主动脉瓣自体肺动脉移植置换术后（罗斯手术）的左心室重塑。

Legarra J J, Concha M, Casares J, Merino C, Muñoz I, Alados P

Department of Cardiac Surgery, Instituto Galego de Medicina Técnica, MED-TEC, Vigo, Pontevedra, Spain.

J Heart Valve Dis. 2001 Jan;10(1):43-8.

BACKGROUND AND AIM OF THE STUDY

Aortic valve replacement (AVR) with a pulmonary autograft is an alternative treatment for young patients with aortic valve disease. Superior hemodynamic performance of the pulmonary autograft, and impact on parameters of left ventricular function were analyzed.

METHODS

Thirty patients (21 males, nine females; mean age 29.97+/-12.29 years; range: 6-54 years) underwent a Ross procedure between November 1997 and November 1999. Seven patients (23%) were children (aged <15 years). In total, 22 patients were analyzed; each had at least three months follow up. Eleven patients had predominant aortic stenosis (AS), and 11 had aortic insufficiency (AI).

RESULTS

There were no operative deaths. Two patients developed severe insufficiency, and the autograft was replaced with a mechanical valve. Pre- and postoperative echocardiograms were reviewed. The mean neoaortic maximal gradient was 7.85+/-5.59 mmHg (range: 3-29 mmHg). AS patients showed reduced interventricular septal (IVS) thickness at one month (from 13.27+/-3.69 to 11.60+/-2.44 mm; p = 0.0165) and 18 months after surgery (p = 0.0104). Left ventricular posterior wall (LVPW) thickness was reduced from 12.04+/-3.75 to 9.48+/-2.47 mm (p = 0.0338) at one month and 18 months (p= 0.0128) after surgery. The left ventricular end-diastolic internal dimension (LVIDd) decreased from 50.71+/-10.20 to 44.98+/-7.29 mm (p = 0.0491) at one month after surgery. In AI patients, LVPW and IVS thicknesses showed no significant variation, and LVIDd was decreased at one month (from 68.50+/-8.39 to 59.04+/-9.21 mm; p = 0.0017) and 18 months (p = 0.0229) after surgery. Left ventricular end-systolic internal dimension (LVIDs) decreased from 44.06+/-6.39 to 39.03+/-7.99 mm (p = 0.0081) at three months after surgery. Left ventricular mass index (LVMI) in the AS group decreased from 179.01+/-62.26 to 115.74+/-37.62 g/m2 (p = 0.0021) at one month after surgery, and at 18 months was normal, with a decrease from 208.77+/-32.89 to 95.89+/-28.82 g/m2 (p= 0.0003) (n = 5). In the AI group, LVMI decreased from 186.25+/-85.21 to 140.58+/-62.02 g/m2 (p = 0.0011) at one month after surgery, and at 18 months from 217.70+/-98.02 to 146.73+/-84.55 g/m2 (p= 0.0131) (n = 5).

CONCLUSION

The pulmonary autograft procedure can be used safely to replace the aortic valve, and allows optimal hemodynamic performance, with no significant aortic regurgitation. The Ross procedure results in normalization of left ventricular dimensions and improvement of left ventricular function early in the postoperative period.

研究背景与目的

采用自体肺动脉瓣置换主动脉瓣是年轻主动脉瓣疾病患者的一种替代治疗方法。分析了自体肺动脉瓣的优越血流动力学性能及其对左心室功能参数的影响。

方法

1997年11月至1999年11月期间，30例患者（21例男性，9例女性；平均年龄29.97±12.29岁；范围：6 - 54岁）接受了罗斯手术。7例患者（23%）为儿童（年龄<15岁）。总共分析了22例患者；每位患者至少随访3个月。11例患者以主动脉瓣狭窄（AS）为主，11例患者以主动脉瓣关闭不全（AI）为主。

结果

无手术死亡病例。2例患者出现严重关闭不全，自体瓣膜被机械瓣膜替代。回顾了术前和术后的超声心动图。新主动脉最大平均压差为7.85±5.59 mmHg（范围：3 - 29 mmHg）。AS患者术后1个月（从13.27±3.69 mm降至11.60±2.44 mm；p = 0.0165）和18个月时室间隔（IVS）厚度减小（p = 0.0104）。术后1个月和18个月时左心室后壁（LVPW）厚度从12.04±3.75 mm降至9.48±2.47 mm（p = 0.0338）（p = 0.0128）。术后1个月时左心室舒张末期内径（LVIDd）从50.71±10.20 mm降至44.98±7.29 mm（p = 0.0491）。在AI患者中，LVPW和IVS厚度无显著变化，术后1个月（从68.50±8.39 mm降至59.04±9.21 mm；p = 0.0017）和18个月时LVIDd减小（p = 0.0229）。术后3个月时左心室收缩末期内径（LVIDs）从44.06±6.39 mm降至39.03±7.99 mm（p = 0.0081）。AS组术后1个月时左心室质量指数（LVMI）从179.01±62.26 g/m²降至115.74±37.62 g/m²（p = 0.0021），18个月时恢复正常，从208.77±32.89 g/m²降至95.89±28.82 g/m²（p = 0.0003）（n = 5）。在AI组中，术后1个月时LVMI从186.25±85.21 g/m²降至140.58±62.02 g/m²（p = 0.0011），18个月时从217.70±98.02 g/m²降至146.73±84.55 g/m²（p = 0.0131）（n = 5）。