Alsoufi Bahaaldin, Karamlou Tara, Bradley Timothy, Williams William G, Van Arsdell Glen S, Coles John G, Smallhorn Jeffrey, Nii Masaki, Guerra Vitor, Caldarone Christopher A
Division of Cardiovascular Surgery, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada.
Ann Thorac Surg. 2006 Oct;82(4):1292-9; discussion 1300. doi: 10.1016/j.athoracsur.2006.04.039.
We evaluated our experience with aortic valve cusp extension techniques to identify predictors of successful intraoperative repair and subsequent durability.
Twenty-two children (ages 5-18 years) underwent aortic cusp extension with autologous pericardium between 1999 and 2005. Sixteen children had previous surgical or percutaneous intervention. Ten children had bicuspid aortic valves. Cusp extensions were performed on 1 cusp in 3 patients, 2 cusps in 3, and 3 cusps in 16. Serial echocardiographic measures (n = 81) were obtained during a 5-year period and underwent blinded review. Longitudinal trajectories of ventricular and aortic valve function were modeled using mixed linear regression analysis.
There was no hospital or late mortality. Five-year freedom from valve replacement was 75%. Comparison of preoperative and post-repair echocardiograms demonstrated reductions in aortic insufficiency (decreased in jet-width/aortic valve diameter ratio from 0.39 +/- 0.12 to 0.22 +/- 0.11; p < 0.0001), aortic stenosis (decreased in peak aortic valve gradient from 41 +/- 25 mm Hg to 29 +/- 15 mm Hg; p = 0.04), and left ventricular end-diastolic dimensions Z-score (decreased from 1.39 +/- 0.38 to 1.16 +/- 0.34; p < 0.001). During the follow-up period, post-repair jet-width and aortic valve diameter increased nonlinearly (p < 0.001). Patients with postoperative peak aortic gradients greater than 30 mm Hg had progression of aortic stenosis, whereas those with lesser postoperative peak gradients tended to regress during follow-up (p < 0.001). The decrement in Z-score of the left ventricular end-diastolic dimensions remained stable during the follow-up period.
Aortic valve cusp extension can result in acceptable hemodynamic results with stabilization of left ventricular geometry. However, residual lesions are common and progression and regression of these lesions can be predicted based on echocardiographic data.
我们评估了主动脉瓣瓣叶延长技术的经验，以确定术中修复成功及后续耐久性的预测因素。
1999年至2005年间，22名儿童（年龄5 - 18岁）接受了自体心包主动脉瓣瓣叶延长术。16名儿童曾接受过手术或经皮介入治疗。10名儿童患有二叶式主动脉瓣。3例患者对1个瓣叶进行了瓣叶延长，3例对2个瓣叶进行了延长，16例对3个瓣叶进行了延长。在5年期间进行了系列超声心动图测量（n = 81），并进行了盲法评估。使用混合线性回归分析对心室和主动脉瓣功能的纵向轨迹进行建模。
无院内死亡或晚期死亡。5年无瓣膜置换率为75%。术前和修复后超声心动图比较显示主动脉瓣反流减少（射流宽度/主动脉瓣直径比值从0.39±0.12降至0.22±0.11；p < 0.0001），主动脉瓣狭窄减轻（主动脉瓣峰值压差从41±25 mmHg降至29±15 mmHg；p = 0.），左心室舒张末期内径Z值降低（从1.39±0.38降至1.16±0.34；p < 0.001）。在随访期间，修复后射流宽度和主动脉瓣直径呈非线性增加（p < 0.001）。术后主动脉峰值压差大于30 mmHg的患者出现主动脉瓣狭窄进展，而术后峰值压差较小的患者在随访期间倾向于病情改善（p < 0.001）。随访期间左心室舒张末期内径Z值的下降保持稳定。
主动脉瓣瓣叶延长术可获得可接受的血流动力学结果，并使左心室几何形状稳定。然而，残余病变常见，这些病变的进展和改善可根据超声心动图数据进行预测。
