Hörer Jürgen, Hanke Thorsten, Stierle Ulrich, Takkenberg Johanna J M, Bogers Ad J J C, Hemmer Wolfgang, Rein Joachim G, Hetzer Roland, Hübler Michael, Robinson Derek R, Sievers Hans H, Lange Rüdiger
Department of Cardiovascular Surgery, German Heart Center Munich at Technical University, Munich, Germany.
Ann Thorac Surg. 2009 Aug;88(2):594-600; discussion 600. doi: 10.1016/j.athoracsur.2009.04.077.
For children who require aortic valve replacement, the Ross operation provides a unique advantage of growth potential of the pulmonary autograft in the aortic position. This study assessed the progression of autograft root diameters and its effect on aortic regurgitation (AR).
Neoaortic echo dimensions from 48 children (<16 years) undergoing Ross operation who had follow-up echocardiograms before age 20 were analyzed (mean follow-up, 5.1 +/- 3.3 years).
The mean age at the time of the Ross operation was 10.0 +/- 4.3 years. Mean z values of the neoaortic annulus (1.5 +/- 0.4), sinus (2.5 +/- 0.4), and sinotubular junction (2.6 +/- 0.9) when the autograft was implanted were significantly larger compared with normal values (p < 0.001, all). The mean z values significantly increased with follow-up at the level of the sinus (0.5 +/- 0.1/year, p < 0.001) and the sinotubular junction (0.7 +/- 0.2, p < 0.001), but not at the level of the annulus (0.1 +/- 0.1, p = 0.59). AR increased with follow-up time (0.07 +/- 0.02 grade/year, p < 0.001). AR increased with sinotubular junction diameter (p = 0.028), but there was not significant evidence of an association with annulus diameter (p = 0.25) or sinus diameter (p = 0.40).
Children undergoing Ross operation have larger neoaortic root dimensions than healthy children. Growth of the annulus matches somatic growth. The diameters of the sinus and the sinotubular junction increase significantly relative to somatic growth. The latter may explain the development of AR.
对于需要进行主动脉瓣置换的儿童，Ross手术具有将自体肺动脉瓣移植至主动脉位置后具备生长潜力的独特优势。本研究评估了自体移植根部直径的进展及其对主动脉瓣反流（AR）的影响。
分析了48例接受Ross手术的儿童（年龄<16岁）的新主动脉回声尺寸，这些儿童在20岁之前进行了超声心动图随访（平均随访时间为5.1±3.3年）。
Ross手术时的平均年龄为10.0±4.3岁。植入自体移植瓣时，新主动脉瓣环（1.5±0.4）、窦部（2.5±0.4）和窦管交界（2.6±0.9）的平均z值显著高于正常值（均p<0.001）。随访期间，窦部（0.5±0.1/年，p<0.001）和窦管交界（0.7±0.2，p<0.001）水平的平均z值显著增加，但瓣环水平（0.1±0.1，p = 0.59）未增加。AR随随访时间增加（0.07±0.02级/年，p<0.001）。AR随窦管交界直径增加（p = 0.028），但没有显著证据表明与瓣环直径（p = 0.25）或窦部直径（p = 0.40）有关联。
接受Ross手术的儿童新主动脉根部尺寸大于健康儿童。瓣环的生长与身体生长相匹配。窦部和窦管交界的直径相对于身体生长显著增加。后者可能解释了AR的发生发展。
