天性主动脉瓣二叶化畸形的诊断、适宜手术时机、围术期处理以及手术疗效。　方法　 60例患者被施行心瓣膜置换术 ,行主动脉瓣机械瓣置换术 5 6例 ,行自体心包瓣置换术 4例 ;同时行主动脉窦瘤破裂修补术 2例 ,胸主动脉瘤修补术 2例 ,动脉导管未闭缝扎术 3例 ,室间隔缺损修补术 5例 ,冠状动脉旁路移植术 3例。其中伴感染性心内膜炎 2 5例。　结果　术后早期死亡 5例 ,死亡率为 8.3 %。随访 4 9例 ,平均随访时间 5 .4年 ,5年生存率为 84 .3 %。　结论　先天性主动脉瓣二叶化畸形以男性居多 ,左、右二叶型较前、后型常见 ,可致主动脉瓣关闭不全和 /或狭窄 ,以关闭不全多见 ( 75 % )。出现充血性心力衰竭、心绞痛、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。     

Results of prosthetic valve replacement for aortic stenosis

Background: Aortic valve replacement with mechanical valves is associated with a small but constant risk of valve thrombosis and thromboembolic and hemorrhagic complications. The surgical outcome of patients with Aortic Stenosis who had aortic valve replacement with mechanical valves is reported here. Methods: Between January 1990 and October 1999, 275 patients underwent prosthetic valve replacement for isolated aortic stenosis. The age ranged between 13 years and 75 years and 230 were males. The cause of aortic stenosis was rheumatic in 185 patients (67.3%), followed by bicuspid aortic valve in 75 patients (27.3%) and degenerative in 15 patients (5.4%). Results: The early mortality was 1.5%. The follow up was 96% complete and ranged from 1 to 104 months (mean 54±24.5months). Six patients (2.2%) developed prosthetic valve endocarditis. Paravalvular leak occurred in 3 (0.9%) patients. Valve thrombosis occurred in 10 patients (1.0% per patient year). The actuarial survival was 81±7% at 5 years and 64±13% at 8 years. Event free survival was 40±14% at 8 years. Conclusion: With current operative techniques and myocardial preservation aortic stenosis patients are at low risk for surgery. However, long term survival is limited due to prosthesis related complications.     

The Ross procedure is the procedure of choice for congenital aortic valve disease

OBJECTIVES: The Ross procedure has emerged as an attractive option for aortic valve replacement in children and young adults. Our objective was to review our experience with the Ross procedure in young patients with congenital aortic valve disease. We also sought for evidence of growth in the autograft. METHODS: From January 1990 to July 2000, 260 patients underwent the Ross procedure for various aortic valve diseases. There were 136 patients less than 18 years of age. Fifty-three (38%) of these patients had congenital aortic valve disease. Ages ranged from 3 months to 18 years (mean, 8 plus minus 5 years; median, 9 years). Ten patients were less than 2 years of age. Pure aortic stenosis was present in 18 patients, mixed stenosis and regurgitation in 32, and pure aortic regurgitation in 3. The aortic valve was bicuspid in 29 patients. Twenty-nine patients had previous procedures, mostly balloon dilation of the aortic valve (n = 8) or surgical aortic valvotomy (n = 12). RESULTS: In all patients immediate results demonstrated a normally functioning neoaortic valve with not more than trivial aortic valve regurgitation. In the patients with stenosis, all levels of obstruction were relieved, and the gradient across the left ventricular outflow tract was completely abolished. Hospital mortality was 3 (5.6%) of 53 (overall Ross mortality was 34 of 260 [1.5%]). The patients were followed up for a mean of 4 years and up to 10 years. One patient died late of a noncardiac cause. Actuarial survival at 10 years was 94% plus minus 2%, and freedom from all events was 93% plus minus 5%. Only 1 patient needed autograft replacement for endocarditis. Intervention related to right ventricle-pulmonary artery conduit was required in 3 patients: balloon dilatation in 2, and reoperation in 1. At last follow-up, all patients but one were classified as being in New York Heart Association functional class I or II with normal or near-normal autograft valve function. Serial measurement of the left ventricular outflow tract and aortic root showed that as patients grew, the size of the outflow tract increased. When indexed to body surface area, this increase correlated with the patients' expected somatic growth. CONCLUSIONS: The Ross procedure for congenital aortic valve disease in children and young adults offers excellent hemodynamics, with the added advantage of real potential for growth. It should be considered the treatment of choice in this age group.     

主动脉瓣重度狭窄171例外科治疗分析

目的 总结主动脉瓣重度狭窄行瓣膜置换术患者的外科治疗经验.方法 1990年12月至2006年12月共有171例主动脉瓣重度狭窄患者接受主动脉瓣置换术.其中男性135例,女性36例;年龄10-75岁,平均(45.8±15.6)岁;病程2个月-52年.主动脉瓣病变的病因依次为风湿性75例、老年性66例、二叶瓣畸形26例及其他先天性主动脉瓣畸形4例.单独主动脉瓣置换124例,主动脉瓣置换+升主动脉置换7例,主动脉瓣置换+冠状动脉旁路移植5例,主动脉瓣置换+二尖瓣成形19例,主动脉瓣置换+升主动脉成形8例,主动脉瓣置换+主动脉根部拓宽8例(Nicks法).结果 全组患者平均手术时间(4.4±0.6)h,心肺转流时间(124.7±38.5)min,其中主动脉阻断时间(78.3±21.7)min,术中平均出血量(754.5±518.4)ml,所有患者均顺利完成手术并脱离心肺转流.术后早期并发症发生率为12.3%(21/171),包括低心排血量综合征7例,多脏器功能衰竭3例,心内膜炎1例,肾功能不全4例,心室颤动1例,开胸止血2例,Ⅲ度房室传导阻滞2例,纵隔感染1例.全组手术死亡率5.8%(10/171),死于心力衰竭4例,心律失常1例,多脏器功能衰竭4例,感染性心内膜炎1例.结论 主动脉瓣重度狭窄患者的外科治疗对手术技术及围手术期处理经验要求较高,积极行瓣膜置换手术效果满意.     

Cryopreserved aortic allografts for aortic root reconstruction: a single institution’s experience

Background. An evaluation of early and long-term results of aortic root replacement with cryopreserved aortic allografts and echocardiographic follow-up of allograft valve function was performed.

Methods. From September 1989 through May 1998, 132 patients aged 17 to 77 years (mean, 50.8 ± 14.8 years) underwent freestanding aortic root replacement with a cryopreserved aortic allograft. Eighty-six (65.1%) patients had New York Heart Association class III or IV functional status before operation, and 27 (20.5%) patients underwent emergency operation. Fifty-nine (44.7%) patients had undergone previous cardiac operations. The cause of aortic disease was acute endocarditis in 63 (47.7%) patients, healed endocarditis in 15 (11.3%), degenerative in 20 (15.2%), congenital in 20 (15.2%), failed prosthesis in 10 (7.6%) and rheumatic in 4 (3.0%). Follow-up was complete, with a mean of 42 months.

Results. There were 12 hospital deaths (9.1%; 70% confidence limits [CL], 6.6% and 11.6%); 9 of them were operated on for active endocarditis (p = 0.062). Multivariate analysis determined age older than 65 years (p = 0.012) and emergency operation (p = 0.009) as independent risk factors for hospital mortality. During follow-up, 6 (5.0%; 70% CL, 3.0% and 7.0%) patients died. Cumulative survival rate for the entire group was 81.8% ± 5.4% at 8 years. Freedom from reoperation for structural valve failure was 100%, freedom from reoperation for any cause was 96.3% ± 1.8% at 8 years. Freedom from endocarditis at 8 years was 97.9% ± 1.4%. Follow-up of allograft valve function showed no or trivial aortic regurgitation in 97% of patients and absence of stenosis of the allograft in 100%.

Conclusions. Aortic root replacement with cryopreserved aortic allografts can be performed with acceptable hospital mortality and long-term results. The durability of cryopreserved aortic allografts is good, and reoperation for structural valve failure is absent at 8 years.     

Determinants of operative mortality for patients undergoing aortic valve replacement. Discriminant analysis of 1,479 operations

The influence of 35 preoperative and intraoperative characteristics on operative mortality risk after 1,479 isolated aortic valve replacement procedures (1967 to 1981) was investigated utilizing univariate and multivariate logistic regression analyses. Mean age at operation was 58 +/- 13 years; 72% of patients were men. Physiology was classified as aortic stenosis (58%), regurgitation (30%), or both (9%). The overall operative mortality rate was 7% +/- 1%, but there were substantial differences in operative mortality rates among physiological subgroups (aortic regurgitation, 10% +/- 2%; aortic stenosis, 6% +/- 1%; stenosis/regurgitation, 5% +/- 2%). Independent determinants of operative mortality rate in the entire group were advanced New York Heart Association functional class, renal dysfunction, physiological subgroup, atrial fibrillation, and older age. In the aortic regurgitation subgroup, functional class, atrial fibrillation, and operative year were independent predictors. In the aortic stenosis subgroup, the significant determinants were functional class, renal dysfunction, age, prosthetic valve dysfunction, and absence of angina. Concomitant coronary bypass grafting, previous operation, endocarditis, and ascending aortic replacement had no independent predictive effect on operative mortality rate. Thus, the early results of aortic valve replacement can be related to several specific variables describing the functional and physiological status of the patient. Operative mortality rate is not independently related to previous operation or concomitant operative procedures. Specific differences in risk factors exist among the various physiological subgroups, probably reflecting the pathophysiology of the different hemodynamic lesions. This information should provide for a more rational approach to aortic valve replacement, at least in terms of early risk/benefit deliberations.     

Long-term follow-up of supra-annular pulmonary autograft aortic root replacement in patients with bicuspid aortic valve

Objective: The performance of the Ross procedure in the case of geometric mismatch between pulmonary autograft and a bicuspid aortic root has not yet been fully evaluated. To prevent geometrically caused autograft dysfunction, a modification of the surgical technique is necessary. Methods: Between January 1996 and January 2007, 50 patients (33 male, 17 female; mean age 50+/-14 years; range 13-63 years) underwent replacement of a diseased bicuspid aortic valve (stenosis in 14 cases; insufficiency in 21; combined disease in 15) with a Ross procedure. The pulmonary autograft was inserted partially in supra-annular position to correct the geometric mismatch between the deeper base of the non-coronary sinus and the right/left coronary sinus. In 24 of these patients, additional tailoring of the non-coronary sinus was necessary. In eight patients the non-coronary sinus was covered with a glutaraldehyde treated autologous pericardial patch to prevent pseudoaneurysm formation. Patients were followed up 1, 2, 5 and 10 years postoperatively. Results: There were no early or late deaths. There were six reoperations. One patient was reoperated because of persistent severe aortic valve insufficiency 9 months postoperatively. Three patients were reoperated for formation of subannular pseudoaneurysm, 6, 9 and 30 months postoperatively. One patient was reoperated for closure of a paravalvular dehiscence. Another patient was reoperated 1 year postoperatively because of a severe pulmonary stenosis due to excessive calcification of the bioprosthesis. Echocardiographic follow-up of the remaining patients showed no evidence of residual or recurrent pulmonary autograft regurgitation or progression of aortic root dilatation. Conclusion: Autograft replacement of the bicuspid aortic valve is challenging, as the geometric mismatch has to be adjusted. Valve dysfunction is avoided by a supra-annular implantation technique, but pseudoaneurysm formation at the base of the non-coronary sinus is a worrying aspect. Patch reinforcement may solve this issue.     

主动脉瓣二瓣畸形所致主动脉瓣狭窄的外科治疗

目的 总结主动脉瓣二瓣畸形所致的单纯主动脉瓣狭窄外科手术治疗经验.方法 1993年5月至2007年12月,共收治主动脉瓣二瓣畸形所致的单纯主动脉瓣狭窄病人103例,其中男66例,女37例.年龄15～75岁,平均(52.9±13.2)岁.心功能Ⅱ级58级,Ⅲ级33例,Ⅳ级12例.所有病人均接受主动脉瓣置换术,同期行左室流出道疏通2例、房颤射频消融2例、升主动脉替换7例,冠状动脉旁路移植11例.结果 手术死亡1例(死亡病0.93%),Ⅲ度房室传导阻滞1例,余者均治愈出院.随访6个月～14年,平均(86.3±26.8)个月.失访14例,随访率84.2%.3例出现脑出血或栓塞并发症,1例猝死,1例非心脏原因死亡.最后随访心功能Ⅰ级67例,Ⅱ级17例,Ⅲ级2例.结论 主动脉瓣置换治疗主动脉瓣二瓣畸形所致的单纯主动脉瓣狭窄有较好的疗效,合并升主动脉扩张应积极处理.