Harada Y, Terada M, Ishihara K, Kurosawa H, Imai Y
Department of Pediatric Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Nihon Geka Gakkai Zasshi. 1988 Nov;89(11):1903-7.
Between February, 1983 and August, 1987, twelve children, aged from 2 years to 16 years, underwent aortic valve replacement associated with enlargement of aortic annulus successfully. According to the form of the left ventricular outflow tract obstruction, enlargement of aortic annulus was performed by Konno procedure in eight cases, by Nicks procedure in three cases and by Manouguian procedure in one case. In Manouguian procedure, mitral valve replacement associated with enlargement of mitral annulus was carried out simultaneously. In Konno and Manouguian procedures, the diameter of aortic annulus was enlarged from 180% to 200% compared with the original annular size, whereas in Nicks procedure, the diameter was enlarged around up to 110%. St. Jude Medical valve, of which size ranged from 21mm to 25mm, was employed in these procedures. All these children survived operation, and the post-operative follow up period ranged from 1 month to 55 months. There was one late death eleven months after Konno procedure because of respiratory failure resulting from pulmonary hypertension which persisted postoperatively. The remaining eleven children are surviving well after procedure. These results suggest that aortic valve replacement associated with enlargement of aortic annulus is an acceptable procedure in children with small aortic annulus or sub-aortic stenosis.
1983年2月至1987年8月期间，12名年龄在2岁至16岁之间的儿童成功接受了主动脉瓣置换术并伴有主动脉瓣环扩大。根据左心室流出道梗阻的形式，8例行Konno手术、3例行Nicks手术、1例行Manouguian手术进行主动脉瓣环扩大。在Manouguian手术中，同时进行二尖瓣置换术并伴有二尖瓣环扩大。在Konno和Manouguian手术中，主动脉瓣环直径比原来的瓣环尺寸扩大了180%至200%，而在Nicks手术中，直径扩大到约110%。这些手术中使用了尺寸范围为21毫米至25毫米的圣犹达医疗瓣膜。所有这些儿童均存活至手术结束，术后随访时间为1个月至55个月。1例在Konno手术后11个月因术后持续存在的肺动脉高压导致呼吸衰竭而晚期死亡。其余11名儿童术后情况良好。这些结果表明，主动脉瓣置换术并伴有主动脉瓣环扩大对于主动脉瓣环小或主动脉瓣下狭窄的儿童是一种可接受的手术。
