Department of Cardiac Surgery, University Clinic of Schleswig-Holstein, Lübeck, Germany.
Eur J Cardiothorac Surg. 2011 Nov;40(5):1127-30. doi: 10.1016/j.ejcts.2011.02.073. Epub 2011 Apr 29.
The remodeling of the dilatated valve annulus with a prosthetic ring for the repair of valve insufficiency is a well-established concept in mitral valve surgery, and may also be suitable for aortic valve reconstruction. In this study, two models of prosthetic aortic annuloplasty devices were investigated.
Fresh porcine aortic roots (n=16) were investigated in a pulsatile flow simulator after patch dilatation of the annulus and subsequent reconstruction using both an external and an internal prosthetic ring. For each configuration, leakage was determined by ultrasonic flow measurements and leaflet co-aptation by transesophageal echocardiography. In addition, valves' motions were recorded by high-speed video.
By the use of the prosthetic annuloplasty rings, leakage volumes decreased significantly compared with the dilatated root, more pronounced with the intra-annular ring. Similarly, the co-aptation height of the leaflets increased. Pressure gradients were not significantly influenced by the ring application, but leaflet motion patterns changed from the usual trapezoid to a more rectangular opening characteristic, visible at both echocardiographic and high-speed video analysis.
The reconstruction of a dilatated aortic valve annulus using external and internal ring devices is feasible and effective for reduction of regurgitation at which the internal ring provides a greater potential to decrease valve insufficiency.
用人工瓣膜环对扩张的瓣环进行重塑，以修复瓣膜关闭不全，这是二尖瓣手术中一个成熟的概念，也可能适用于主动脉瓣重建。本研究探讨了两种人工主动脉瓣环成形装置的模型。
在脉动流模拟器中，对经瓣环补片扩张后的新鲜猪主动脉根部（n=16）进行研究，然后使用外部和内部人工环进行重建。对于每种构型，通过超声流量测量确定泄漏量，通过经食管超声心动图确定瓣叶对合。此外，通过高速摄像记录瓣膜运动。
与扩张的根部相比，使用人工瓣环成形环后，泄漏量显著减少，而内环的效果更为明显。同样，瓣叶的对合高度也增加了。环的应用对压力梯度没有显著影响，但瓣叶运动模式从通常的梯形变为更具矩形开口特征，在超声心动图和高速视频分析中均可观察到。
使用外部和内部环装置对扩张的主动脉瓣环进行重建是可行和有效的，可以减少反流，其中内环有更大的潜力降低瓣膜关闭不全。
