Mavroudis Constantine, Backer Carl L, Kaushal Sunjay
Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic Children's Hospital, Cleveland Clinic Lerner School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2009:76-86. doi: 10.1053/j.pcsu.2009.01.008.
Aortic stenosis and aortic insufficiency in young children present multiple challenges to the patient, family, and surgeon. Mechanical valves require anticoagulation therapy, which is a poor option in active youngsters and noncompliant adolescents. Aortic valvuloplasty and the various forms of the Ross/Ross-Konno operations appear to be good solutions in this patient population due to valve preservation for the former and autograft growth for the latter. However, valvuloplasty failure and autograft dilatation have developed in some patients. In addition, heart block remains a problem in those patients who require an annular enlarging operation. We review our experience with the various forms of valvuloplasty, Ross operation, Konno operation, Ross-Konno operation, and the modified Ross-Konno operation, which we have used to eliminate heart block in patients who require an annular enlarging operation.
小儿主动脉瓣狭窄和主动脉瓣关闭不全给患者、家庭及外科医生带来了诸多挑战。机械瓣膜需要抗凝治疗，这对于活跃的儿童和依从性差的青少年而言并非理想选择。主动脉瓣成形术以及各种形式的罗斯手术/罗斯 - 孔诺手术，对于这一患者群体似乎是不错的解决方案，前者可保留瓣膜，后者能实现自体移植物生长。然而，部分患者出现了瓣膜成形术失败和自体移植物扩张的情况。此外，对于那些需要进行瓣环扩大手术的患者，心脏传导阻滞仍是一个问题。我们回顾了我们在各种形式的瓣膜成形术、罗斯手术、孔诺手术、罗斯 - 孔诺手术以及改良罗斯 - 孔诺手术方面的经验，我们运用这些手术来消除那些需要进行瓣环扩大手术的患者的心脏传导阻滞。
