David T E, Omran A, Ivanov J, Armstrong S, de Sa M P, Sonnenberg B, Webb G
Divisions of Cardiovascular Surgery and Cardiology of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2000 Feb;119(2):210-20. doi: 10.1016/S0022-5223(00)70175-9.
Dilation of pulmonary autograft after the Ross procedure is being recognized with increasing frequency. This study was undertaken to examine the extent of this problem and factors that may be associated with it.
The clinical, operative, and echocardiographic data of 118 patients who underwent the Ross procedure were reviewed. The mean age of 79 men and 39 women was 34 +/- 9 years, range 17 to 57 years. Bicuspid or other congenital aortic valve disease was present in 81% of patients. The pulmonary autograft was sutured as a valve in the subcoronary position in 2 patients, as a root inside of the aortic root in 45, and was used for complete aortic root replacement in 71. Teflon felt was not used to buttress the proximal or the distal anastomosis of the pulmonary autograft. The diameters of the sinuses of Valsalva, aortic anulus, and sinotubular junction were measured early and late after the operation with echocardiography. The mean follow-up was 44 months.
The diameter of the sinuses of Valsalva increased from 31.4 +/- 0.4 mm to 33.7 +/- 0.5 mm (P =.01). Analysis of covariance revealed a significant change over time in this diameter, as well as a difference between operative techniques, with replacement of the aortic root being associated with a higher risk of dilation (P =. 0006). In 13 patients the diameter ranged from 40 to 51 mm. The diameter of the aortic anulus decreased in most patients and increased in 15, but there was no interaction between these changes and the operative technique. The diameter of the sinotubular junction increased in patients who had aortic root replacement and decreased in patients who had aortic root inclusion (P =.007). Moderate aortic insufficiency developed in 7 patients, and 3 required replacement of the pulmonary autograft. All patients with moderate aortic insufficiency had dilation of the aortic anulus and/or sinotubular junction.
Dilation of the pulmonary autograft after the Ross procedure may occur because of an intrinsic abnormality of the pulmonary root in patients with congenital aortic valve disease. The technique of aortic root replacement is associated with a higher risk of dilation of the sinuses of Valsalva and sinotubular junction than the technique of aortic root inclusion.
Ross手术后肺动脉自体移植物扩张的情况越来越多地被认识到。本研究旨在探讨这一问题的严重程度以及可能与之相关的因素。
回顾了118例行Ross手术患者的临床、手术及超声心动图资料。79例男性和39例女性的平均年龄为34±9岁，范围为17至57岁。81%的患者存在二叶式或其他先天性主动脉瓣疾病。2例患者将肺动脉自体移植物作为瓣膜缝合于冠状动脉下位置，45例作为主动脉根部内的根部，71例用于完全主动脉根部置换。未使用特氟龙毡来支撑肺动脉自体移植物的近端或远端吻合口。术后早期和晚期通过超声心动图测量主动脉瓣窦、主动脉瓣环和窦管交界的直径。平均随访时间为44个月。
主动脉瓣窦直径从31.4±0.4mm增加到33.7±0.5mm（P = 0.01）。协方差分析显示该直径随时间有显著变化，以及手术技术之间存在差异，主动脉根部置换与更高的扩张风险相关（P = 0.0006）。13例患者的直径范围为40至51mm。大多数患者的主动脉瓣环直径减小，15例增大，但这些变化与手术技术之间没有相互作用。在进行主动脉根部置换的患者中窦管交界直径增加，而在进行主动脉根部包绕的患者中减小（P = 0.007）。7例患者出现中度主动脉瓣关闭不全，3例需要更换肺动脉自体移植物。所有中度主动脉瓣关闭不全的患者均有主动脉瓣环和/或窦管交界扩张。
Ross手术后肺动脉自体移植物扩张可能是由于先天性主动脉瓣疾病患者肺动脉根部的内在异常所致。与主动脉根部包绕技术相比，主动脉根部置换技术与主动脉瓣窦和窦管交界扩张的风险更高相关。
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