Yamamoto Yoshitaka, Iino Kenji, Shintani Yoshiko, Kato Hiroki, Kimura Keiichi, Watanabe Go, Takemura Hirofumi
Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan.
Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan.
Semin Thorac Cardiovasc Surg. 2017;29(2):143-149. doi: 10.1053/j.semtcvs.2016.11.002. Epub 2016 Nov 22.
Aortic valve replacement (AVR) remains the standard surgical intervention for aortic valve disease and is preferred by many surgeons, despite its associated clinical issues. The clinical efficacy of aortic valve neocuspidization (AVNeo) with glutaraldehyde-treated autologous pericardium, the Ozaki procedure, has recently been reported. Although it is presumed to preserve the normal aortic annulus motion, changes to the aortic annulus during the cardiac cycle after AVNeo remain unclear. From March to December 2014, aortic annular dimensions were measured for 23 patients; the sample included 8 patients who had undergone AVNeo, 10 patients with normal aortic valves, and 5 patients who had undergone AVR. Measurements were recorded using electrocardiography-gated multidetector computed tomography. Data were analyzed using automated aortic root analysis software. Postoperative peak pressure gradients for the AVNeo and AVR groups were compared. No statistically significant differences in annulus variation were observed between patients who had undergone AVNeo and those with normal aortic valves. Annular area was larger during systole than during diastole in both groups. Postoperative peak pressure gradients were significantly lower in the AVNeo group than in the AVR group. The results of the present study demonstrated that aortic annular dimensions after AVNeo are similar to the dimensions of normal aortic valves. This was evidenced using electrocardiography-gated multidetector computed tomography, previously reported as the most reliable method, to evaluate annulus motion during the cardiac cycle. Lower postoperative peak pressure gradients might underlie the observed changes. These advantages will help in rectifying AVR defects.
主动脉瓣置换术（AVR）仍然是治疗主动脉瓣疾病的标准外科手术，尽管存在相关临床问题，但仍被许多外科医生所青睐。最近有报道称，采用戊二醛处理的自体心包进行主动脉瓣新瓣化（AVNeo），即小崎手术，其临床疗效显著。尽管推测该手术可保留正常主动脉瓣环运动，但AVNeo术后心动周期中主动脉瓣环的变化仍不明确。2014年3月至12月，对23例患者进行了主动脉瓣环尺寸测量；样本包括8例行AVNeo手术的患者、10例主动脉瓣正常的患者和5例行AVR手术的患者。使用心电图门控多层螺旋计算机断层扫描记录测量数据。采用自动主动脉根部分析软件对数据进行分析。比较了AVNeo组和AVR组术后的峰值压力梯度。接受AVNeo手术的患者与主动脉瓣正常的患者之间，在瓣环变化方面未观察到统计学上的显著差异。两组在收缩期的瓣环面积均大于舒张期。AVNeo组术后的峰值压力梯度显著低于AVR组。本研究结果表明，AVNeo术后的主动脉瓣环尺寸与正常主动脉瓣的尺寸相似。这是通过心电图门控多层螺旋计算机断层扫描证实的，该方法此前被报道为评估心动周期中瓣环运动最可靠的方法。术后较低的峰值压力梯度可能是观察到的变化的原因。这些优势将有助于纠正AVR的缺陷。
