Takakura H, Sasaki T, Hashimoto K, Hachiya T, Onoguchi K, Oshiumi M, Takeuchi S
Department of Cardiovascular Surgery, Saitama Cardiovascular and Respiratory Center, 1696 Itai Kounan-machi, Osato-gun, Saitama 360-0105, Japan.
Ann Thorac Cardiovasc Surg. 2000 Jun;6(3):190-2.
Three female patients with aortic stenosis associated with a severely small annulus underwent aortic valve replacement. In intraoperative measurements, a 19-mm obtulator could not pass through the aortic annulus in each case. We therefore concluded that it would be difficult to implant an appropriate-sized prosthesis in a routine fashion, so we performed an annular enlargement in a modified Nicks procedure. By using a wide teardrop-shaped patch for enlargement and slightly tilting insertion of a prosthesis, a 21 mm bileaflet mechanical prosthesis could be inserted into the enlarged annulus. Despite being a simpler method than other enlarging procedures, a two- or three-sizes larger prosthesis than the native annulus can be inserted with relative ease. Thus, the use of a 19 mm mechanical prosthesis may be avoidable in most adult cases.
三名患有主动脉瓣狭窄且瓣环严重狭小的女性患者接受了主动脉瓣置换术。在术中测量中，每个病例中19毫米的闭合器均无法通过主动脉瓣环。因此，我们得出结论，以常规方式植入合适尺寸的人工瓣膜将很困难，所以我们采用改良的尼克（Nicks）手术进行瓣环扩大。通过使用宽泪滴形补片进行扩大，并将人工瓣膜稍作倾斜插入，一个21毫米的双叶机械瓣膜能够被插入扩大后的瓣环。尽管该方法比其他扩大手术更简单，但可以相对轻松地插入比天然瓣环大两到三个尺寸的人工瓣膜。因此，在大多数成人病例中可能无需使用19毫米的机械瓣膜。
