Thakeb Yosry M, Sakr Samar, El Sarawy Emad, Salem Alsayed M
Cardiothoracic Surgery Department, National Heart Institute, Giza, Egypt.
Department of Biochemistry, Faculty of Science, Mansoura University, Mansoura, Egypt.
J Card Surg. 2020 Mar;35(3):598-602. doi: 10.1111/jocs.14429. Epub 2020 Jan 25.
In recent years, repair techniques for diseased aortic valves have received increasing attention. This study reports the short-term outcome of aortic valve repair (AVr) for three pathologic categories: rheumatic heart disease, aortic regurgitations (ARs) from subarterial ventricular septal defect (VSD), and infective endocarditis in order achieve the valve competency.
From January 2017 to March 2019, 30 patients underwent AVr with significant AR in the National Heart Institute (NHI) and Banha university. All patients underwent echocardiography before and after the procedure; 30 patients underwent AVr with significant AR, nine patients (30%) with juxta-arterial VSD, two patients (6.66%) with infective endocarditis (IE), and 19 patients (63.33%) with rheumatic aortic valve disease. For intraoperative transesophageal echocardiography and direct examination for better clarification of the anatomy and guidance of repair after cardiopulmonary bypass (CPB), annular repair, leaflet repair by shaving, plication, triangular resection, augmentation with the pericardium, and VSD closure were done.
Only three patients developed aortic incompetence grade II, no in-hospital mortality; however, we had 3 months later mortality for one patient with IE, only one patient with rheumatic heart disease progressed from grade II to grade IV aortic incompetence (AI) and aortic valve replacement was done so AVr was successfully done for the subaortic VSD, rheumatic, and IE patients instead of replacement of the valve.
In favor of AVr, good patient selection, amenable techniques for the suitable pathology will give a good target hence the aim of the work.
近年来，病变主动脉瓣的修复技术受到越来越多的关注。本研究报告了针对三种病理类型的主动脉瓣修复（AVr）的短期结果：风湿性心脏病、动脉下室间隔缺损（VSD）所致主动脉反流（AR）以及感染性心内膜炎，以实现瓣膜功能正常。
2017年1月至2019年3月，30例患者在国家心脏研究所（NHI）和班哈大学接受了伴有严重AR的AVr手术。所有患者在手术前后均接受了超声心动图检查；30例患者接受了伴有严重AR的AVr手术，9例（30%）患有近动脉VSD，2例（6.66%）患有感染性心内膜炎（IE），19例（63.33%）患有风湿性主动脉瓣疾病。为了在体外循环（CPB）后更好地明确解剖结构并指导修复，进行了术中经食管超声心动图检查和直接检查，进行了瓣环修复、通过削薄、折叠、三角形切除进行瓣叶修复、心包补片、以及VSD闭合。
仅3例患者出现II级主动脉瓣关闭不全，无院内死亡；然而，我们有1例IE患者在3个月后死亡，只有1例风湿性心脏病患者从II级进展为IV级主动脉瓣关闭不全（AI）并进行了主动脉瓣置换，因此对于主动脉下VSD、风湿性和IE患者成功进行了AVr而非瓣膜置换。
支持AVr，良好的患者选择、适用于合适病理情况的技术将给出良好的目标，因此也是本研究工作的目的。
