Della Corte Alessandro, De Santo Luca S, Amarelli Cristiano, Romano GianPaolo, De Feo Marisa, Torella Michele, Scardone Michelangelo, Cotrufo Maurizio
Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy.
Ital Heart J. 2003 Dec;4(12):875-9.
Some patients with primary aortic valve disease can present with an associated asymmetrical dilation of the aortic root and/or ascending aorta without diffuse congenital aortic wall defects. In such cases "waistcoat aortoplasty" has been performed: the present study updates the report of the results of 73 procedures.
Seventy-three patients underwent aortic valve replacement and waistcoat aortoplasty. Sinus dilation was repaired by plicating the subcoronary redundant aortic wall using the anchoring sutures of the valve prosthesis. Through a triangular resection the most diseased segment of the aortic wall was removed and the aorta was reconstructed with a double layer technique. Thus autologous reinforcement of the convex right postero-lateral wall and stress reduction on the aortotomy suture line were both achieved. Echocardiography was performed preoperatively, postoperatively and then every 6 months. The paired Student's t-test was employed to evaluate the significance of the diameter variations.
The procedure was performed with no hospital mortality and a low postoperative morbidity. The post-reduction diameters at the sinuses, sinotubular junction and ascending aorta were significantly smaller than the preoperative ones (p < 0.001). During an echocardiographic follow-up of 39.2 +/- 12.5 months (range 14-58 months), no significant increase in the root (p = 0.18), sinotubular junction (p = 0.22), and ascending diameter (p = 0.34) was observed.
Although further studies are needed to confirm these results in the longer term, waistcoat aortoplasty should be taken into consideration in case of asymmetric ascending dilation secondary to aortic valve disease-related medial degeneration.
一些原发性主动脉瓣疾病患者可出现主动脉根部和/或升主动脉的不对称扩张，而无弥漫性先天性主动脉壁缺损。在这种情况下，已实施了“背心式主动脉成形术”：本研究更新了73例手术结果的报告。
73例患者接受了主动脉瓣置换术和背心式主动脉成形术。通过使用瓣膜假体的锚定缝线折叠冠状动脉下冗余的主动脉壁来修复窦部扩张。通过三角形切除去除主动脉壁病变最严重的部分，并用双层技术重建主动脉。从而实现了右后外侧凸壁的自体加固和主动脉切开缝合线上的应力降低。术前、术后及术后每6个月进行超声心动图检查。采用配对t检验评估直径变化的显著性。
手术无医院死亡，术后发病率低。窦部、窦管交界部和升主动脉的缩窄后直径显著小于术前（p<0.001）。在39.2±12.5个月（范围14 - 58个月）的超声心动图随访中，未观察到根部（p = 0.18）、窦管交界部（p = 0.22）和升主动脉直径（p = 0.34）有显著增加。
尽管需要进一步研究以长期证实这些结果，但对于因主动脉瓣疾病相关中层退变继发的不对称升主动脉扩张病例，应考虑采用背心式主动脉成形术。
