Tokunaga H, Koyanagi H, Hashimoto A, Nakano K, Hirayama T, Hachida M, Imamaki M
Department of Cardiovascular Surgery, Tokyo Women's Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Apr;40(4):467-71; discussion 471-2.
From January, 1978 to December, 1990, 85 patients with congenital bicuspid aortic valve underwent aortic valve replacements (AVR) with St. Jude Medical valve prosthesis. We classified congenital bicuspid aortic valve into four types. Type I (44.7%): Two cusps are situated right and left, a coronary artery arises from each related sinus of valsalva. Type II (22.4%): Type I + raphe in the right cusp. Type III (3.5%): one cusp is located anteriorly, the other posteriorly and both coronary arteries arise from anterior cusp. Type IV (29.4%): Type III + raphe in the anterior cusp. Regarding to preoperative diagnosis, aortic stenosis dominated in Type I (78.8%) and aortic regurgitation dominated in Type IV (72.0%). Implanted valve sizes were 22.2 +/- 1.8 (Type I), 23.4 +/- 1.6 (Type II) and 24.0 +/- 2.2 (Type IV). There was a significant difference between Type I and Type II, same as Type I and Type IV. Babb's method and outflow measurement method were utilized to predict the aortic annular size. However, both of them were not reliable for estimating the size of the aortic annulus in cases of aortic stenosis undergoing AVR with a 21 mm prosthesis.
1978年1月至1990年12月，85例先天性二叶式主动脉瓣患者接受了圣犹达医疗瓣膜假体置换主动脉瓣（AVR）手术。我们将先天性二叶式主动脉瓣分为四种类型。I型（44.7%）：两个瓣叶分别位于左右两侧，冠状动脉分别发自各自相关的主动脉窦。II型（22.4%）：I型 + 右瓣叶有嵴。III型（3.5%）：一个瓣叶位于前方，另一个位于后方，两条冠状动脉均发自前方瓣叶。IV型（29.4%）：III型 + 前方瓣叶有嵴。术前诊断方面，I型以主动脉狭窄为主（78.8%），IV型以主动脉反流为主（72.0%）。植入瓣膜尺寸为22.2±1.8（I型）、23.4±1.6（II型）和24.0±2.2（IV型）。I型与II型之间以及I型与IV型之间存在显著差异。采用巴布氏法和流出道测量法预测主动脉瓣环大小。然而，对于接受21毫米假体AVR手术的主动脉狭窄患者，这两种方法在估计主动脉瓣环大小方面都不可靠。
