Ando Yusuke, Ochiai Yoshie, Tokunaga Shigehiko, Hisahara Manabu, Baba Hironori, Miyagi Chihiro, Takigawa Tomoya
Department of Cardiovascular Surgery, Japan Community Health Care Organization Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, 806-8501, Japan.
Pediatr Cardiol. 2019 Apr;40(4):776-783. doi: 10.1007/s00246-019-02064-9. Epub 2019 Feb 7.
Progressive dilatation of the pulmonary autograft is one of the greatest concerns after the Ross procedure. Increased stress in the arterial wall may cause changes in the elastic properties of the pulmonary autograft, and thus lead to pathological dilatation. The present study aimed to investigate the changes in the autograft diameter and stiffness during follow-up after the Ross procedure. A total of ten patients underwent the Ross procedure at our institution between 2003 and 2011. Echocardiography was used to measure the diameters of the pulmonary autograft at the level of the annulus, sinus of Valsalva, and sinotubular junction. The stiffness index was calculated from the angiographic data, and compared with that of 16 age-matched control children. The diameters of the pulmonary autograft increased throughout the follow-up period, particularly at the level of the sinus of Valsalva and at the sinotubular junction. The aortic root was stiffer in Ross patients compared with control children (7.9 ± 1.8 vs. 3.9 ± 0.7 immediately postoperatively, p < 0.01; 10.1 ± 2.8 vs. 4.2 ± 1.4 at 5 years postoperatively, p < 0.01). Although no significant relationship was found between the stiffness index and the autograft diameter, the stiffness index tended to increase over time. Dilatation of the pulmonary autograft was accompanied by progressive change in aortic stiffness. Longer follow-up is warranted to clarify the impact of this change in aortic stiffness on autograft failure.
肺动脉自体移植的渐进性扩张是Ross手术（主动脉根部替换术）后最令人担忧的问题之一。动脉壁应力增加可能导致肺动脉自体移植弹性特性改变，进而导致病理性扩张。本研究旨在探讨Ross手术后随访期间自体移植血管直径和硬度的变化。2003年至2011年间，共有10例患者在本机构接受了Ross手术。采用超声心动图测量肺动脉自体移植在瓣环、主动脉窦和窦管交界处水平的直径。根据血管造影数据计算硬度指数，并与16名年龄匹配的对照儿童进行比较。在整个随访期间，肺动脉自体移植的直径均增加，尤其是在主动脉窦和窦管交界处水平。与对照儿童相比，Ross手术患者的主动脉根部更硬（术后即刻：7.9±1.8 vs. 3.9±0.7，p<0.01；术后5年：10.1±2.8 vs. 4.2±1.4，p<0.01）。虽然未发现硬度指数与自体移植血管直径之间存在显著相关性，但硬度指数有随时间增加的趋势。肺动脉自体移植的扩张伴随着主动脉硬度的逐渐变化。需要更长时间的随访来阐明主动脉硬度的这种变化对自体移植血管功能衰竭的影响。
