Bail Dorothee H L, Walker Tobias, Gruler Miriam, Ziemer Gerhard
Department of Thoracic, Cardiac and Vascular Surgery, University of Tübingen, Germany.
Echocardiography. 2007 May;24(5):457-63. doi: 10.1111/j.1540-8175.2007.00417.x.
Reduction ascending aortoplasty (RAA) is a controversial procedure. Agreement has not yet been made regarding the indication for surgery and surgical technique. The goal of this study was to examine the long-term outcome of RAA without external support, and to compare the accuracy of transthoracic echocardiographic with computed tomographic (CT) measurements. Of particular interest was whether the important elastic properties of the aorta, the Windkessel function, is preserved following reduction aortoplasty of the ascending aorta without external wrapping.
Ninety-eight patients with dilation of the ascending aorta underwent reduction aortoplasty with concomitant cardiac procedures. Fifty-four patients were available for follow-up. Measurement of the ascending aortic diameter was performed prior to and directly following surgery, and 37 months postoperatively (range: 10-96 months). Both echocardiography and CT imaging were performed. The elastic properties of the ascending aorta were determined by measuring the distension of the ascending aorta during diastole and systole by means of transthoracic echocardiography. Fifteen patients with graft replacement of the ascending aorta were examined, and the control group contained 11 healthy volunteers.
The diameter of the ascending aorta was significantly reduced in all patients who had undergone RAA. The change in diameter between diastole and systole was 3 mm in patients with reduction aortoplasty. Patients with graft replacement had a change of only 0.07 cm. There was no relevant increase (2 mm) in diameter at follow-up. Echocardiographic and CT measurements of the aortic diameter did not differ.
RAA without external wrapping shows good long-term results in patients with a dilated ascending aorta who underwent concomitant cardiac procedures. Echocardiography is very accurate in measuring the ascending aortic diameter, which makes it a cost-effective diagnostic tool. Moreover, ascending aortoplasty without external wrapping preserves the important elastic properties, namely the Windkessel function. Follow-up of the cardiac function and aortic diameter can be performed easily and precisely in the outpatient setting.
升主动脉缩窄成形术（RAA）是一种存在争议的手术。关于手术指征和手术技术尚未达成共识。本研究的目的是探讨无外部支撑的RAA的长期疗效，并比较经胸超声心动图与计算机断层扫描（CT）测量的准确性。特别关注的是，在不进行外部包裹的升主动脉缩窄成形术后，主动脉重要的弹性特性即Windkessel功能是否得以保留。
98例升主动脉扩张患者在进行心脏手术的同时接受了升主动脉缩窄成形术。54例患者可供随访。在手术前、手术刚结束时以及术后37个月（范围：10 - 96个月）测量升主动脉直径。同时进行了超声心动图和CT成像检查。通过经胸超声心动图测量舒张期和收缩期升主动脉的扩张情况来确定升主动脉的弹性特性。检查了15例行升主动脉移植置换术的患者，对照组包含11名健康志愿者。
所有接受RAA的患者升主动脉直径均显著减小。升主动脉缩窄成形术患者舒张期和收缩期之间的直径变化为3mm。行移植置换术的患者直径变化仅为0.07cm。随访时直径无相关增加（2mm）。超声心动图和CT测量的主动脉直径无差异。
对于接受心脏手术同时伴有升主动脉扩张的患者，不进行外部包裹的RAA显示出良好的长期效果。超声心动图在测量升主动脉直径方面非常准确，这使其成为一种具有成本效益的诊断工具。此外，不进行外部包裹的升主动脉缩窄成形术保留了重要的弹性特性，即Windkessel功能。在门诊环境中可以轻松、精确地对心功能和主动脉直径进行随访。
