Kazui Toshinobu, Izumoto Hiroshi, Nasu Masataka, Kawazoe Kohei
Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, 1-2-1 Chuoudori Morioka City, Iwate, Japan.
Interact Cardiovasc Thorac Surg. 2004 Sep;3(3):465-9. doi: 10.1016/j.icvts.2004.03.008.
We have performed aortic root remodeling concomitant with aortic annuloplasty (subvalvular circular annuloplasty: it tightens the aortic annulus, using Gore-Tex strip (N.L. Gore and Associates, Arizona, USA)) in patients with AAE and AR. We examined morphologic changes in the aortic root during cardiac cycles, using pre- and post-operative echocardiography. Twelve patients were underwent the procedure. Their grade of AR was 3.2+/-1.0. Five adults with normal aortic roots were studied as controls. The systolic and diastolic radius of each cusp was measured at the annulus, the Valsalva and the STjunction level. The ratio of diastolic radius to systolic radius in the control, pre-operative data and post-operative data was obtained. In the controls, the rate of diameter change during the cardiac cycle was largest at the annulus level (Right coronary cusp (RCC), Left coronary cusp (RCC), Noncoronary cusp (NCC); 1.00+/-0.2, 1.12+/-0.1, 1.23+/-0.2), second largest at Valsalva level (RCC, LCC, NCC; 0.96+/-0.6, 1.07+/-0.2, 0.97+/-0.2), and smallest at the ST junction (RCC, LCC, NCC; 0.95+/-0.4, 1.03+/-0.2, 0.93+/-0.2). Pre-operative data showed that it was largest at the Valsalva level. Post-operative data showed that the rate of change at each level was not significantly different from the control data. All patients were in NYHA class I and the grade of AR was 0.4+/-0.7 at the latest follow-up. Subvalvular circular annuloplasty did not interfere with annulus motion during the cardiac cycle. Aortic root remodeling and concomitant aortic annuloplasty restored near normal cyclic aortic root motion and morphology on the short-term.
我们对患有主动脉瓣叶扩张症（AAE）和主动脉瓣反流（AR）的患者进行了主动脉根部重塑，并同时进行了主动脉瓣环成形术（瓣下圆形瓣环成形术：使用美国亚利桑那州的戈尔公司生产的戈尔特斯条带收紧主动脉瓣环）。我们使用术前和术后超声心动图检查了心动周期中主动脉根部的形态变化。12例患者接受了该手术。他们的主动脉瓣反流分级为3.2±1.0。选取5名主动脉根部正常的成年人作为对照。在瓣环、瓦尔萨尔瓦窦和窦管交界水平测量每个瓣叶的收缩期和舒张期半径。获得了对照组、术前数据和术后数据中舒张期半径与收缩期半径的比值。在对照组中，心动周期中直径变化率在瓣环水平最大（右冠状动脉瓣叶（RCC）、左冠状动脉瓣叶（LCC）、无冠状动脉瓣叶（NCC）；1.00±0.2、1.12±0.1、1.23±0.2），在瓦尔萨尔瓦窦水平次之（RCC、LCC、NCC；0.96±0.6、1.07±0.2、0.97±0.2），在窦管交界水平最小（RCC、LCC、NCC；0.95±0.4、1.03±0.2、0.93±0.2）。术前数据显示在瓦尔萨尔瓦窦水平最大。术后数据显示各水平的变化率与对照数据无显著差异。所有患者均处于纽约心脏协会（NYHA）心功能I级，在最近一次随访时主动脉瓣反流分级为0.4±0.7。瓣下圆形瓣环成形术在心动周期中不干扰瓣环运动。主动脉根部重塑及同期主动脉瓣环成形术在短期内恢复了接近正常的主动脉根部周期性运动和形态。
