Miyahara Shunsuke, Omura Atsushi, Sakamoto Toshihito, Nomura Yoshikatsu, Inoue Takeshi, Minami Hitoshi, Okada Kenji, Okita Yutaka
Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Heart Valve Dis. 2013 Jul;22(4):509-16.
The study aim was to examine the echocardiographic features associated with recurrent aortic regurgitation (AR) after valve-preserving aortic root reconstruction surgery.
Echocardiographic data from 86 patients who underwent aortic root replacement with or without cusp repair were retrospectively reviewed. An analysis was conducted of the height difference between the level of the ventriculoaortic junction (VAJ) and the central free margin of the cusp, defined as the effective height (EH), and the length from the aortic annulus to the edge of the body of Arantius, defined as the geometric height (GH), in addition to root dimensions (diameter of VAJ, sinus of Valsalva, and sinotubular junction).
All patients presented with < or = mild AR at discharge. After a median follow up duration of 46.4 months, the development of moderate AR or greater was observed in 14 patients. The overall actuarial freedom from moderate AR or greater, and freedom from reoperation at three and five years were 86.2 +/- 4.4% and 81.8 +/- 5.2%, and 94.0 +/- 3.0% and 91.8 +/- 3.6%, respectively. The postoperative EH (7.47 +/- 3.3 mm in > mild AR group, versus 8.81 +/- 2.1 mm in < or = mild AR group, p = 0.049), the incidence of postoperative eccentric jet (57.1% in > mild AR group versus 12.5% in < or = mild AR group, p = 0.0005) and cusp billowing (78.6% in > mild AR group versus 20.8% in < or = mild AR group, p < 0.0001) were significantly correlated with > mild AR in the follow up. There was also correlation between postoperative EH and the severity of recurrent AR at follow up (p = -0.33, p = 0.0019).
Objective information on cusp configuration, such as EH, should play an important role in stabilizing the outcome of valve-sparing surgery.
本研究旨在探讨保留瓣膜主动脉根部重建术后与复发性主动脉瓣反流（AR）相关的超声心动图特征。
回顾性分析86例行主动脉根部置换术（伴或不伴瓣叶修复）患者的超声心动图数据。除根部尺寸（心室主动脉连接部[VAJ]直径、主动脉窦和窦管交界）外，还分析了心室主动脉连接部水平与瓣叶中央游离缘之间的高度差，定义为有效高度（EH），以及从主动脉瓣环到Arantius体边缘的长度，定义为几何高度（GH）。
所有患者出院时均表现为轻度或轻度以下AR。中位随访时间46.4个月后，14例患者出现中度或更严重的AR。3年和5年时，无中度或更严重AR以及无需再次手术的总体精算生存率分别为86.2±4.4%和81.8±5.2%，以及94.0±3.0%和91.8±3.6%。术后EH（轻度以上AR组为7.47±3.3mm，轻度或轻度以下AR组为8.81±2.1mm，p = 0.049）、术后偏心反流发生率（轻度以上AR组为57.1%，轻度或轻度以下AR组为12.5%，p = 0.0005）和瓣叶膨出（轻度以上AR组为78.6%，轻度或轻度以下AR组为20.8%，p < 0.0001）在随访中与轻度以上AR显著相关。术后EH与随访时复发性AR的严重程度之间也存在相关性（p = -0.33，p = 0.0019）。
关于瓣叶形态的客观信息，如EH，在稳定保留瓣膜手术的结果中应发挥重要作用。
