Aithoussa M, Moutakiallah Y, Abdou A, Bamous M, Nya F, Atmani N, Seghrouchni A, Selkane C, Amahzoune B, Wahid F A, Elbekkali Y, Drissi M, Berrada N, Azendour H, Boulahya A
Service de chirurgie cardiaque, hôpital militaire d'instruction Mohammed V, Hay Riyad, BB 10100 Rabat, Maroc.
Ann Cardiol Angeiol (Paris). 2013 Apr;62(2):101-7. doi: 10.1016/j.ancard.2012.04.004. Epub 2012 Apr 30.
Aortic valve replacement improves clinical symptoms and left ventricular systolic function in patients with chronic aortic regurgitation despite a higher surgical risk. The objective of this study is to determine if left ventricular function will be normalized after surgery.
This retrospective study included 40 patients (nine females and 31 males) with chronic aortic regurgitation and left ventricular systolic dysfunction who were evaluated by echocardiography Doppler. Were included patients with left ventricular ejection fraction less or equal to 45%. Ages ranged from 18 to 77 years (mean = 46.4 ± 12.6 years). Preoperatively, six patients (15%) were asymptomatic, ten (25%) were in NYHA II, half (50%) in NYHA III and four (10%) in NYHA IV. The mean preoperative ejection fraction (EF) was 36.2 ± 2%. The mean end systolic and diastolic dimensions were 61.7 ± 8.5 mm and 78.9 ± 9.7 mm respectively. Aortic regurgitation was quantified grade III in sixteen patients (40%) and grade IV in twenty-four (60%).
Thirty-seven patients underwent aortic valve replacement and three Bentall operations. Hospital mortality was 7.5% (3/40). The mean follow-up period was 69.7 months. All survivor patients were investigated. Out of these, five were lost and 32 were controlled. Symptomatic improvement was noted in most of the survivors. Sixty percent (24/40) were severely symptomatic before and only 6.25% (2/32) during follow-up. The ejection fraction increased significantly after surgery (36.2 ± 2% in preoperative period vs. 55.2 ± 10% in postoperative period, P < 0.02). Left ventricular diameters decreased significantly also. Survival rates were 3-year 94%, 5-year 91% and 7-year 89%.
Despite reduced left ventricular systolic function, aortic valve replacement in chronic aortic regurgitation was associated with acceptable operative risk. Surgery improves functional status, symptoms and ejection fraction in most patients.
尽管手术风险较高，但主动脉瓣置换术可改善慢性主动脉瓣反流患者的临床症状和左心室收缩功能。本研究的目的是确定术后左心室功能是否会恢复正常。
这项回顾性研究纳入了40例（9例女性和31例男性）患有慢性主动脉瓣反流和左心室收缩功能障碍的患者，这些患者通过超声心动图多普勒进行评估。纳入左心室射血分数小于或等于45%的患者。年龄范围为18至77岁（平均 = 46.4 ± 12.6岁）。术前，6例（15%）无症状，10例（25%）为纽约心脏协会（NYHA）II级，半数（50%）为NYHA III级，4例（10%）为NYHA IV级。术前平均射血分数（EF）为36.2 ± 2%。平均收缩末期和舒张末期直径分别为61.7 ± 8.5 mm和78.9 ± 9.7 mm。16例患者（40%）的主动脉瓣反流定量为III级，24例（60%）为IV级。
37例患者接受了主动脉瓣置换术，3例接受了Bentall手术。医院死亡率为7.5%（3/40）。平均随访期为69.7个月。对所有存活患者进行了调查。其中，5例失访，32例得到随访。大多数存活患者的症状有改善。术前60%（24/40）有严重症状，随访期间仅6.25%（2/32）有严重症状。术后射血分数显著增加（术前为36.2 ± 2%，术后为55.2 ± 10%，P < 0.02）。左心室直径也显著减小。3年生存率为94%，5年生存率为91%，7年生存率为89%。
尽管左心室收缩功能降低，但慢性主动脉瓣反流患者进行主动脉瓣置换术的手术风险是可接受的。手术可改善大多数患者的功能状态、症状和射血分数。
