Pepper John, Golesworthy Tal, Utley Martin, Chan John, Ganeshalingam Skandadas, Lamperth Michael, Mohiaddin Raad, Treasure Tom
Royal Brompton Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):360-5. doi: 10.1510/icvts.2009.220319. Epub 2009 Dec 11.
Fatal aortic dissection commonly occurs in Marfan syndrome. Prevention currently relies on elective replacement of the aortic root. We are evaluating the placement of a manufactured, bespoke external support derived from a computer aided design in a prospective study. In the first ten patients, measurements were made consistently of the ascending aorta at the level of closure of the aortic valve cusps from magnetic resonance imaging (MRI) studies taken preoperatively and at fixed intervals thereafter. Before and after images were presented for measurement amongst duplicate images of 37 unoperated Marfan patients to permit assessment of intra-observer measurement reproducibility. All images were presented in random sequence to a radiologist unaware of the research question. The largest difference between the preoperative measurement and that made at least one year after surgery was determined. All patients had surgery as planned without complications and were alive at one year. In eight of the ten patients, the largest observed change was a marked reduction in aortic root diameter. The primary objective of this surgery was achieved in each case, reinforcing the ascending aorta whilst leaving the native aortic valve intact and conserving the blood/endothelium interface.
致命性主动脉夹层通常发生在马凡综合征患者中。目前预防措施依赖于择期主动脉根部置换术。我们正在一项前瞻性研究中评估一种基于计算机辅助设计制造的定制外部支撑装置的植入情况。在前十位患者中，从术前及之后固定间隔时间所做的磁共振成像（MRI）研究中，对主动脉瓣叶闭合水平处的升主动脉进行了一致的测量。术前和术后图像在37例未经手术的马凡综合征患者的重复图像中呈现以供测量，以评估观察者内测量的可重复性。所有图像以随机顺序呈现给一位对研究问题不知情的放射科医生。确定术前测量值与术后至少一年测量值之间的最大差异。所有患者均按计划进行了手术，无并发症，术后一年均存活。在十位患者中的八位中，观察到的最大变化是主动脉根部直径显著减小。该手术的主要目标在每个病例中均得以实现，加固了升主动脉，同时保留了天然主动脉瓣并维持了血液/内皮界面。
