Ionescu M I, Abid A, Wooler G H
Isr J Med Sci. 1975 Feb-Mar;11(2-3):185-96.
Experience with tissue valves for heart valve replacement over the past seven years is presented and analyzed. Between February 1967 and March 1969, 87 patients had heart valves replaced with preserved heterologous aortic valves. Valve failure occurred in 19 of the 70 operative survivors. There are 45 long-term survivors with heterologous aortic valves; 10 have regurgitant murmurs and 35 have valves functioning normally. Microscopic examination of failed valves has shown that the heterologous aortic valve gradually becomes a mechanically vulnerable structure in a state of rejection. During the past five years. autologous and homologous fascia lata and heterologous pericardium, mounted on a support frame, were used in 241 patients (131 aortic, 103 mitral and seven tricuspid). The follow-up period for the fascia lata group was 40 to 62 months and for the pericardial group 7 to 39 months. There have been significant differences in valve function with regard to both the site of valve insertion and the type of tissue used. Pericardial valves in the aortic position have produced the best results and autologous fascial valves in the mitral position, the worst. Valve failure occurred in only six patients, all with autologous fascia in the mitral position. The incidence of thromboembolism in the entire series was very low even though anticoagulants were not used. Analysis of clinical and hemodynamic results has shown that preserved heterologous pericardium has the potential for an adequate heart valve substitute.
本文介绍并分析了过去七年中使用组织瓣膜进行心脏瓣膜置换的经验。1967年2月至1969年3月期间，87例患者接受了保存的异种主动脉瓣膜置换心脏瓣膜手术。70例手术幸存者中有19例发生瓣膜功能衰竭。有45例长期存活者使用了异种主动脉瓣膜；其中10例有反流性杂音，35例瓣膜功能正常。对功能衰竭瓣膜的显微镜检查表明，异种主动脉瓣膜在排斥状态下逐渐成为机械上易受损的结构。在过去五年中，241例患者（131例主动脉瓣、103例二尖瓣和7例三尖瓣）使用了安装在支撑框架上的自体和同种阔筋膜以及异种心包。阔筋膜组的随访期为40至62个月，心包组为7至39个月。瓣膜功能在瓣膜植入部位和所用组织类型方面存在显著差异。主动脉位置的心包瓣膜效果最佳，二尖瓣位置的自体阔筋膜瓣膜效果最差。仅6例患者发生瓣膜功能衰竭，均为二尖瓣位置的自体阔筋膜瓣膜。尽管未使用抗凝剂，但整个系列中的血栓栓塞发生率非常低。临床和血流动力学结果分析表明，保存的异种心包有潜力成为合适的心脏瓣膜替代品。
