Leyh R G, Kofidis T, Hagl C, Fischer S, Knobloch K, Akhyari P, Karck M, Haverich A
Medizinische Hochschule Hannover Carl-Neuberg-Str. 1 30623 Hannover, Germany.
Z Kardiol. 2003 May;92(5):392-7. doi: 10.1007/s00392-003-0920-9.
The safety and effectiveness of combined aortic root autograft replacement in combination with ascending aorta replacement has been demonstrated recently. Replacement of the ascending aorta with a vascular prosthesis results in an increase in aortic root distension, and aortic root wall stress. In this study we aimed to assess the autograft root dimensions, distensibility, and autograft valve function in patients after Ross operation combined with replacement of the ascending aorta compared to patients who underwent Ross operation only.
Echocardiographic follow-up was performed on 28 patients after Ross operation with complete root replacement only (group R) and 12 patients who received an additional replacement of the ascending aorta (group R/A). The mean follow-up time was 24.9 +/- 17.2 months. Autograft root dimensions, root distensibility and valve function were assessed by echo-cardiography. The aortic root was measured at the level of the annulus, sinus of valsalva, and sinotubular junction. The distensibility was calculated as percent change of radius.
The mean distensibility at the annulus level was higher in group R/A (18.4 +/- 6.8% vs 13.4 +/- 8.1%; p = 0.047); at the level of the sinus of valsalva and sinotubular junction no differences were observed. The autograft pressure gradient was within physiological limits in all patients. The majority of patients showed a competent autograft valve (group R: AI 0 degree; 83%, AI I degree; 14%, AI II degree; 3%; group R/A: AI 0 degree; 75%, AI I degree; 25%).
Replacement of the ascending aorta with a non-compliant prosthesis does not effect root dimension, distensibility, and valve function.
近期已证实主动脉根部自体移植物置换联合升主动脉置换的安全性和有效性。用血管假体置换升主动脉会导致主动脉根部扩张和主动脉根壁应力增加。在本研究中，我们旨在评估与仅接受罗斯手术的患者相比，罗斯手术联合升主动脉置换术后患者的自体移植物根部尺寸、扩张性和自体移植物瓣膜功能。
对28例仅行完全根部置换的罗斯手术后患者（R组）和12例接受了额外升主动脉置换的患者（R/A组）进行超声心动图随访。平均随访时间为24.9±17.2个月。通过超声心动图评估自体移植物根部尺寸、根部扩张性和瓣膜功能。在瓣环、主动脉窦和窦管交界处水平测量主动脉根部。扩张性计算为半径变化百分比。
R/A组瓣环水平的平均扩张性较高（18.4±6.8%对13.4±8.1%；p = 0.047）；在主动脉窦和窦管交界处水平未观察到差异。所有患者的自体移植物压力梯度均在生理范围内。大多数患者的自体移植物瓣膜功能良好（R组：主动脉瓣反流0度；83%，主动脉瓣反流I度；14%，主动脉瓣反流II度；3%；R/A组：主动脉瓣反流0度；75%，主动脉瓣反流I度；25%）。
用顺应性差的假体置换升主动脉不会影响根部尺寸、扩张性和瓣膜功能。
