Bacha Emile A, McElhinney Doff B, Guleserian Kristine J, Colan Steven D, Jonas Richard A, del Nido Pedro J, Marx Gerald R
Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Mass 02115, USA.
J Thorac Cardiovasc Surg. 2008 Mar;135(3):552-9, 559.e1-3. doi: 10.1016/j.jtcvs.2007.09.057.
Surgical aortic valvuloplasty is increasingly employed in the management of children and adolescents with aortic regurgitation, but the durability of this approach and factors associated with outcome are not well defined.
From 1989 to 2005, a total of 81 patients younger than 19 years with moderate or severe aortic regurgitation underwent surgical aortic valvuloplasty. Aortic regurgitation was congenital in 20 cases, after treatment of aortic stenosis in 30, from other injuries to the aortic valve in 12, and from other causes in 19. Eighteen patients had moderate or severe aortic stenosis. Preoperative left ventricular end-diastolic dimension z score was 4.9 +/- 2.7.
After surgical aortic valvuloplasty with various techniques, including pericardial leaflet augmentation in 80%, aortic regurgitation was improved in 77 patients and was mild or less in 68. Ten of 18 patients with moderate or severe aortic stenosis before repair had a decrease to mild, whereas 2 had progression from mild to moderate. Left ventricular end-diastolic dimension z score decreased by 2.9 +/- 2.1 (P < .001). During follow-up (median 4.7 years), 33 patients underwent aortic valve reinterventions, including aortic valve replacement in 25. Estimated freedoms from aortic valve replacement were 72% +/- 6% at 5 years and 54% +/- 9% at 7.5 years and were shorter in patients with moderate or severe aortic stenosis before surgical aortic valvuloplasty. Among surviving patients who did not undergo aortic valve replacement, aortic regurgitation at follow-up was moderate in 21 and trivial or mild in 34; left ventricular and aortic root dimensions were preserved.
Surgical aortic valvuloplasty is a valid option with good intermediate results for children and adolescents with aortic regurgitation from a variety of causes, particularly for patients with less than moderate aortic stenosis.
外科主动脉瓣成形术越来越多地用于治疗患有主动脉瓣反流的儿童和青少年，但这种方法的持久性以及与预后相关的因素尚未明确界定。
1989年至2005年，共有81例19岁以下患有中度或重度主动脉瓣反流的患者接受了外科主动脉瓣成形术。20例主动脉瓣反流为先天性，30例为主动脉瓣狭窄治疗后所致，12例因主动脉瓣其他损伤引起，19例由其他原因导致。18例患者患有中度或重度主动脉瓣狭窄。术前左心室舒张末期内径z值为4.9±2.7。
采用包括80%心包瓣叶扩大术在内的各种技术进行外科主动脉瓣成形术后，77例患者的主动脉瓣反流得到改善，68例患者的反流为轻度或更低程度。18例修复前患有中度或重度主动脉瓣狭窄的患者中，10例降至轻度，而2例从轻度进展为中度。左心室舒张末期内径z值下降了2.9±2.1（P<.001）。在随访期间（中位时间4.7年），33例患者接受了主动脉瓣再次干预，其中25例行主动脉瓣置换术。估计5年时主动脉瓣置换术的自由度为72%±6%，7.5年时为54%±9%，且在外科主动脉瓣成形术前患有中度或重度主动脉瓣狭窄的患者中自由度更低。在未接受主动脉瓣置换术的存活患者中，随访时21例患者的主动脉瓣反流为中度，34例为微量或轻度；左心室和主动脉根部尺寸得以保留。
对于各种原因引起的主动脉瓣反流的儿童和青少年，尤其是主动脉瓣狭窄程度小于中度的患者，外科主动脉瓣成形术是一种有效的选择，中期效果良好。
