Martin Julie W, Deeb G Michael, Bach David S
Department of Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA.
J Heart Valve Dis. 2003 Nov;12(6):726-33.
Aortic root dilation at the sinotubular junction (STJ) results in aortic regurgitation associated with normal valves and with a complete subcoronary stentless aortic bioprosthesis. The study aim was to assess for progressive aortic root dilation following modified subcoronary Freestyle aortic valve replacement (AVR), and to compare for differences between implant techniques.
Aortic root diameter was measured at the annulus, sinuses of Valsalva, STJ and tubular aorta on post-pump transesophageal echocardiograms and on early (3-month) and late (>2 years) transthoracic echocardiograms among 16 patients after modified subcoronary Freestyle valve replacement, 16 after root inclusion, and three after total root replacement.
Mean follow up was 3.9 +/- 0.8, 3.3 +/- 0.7 and 3.5 +/- 1.1 years for modified subcoronary, root inclusion and total root patients, respectively. The aortic annulus, sinuses and STJ increased in diameter to similar extents between surgery and three months after modified subcoronary and root inclusion surgery, with no further increase at late follow up (modified subcoronary STJ 18.4 +/- 3.7, 21.1 +/- 3.7 and 20.5 +/- 4.4 mm on intraoperative, early and late echocardiography, respectively; root inclusion STJ 21.8 +/- 3.9, 25.4 +/- 4.6 and 24.4 +/- 4.4 mm, respectively). There were no changes in aortic root diameter after total root replacement (STJ 23.7 +/- 1.2 and 25.7 +/- 6.0 on intraoperative and late follow up, respectively). Aortic regurgitation prevalence was low, and similar between groups.
Small but significant increases in aortic root dimensions were seen during the first three months after modified subcoronary and root inclusion surgery, with no subsequent change. The early changes were likely caused by resorption of paravalvular edema and hematoma transiently affecting aortic root measurements in the perioperative period. There was no evidence of progressive STJ dilation at 3.9 years after modified subcoronary Freestyle AVR.
主动脉窦管交界（STJ）处的主动脉根部扩张会导致与正常瓣膜及完全性冠状动脉下无支架主动脉生物瓣膜相关的主动脉瓣反流。本研究的目的是评估改良冠状动脉下Freestyle主动脉瓣置换术（AVR）后主动脉根部是否进行性扩张，并比较植入技术之间的差异。
在16例行改良冠状动脉下Freestyle瓣膜置换术的患者、16例行根部植入术的患者以及3例行全根部置换术的患者中，于术后经食管超声心动图以及早期（3个月）和晚期（>2年）经胸超声心动图检查时，测量主动脉瓣环、主动脉窦、STJ和主动脉管的直径。
改良冠状动脉下、根部植入和全根部置换患者的平均随访时间分别为3.9±0.8年、3.3±0.7年和3.5±1.1年。改良冠状动脉下和根部植入手术后，主动脉瓣环、主动脉窦和STJ的直径在手术至术后3个月间以相似程度增加，晚期随访时未进一步增大（改良冠状动脉下STJ在术中、早期和晚期超声心动图检查时分别为18.4±3.7、21.1±3.7和20.5±4.4mm；根部植入STJ分别为21.8±3.9、25.4±4.6和24.4±4.4mm）。全根部置换术后主动脉根部直径无变化（STJ在术中及晚期随访时分别为23.7±1.2和25.7±6.0）。主动脉瓣反流的患病率较低，且各组间相似。
改良冠状动脉下和根部植入手术后的前三个月，主动脉根部尺寸有小幅度但显著的增加，随后无变化。早期变化可能是由于瓣周水肿和血肿的吸收，在围手术期短暂影响了主动脉根部的测量。改良冠状动脉下Freestyle AVR术后3.9年，没有证据表明STJ会进行性扩张。
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