El Khoury G A, Underwood M J, Glineur D, Derouck D, Dion R A
Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Ann Thorac Surg. 2000 Oct;70(4):1246-50. doi: 10.1016/s0003-4975(00)01716-1.
Patients with aneurysms of the ascending aorta or aortic root may have associated aortic insufficiency (AI). We reviewed our experience with aortic root remodeling and reconstruction of the sino-tubular junction.
Forty-five patients were operated on between July 1995 and September 1998. Transesophageal echocardiography showed AI grade III or IV in 15 patients. Twenty-seven patients had replacement of all three sinuses, 10 of one or two sinuses. Reconstruction of the sino-tubular junction alone was performed in 8 patients.
There was one death at 28 days. Perioperative transesophageal echocardiography showed no or discrete AI in all patients. There has been one aortic valve replacement at day 4 postoperatively for cusp repair failure. Transesophageal echocardiography in 40 patients at a mean time of 12.5 months showed no progression of AI in 38 patients, and a grade II in 2. Clinical follow-up averaged 14.5 months. There have been three late, not procedure-related deaths. Thirty-six patients are in New York Heart Association functional class I. There have been no cases of endocarditis.
Aortic remodeling is successful in eliminating AI in patients with aortic root disease with minimal mortality and morbidity. Early echocardiography (1 year) has shown no progression of AI in 95% of cases.
升主动脉或主动脉根部动脉瘤患者可能合并主动脉瓣关闭不全（AI）。我们回顾了我们在主动脉根部重塑和窦管交界重建方面的经验。
1995年7月至1998年9月期间对45例患者进行了手术。经食管超声心动图显示15例患者为III级或IV级AI。27例患者进行了三个窦全部置换，10例进行了一个或两个窦置换。8例患者仅进行了窦管交界重建。
28天时有1例死亡。围手术期经食管超声心动图显示所有患者无AI或仅有轻微AI。术后第4天有1例因瓣叶修复失败进行了主动脉瓣置换。40例患者平均在12.5个月时进行的经食管超声心动图显示，38例患者AI无进展，2例为II级。临床随访平均14.5个月。有3例晚期非手术相关死亡。36例患者纽约心脏协会心功能分级为I级。无感染性心内膜炎病例。
主动脉重塑成功消除了主动脉根部疾病患者的AI，死亡率和发病率极低。早期（1年）超声心动图显示95%的病例AI无进展。
