瓣环结构重建的瓣膜置换手术

目的 总结瓣环结构重建的瓣膜置换手术技术及临床效果.方法 2003年1月至2009年5月59例病人行瓣环结构重建的瓣膜置换手术,其中细小主动脉根部43例,感染性心内膜炎累及瓣环结构13例,钙化性主动脉瓣病变钙化斑累及主动脉瓣环2例,主动脉瓣二尖瓣置换手术后主动脉根部出血1例.行主动脉瓣环重建加主动脉瓣置换术40例,二尖瓣瓣环重建二尖瓣置换术7例,主动脉-二尖瓣纤维环重建加主动脉二尖瓣置换术12例.结果 二尖瓣瓣环重建加二尖瓣置换手术与常规二尖瓣置换手术的主动脉阻断时间差异无统计学意义;而主动脉瓣瓣环重建加主动脉瓣置换以及二尖瓣-主动脉瓣纤维连接重建加二尖瓣主动脉瓣置换手术的主动脉阻断时间均明显延长.本组术后早期死亡4例,占6.7%.术后再次开胸止血2例,Ⅲ度房室传导阻滞2例,呼吸功能不全2例,急性肾功能衰竭2例.术后6个月复查超声心动图,无瓣周漏.结论 瓣环结构重建手术适合于瓣环过小需置人与体表面积相匹配的人工瓣膜、瓣膜病变累及瓣环结构的完整性或手术损伤等情况,尽管其手术操作较为复杂,主动脉阻断和体外循环时问均有所延长,但手术操作引起死亡的比率并未增加.

Abstract：

Objective To investigate the surgical technique and clinical outcomes of reconstruction of the annulus and the intervalvular fibrous body during valve replacements. Methods Fifty-nine patients underwent reconstruction of the annulus or the intervalvular fibrous body during the valve replacement. Indications for the operation were small aortic annulus which may cause patient/prosthesis mismatch in 43, active infective endocarditis with the abscess in the periannulus tissue in 13, extensive calcification of the aortic annulus in 2 and an active bleeding complication of the aortic root after aortic and mitral valve replacement in 1. The reconstruction was done with fresh autologous pericardium. Results The aortic clamping time in reconstruction of the intervalvular fibrous body with double valve replacement was longer than that of the regular double valve replacement. Four patients died in the perioperative period, giving an overall in- hospital mortality of 6.7%. Postoperative complication were: re-sternotomy for bleeding in 2, Ⅲ degree A-V block in 2, respiratory dysfunction in 2, and acute renal failure in 2. Patients were followed up for 6 months by echocardiography study, and no periannular leakage was found. Conclusion Reconstruction of the annulus is an effective technique for patients with a small aortic annulus, extensive calcification of the interventricular fibrous body and active infective endocarditis with abscess. Although the operative procedure is challenging and taking more time, the technique is safe and reproducible.

Valve replacement plus reconstruction of the annulus

Objective To investigate the surgical technique and clinical outcomes of reconstruction of the annulus and the intervalvular fibrous body during valve replacements. Methods Fifty-nine patients underwent reconstruction of the annulus or the intervalvular fibrous body during the valve replacement. Indications for the operation were small aortic annulus which may cause patient/prosthesis mismatch in 43, active infective endocarditis with the abscess in the periannulus tissue in 13, extensive calcification of the aortic annulus in 2 and an active bleeding complication of the aortic root after aortic and mitral valve replacement in 1. The reconstruction was done with fresh autologous pericardium. Results The aortic clamping time in reconstruction of the intervalvular fibrous body with double valve replacement was longer than that of the regular double valve replacement. Four patients died in the perioperative period, giving an overall in- hospital mortality of 6.7%. Postoperative complication were: re-sternotomy for bleeding in 2, Ⅲ degree A-V block in 2, respiratory dysfunction in 2, and acute renal failure in 2. Patients were followed up for 6 months by echocardiography study, and no periannular leakage was found. Conclusion Reconstruction of the annulus is an effective technique for patients with a small aortic annulus, extensive calcification of the interventricular fibrous body and active infective endocarditis with abscess. Although the operative procedure is challenging and taking more time, the technique is safe and reproducible.