自体心包补片修补主动脉瓣环辅助主动脉瓣置换

背景：在主动脉置换过程中常遇到瓣环钙化、瓣周囊肿等特殊情况,这时一般应用特殊技术辅助主动脉瓣置换。目的：观察自体心包补片修补主动脉瓣环辅助主动脉瓣置换治疗钙化性主动脉瓣狭窄并瓣环钙化的临床可行性。方法：回顾性分析2009年1月至 2012年1月郑州大学第一附属医院42例钙化性主动脉瓣狭窄并瓣环钙化患者的临床资料,并通过统计学软件处理自体心包补片修补主动脉瓣环技术辅助主动脉瓣置换前后的主动脉瓣有效瓣口面积指数、最大跨瓣压差、血流峰值速度、左室射血分数等数据,分析自体心包补片修补主动脉瓣环技术辅助主动脉瓣置换的应用效果。结果与结论：无置换中死亡病例,置换中主动脉阻断时间为52-88(63.0±18.1) min,体外循环时间为78-122(102.6±25.1) min,置换后1例患者出现急性肾功能衰竭,经床旁血透治疗后治愈。余患者无严重置换并发症。置换后住院天数为7-20(13.6±5.5) d。置换后多普勒超声心动图示：瓣膜功能良好,均未发现主动脉瓣周漏。置换后6个月的主动脉瓣有效瓣口面积指数、最大跨瓣压差、血流峰值速度、左室射血分数均有显著改善,与置换前比较差异均有显著性意义(P < 0.05)。证实对置换适应证合适的特殊换瓣患者,自体心包补片修补主动脉瓣环辅助主动脉瓣置换可取得满意的外科治疗效果,且操作安全简单,是一项可行的技术。

Autologous pericardium patch repairs the aortic annulus to assist aortic valve replacement

BACKGROUND:Annulus calcification and paravalvular cysts often appear during aortic valve replacement. At this time, special techniques are generally used to assist the aortic valve replacement.OBJECTIVE:To investigate the clinical feasibility of pericardium patch repaired aortic annulus to assist aortic valve replacement for the treatment of calcific aortic stenosis complicated by annulus calcification. METHODS:Forty two patients with calcific aortic stenosis complicated by annulus calcification were selected from the First Affiliated Hospital of Zhengzhou University during January 2009 and January 2012. Their clinical data were retrospectively analyzed. The effective orifice area index of aortic valve, maximum transvalvular pressure gradient, peak blood flow velocity and left ventricular ejection fraction were analyzed with statistical software before and after pericardium patch repaired aortic annulus assisted aortic valve replacement, and then the effect of autologous pericardium patch repaired aortic annulus to assist aortic valve replacement was analyzed. RESULTS AND CONLUSION:There was no intraoperative death during the pericardium patch repaired aortic annulus assisted aortic valve replacement. The intraoperative aortic clamping time was 52-88 (63.0±18.1) minutes, and the cardiopulmonary bypass time was 78-122 (102.6±25.1) minutes. One patient appeared acute renal failure after replacement, and cured after the bedside hemodialysis treatment. The rest patients had no serious complications. The length of hospital stay was 7-20 (13.6±5.5) days. The postoperative Doppler echocardiography showed the heart valve prosthesis was good, and no paravalvular leaks were found. The orifice area index of aortic valve, maximum transvalvular pressure gradient, peak blood flow velocity and left ventricular ejection fraction were significantly improved at 6 months after replacement, and the differences were significant when compared with those before replacement (P < 0.05). In patients with appropriate surgical indications, the autologous pericardium patch repaired aortic annulus assisted aortic valve replacement surgery can achieve satisfactory effects, and the operation is safe and simple, which is considered as a practicable technology.