改良Manouguian法联合主动脉环上瓣置入的临床应用

目的 介绍改良Manouguian法主动脉瓣环扩大成形术联合环上瓣置入在成人双瓣膜置换术中应用的临床效果。方法 从2004年8月～2007年6月，选择12例（男4例，女8例；年龄47.7±11.5岁）二尖瓣、主动脉瓣双瓣膜病变伴主动脉瓣环窄小的患者，术中测得主动脉瓣环直径17～21mm。采用改良Manouguian法扩大主动脉瓣环，主动脉瓣位置入ATS AP（环上瓣）机械瓣，二尖瓣位置入ATS 标准机械瓣，行双瓣膜置换术。主动脉瓣位置入ATS AP瓣18mm 2例，20mm 8例，22mm 2例。二尖瓣位置入ATS 标准瓣25mm 8例，27mm 4例。术后3～12个月行多普勒超声心动图检查。结果 本组无手术和住院死亡病例。术后3个月随访，心功能I级8例，II级2例。多普勒超声心动图检查未发现PPM现象。结论 二尖瓣、主动脉瓣双瓣膜病变伴主动脉瓣环窄小的成人患者在双瓣膜置换术中采用改良Manouguian法行主动脉瓣环扩大成形术联合使用ATSAP机械瓣，可置入足够大的人工瓣膜，以提高手术的成功率和远期疗效。

Clinical Experience of Patch Enlargement of the Small Aortic Annulus by a Modified Manouguian Procedure and ATS AP Prosthetic Valve Implanted in the Aortic Position for Double Valve Replacement in Adults

Objective To introduce the clinical experience of patch enlargement of the small aortic annulus by a modified Manouguian procedure and ATS AP （advanced performance） prosthetic valve implanted in the aortic position for combined aortic and mitral valve replacement in adults. Methods 12 consecutive patients （4 men,6 women; age 47.7 ±11.5 years） with combined aortic and mitral valve disease and small aortic annulus from April 2004 to June 2007 were enrolled in the study. In intra-operative measurements, the diameters of aortic annulus ranged from 17mm to 20mm. Patch enlargement of the small aortic annulus was performed by a modified Manouguian procedure,and then ATS AP prosthetic valve was implanted in the aortic position and ATS standard prosthetic valve was implanted in the mitral position. The ATS AP prosthetic valve （18mm in 2 patients,20 mm in 8 patients,22mm in 2 patients） was implanted in aortic position and the ATS standard prosthetic valve （25mm in 8 patients,27mm in 4 patients） was implanted in mitral position,respectively. Doppler echocardiography was performed at least three months after the operation （ranged from 3 months to 12 months）. Results There were no operative and in-hospital deaths. All patients were followed up from 5 to 32 months and their cardiac function was significantly improved three months after the operation （NYHA Class Ⅰ in 8 cases, NYHA Class Ⅱ in 2 cases）. No prosthesis-patient mismatch was found by Doppler echocardiography. Conclusion It can implant large enough size of aortic prosthetic valve by patch enlargement of the aortic annulus and implantation of ATS AP prosthetic valve in aortic position in adults who undergo double valve replacement with small aortic annulus, which can improve successful operative rate and long-term effectiveness.