Lundblad R, Hagen O M, Smith G, Kvernebo K
Department of Cardiothoracic Surgery, Ullevål University Hospital, Oslo, Norway.
J Heart Valve Dis. 2001 Mar;10(2):196-201.
Aortic valve replacement can result in patient-valve mismatch and attenuated left ventricular remodeling. Using CarboMedics mechanical valves, we examined if the supraannular Top Hat prosthesis provided a size advantage over the intraannular valve.
Seventeen patients with aortic stenosis and aortic root < or = 23 mm were randomized to receive a CarboMedics supraannular Top Hat valve (n = 7) or an intraannular valve (n = 10). Doppler echocardiography was performed preoperatively, and after three months.
There was no difference in aortic annulus size, but mean prosthesis size was significantly larger in the Top Hat group than in the intraannular group (25.00 mm versus 21.60 mm); the mean size improvement for Top Hat patients was 3.14 mm. After three months, all patients had excellent functional improvement and low transvalvular pressure gradients, with slightly higher effective valve opening area in the Top Hat group.
The supraannular Top Hat valve provides an advantage of one to two sizes over the intraannular valve, and improves the effective valve opening area. Both valves offer favorable hemodynamic performance and functional improvement.
主动脉瓣置换可导致患者-瓣膜不匹配及左心室重构减弱。我们使用CarboMedics机械瓣膜，研究了瓣环上Top Hat假体相对于瓣环内瓣膜是否具有尺寸优势。
17例主动脉瓣狭窄且主动脉根部≤23 mm的患者被随机分为两组，分别接受CarboMedics瓣环上Top Hat瓣膜（n = 7）或瓣环内瓣膜（n = 10）。术前及术后三个月进行多普勒超声心动图检查。
主动脉瓣环大小无差异，但Top Hat组的平均假体尺寸显著大于瓣环内瓣膜组（25.00 mm对21.60 mm）；Top Hat组患者的平均尺寸增加了3.14 mm。三个月后，所有患者的功能均有显著改善，跨瓣压差较低，Top Hat组的有效瓣口面积略高。
瓣环上Top Hat瓣膜相对于瓣环内瓣膜具有一到两个尺寸的优势，并改善了有效瓣口面积。两种瓣膜均具有良好的血液动力学性能和功能改善效果。
