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。

The surgical treatment of inborn bicuspid aortic valve with aortic valve stenosis

Objective To explore the experience of the surgical treatment of inborn bicuspid aortic valve result in aortic valve stenosis. Methods Between September 1995 and December 2010, 46 patients with inborn bicuspid aortic valve result in aortic valve stenosis, 32 males and 4 females, age 14-72, underwent surgical treat- ment of bicuspid aortic valve in Union Hospital, Fujian Medical University. The surgical results and relevant influ- encing factors were studied retrospectively. Results The patients were followed up from 3 month to 12 years post- operation, one ease died of sudden death, the other one was detected par＇s eneephalica complication relation with anticoagulation, heart function Ⅰ （36eases）, heart function Ⅱ （9 cases）. The aortic valve straddle valve gradient pressure was 17-51 mm Hg by ultrasonic cardiogram follow up,. and the average was （29.2＋11.5）ram Hg. Con- dusion The aortic valve replacement is an effective treatment for patients with inborn bicuspid aortic valve result in aortic valve stenosis. The artificial valve effective orifice area is key measures of successful surgical treatment.