Li Yang, Meng Wei, Zhang Eryong
Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Jul;26(7):819-22.
To evaluate the effectiveness of unsupported reduction ascending aortoplasty for dilatation of the ascending aorta.
Between September 2005 and May 2011, 53 patients with aortic valve disease and dilatation of the ascending aorta underwent aortic valve replacement with unsupported reduction ascending aortoplasty. There were 41 males and 12 females, aged 22-75 years (mean, 52 years). The disease duration was 1 month to 14 years. The color Doppler echocardiography showed that the diameter of the ascending aorta before surgery was (45.9 +/- 3.3) mm; bicuspid aortic valve and tri-aortic valve were observed in 13 and 40 cases respectively. The heart functions were graded as II level in 19 cases, III level in 33 cases, and IV level in 1 case according to the standard of New York Heart Disease Academy (NYHA).
After operation, mediastinum errhysis occurred in 1 case, pneumonia in 3 cases, and III degree atrioventricular block in 1 case. There was no related complication of the aortoplasty. All the patients were followed up 3-68 months (mean, 15 months), and had no obvious chest tightness and palpitation. At last follow-up, the NYHA heart functions were graded as I level in 22 cases, II level in 31 cases; the diameter of the ascending aorta was (35.2 +/- 4.0) mm, showing significant difference when compared with the preoperative one (P = 0.000), but no significant difference when compared with the one at discharge (34.0 +/- 2.5) mm (P = 0.245). There was significant difference in the diameter of the ascending aorta between last follow-up and preoperation, at discharge in the patients who were followed up more than 60 months (P < 0.05); significant difference was found between last follow-up and preoperation in patients with bicuspid aortic valve (P < 0.05), but no significant difference between last follow-up and preoperation (P > 0.05) in patients whose diameter of the ascending aorta was more than 50 mm before operation.
Unsupported reduction ascending aortoplasty has good short- and mid-term results in treating aortic valve disease with mild to moderate dilatation (diameter range, 40-50 mm) of the ascending aorta. Inclusion criteria of the aortoplasty should be strict. Long-term results need further follow-up.
评估非支撑性降主动脉成形术治疗升主动脉扩张的有效性。
2005年9月至2011年5月，53例主动脉瓣疾病合并升主动脉扩张患者接受了非支撑性降主动脉成形术联合主动脉瓣置换术。其中男性41例，女性12例，年龄22 - 75岁（平均52岁）。病程1个月至14年。彩色多普勒超声心动图显示术前升主动脉直径为（45.9±3.3）mm；13例为二叶式主动脉瓣，40例为三叶式主动脉瓣。根据纽约心脏病学会（NYHA）标准，心功能Ⅱ级19例，Ⅲ级33例，Ⅳ级1例。
术后发生纵隔出血1例，肺炎3例，Ⅲ度房室传导阻滞1例。未发生与主动脉成形术相关的并发症。所有患者均获随访3 - 68个月（平均15个月），无明显胸闷、心悸。末次随访时，NYHA心功能Ⅰ级22例，Ⅱ级31例；升主动脉直径为（35.2±4.0）mm，与术前比较差异有统计学意义（P = 0.000），与出院时（34.0±2.5）mm比较差异无统计学意义（P = 0.245）。随访时间超过60个月的患者末次随访与术前、出院时升主动脉直径比较差异有统计学意义（P < 0.05）；二叶式主动脉瓣患者末次随访与术前比较差异有统计学意义（P < 0.05），术前升主动脉直径大于50 mm的患者末次随访与术前比较差异无统计学意义（P > 0.05）。
非支撑性降主动脉成形术治疗轻度至中度扩张（直径范围40 - 50 mm）的主动脉瓣疾病具有良好的中短期效果。主动脉成形术的纳入标准应严格。长期效果需进一步随访。
