Durán C M, Alonso J, Gaite L, Alonso C, Cagigas J C, Marce L, Fleitas M G, Revuelta J M
Department of Cardiovascular Surgery, Hospital Nacional, Marqués de Valdecilla, University of Cantabria, Santander, Spain.
Eur J Cardiothorac Surg. 1988;2(4):217-23. doi: 10.1016/1010-7940(88)90075-9.
From July 1974 to January 1986, 50 patients underwent conservative repair for rheumatic aortic valvular disease at our institution. Eleven were male and 39 female, with an average age of 39.5 years (range 17-57). The aortic lesion was associated in all cases with a predominant mitral lesion. Twenty-five also had tricuspid disease which was surgically treated in 17. Twenty-six had aortic regurgitation and 24, a mixed lesion. The surgical techniques used were: (1) commissurotomy, (2) annuloplasty, (3) cusp free edge unfolding and (4) supra-aortic crest enhancement. Two patients had one cusp extended with pericardium. There were 3 hospital deaths (6%). Six patients were lost to follow-up at different periods. Maximum follow-up was 12.58 years with a mean of 7.78 years per patient. Twelve required reoperation with 3 deaths. Three reoperations were due to failure of the mitral bioprosthesis without reoperation on the aortic valve. Of the remaining 9 patients who had aortic and mitral dysfunction, 4 had severe aortic insufficiency. The actuarial freedom from reoperation at 13 years was 75% and the overall actuarial survival was 86%. It is concluded that these surgical techniques can be applied successfully in moderate rheumatic aortic valve disease accompanying a predominant mitral lesion. This is particularly relevant when a mitral reconstruction has been performed.
1974年7月至1986年1月，我院对50例风湿性主动脉瓣膜病患者进行了保守修复手术。其中男性11例，女性39例，平均年龄39.5岁（17 - 57岁）。所有病例中主动脉病变均伴有主要的二尖瓣病变。25例还患有三尖瓣疾病，其中17例接受了手术治疗。26例有主动脉反流，24例为混合性病变。所采用的手术技术包括：（1）交界切开术；（2）瓣环成形术；（3）瓣叶游离缘展开术；（4）主动脉嵴上增强术。2例患者用心包延长了一个瓣叶。有3例医院死亡（6%）。6例患者在不同时期失访。最大随访时间为12.58年，平均每位患者7.78年。12例需要再次手术，其中3例死亡。3例再次手术是由于二尖瓣生物瓣失败，主动脉瓣未再次手术。其余9例有主动脉和二尖瓣功能障碍的患者中，4例有严重主动脉瓣关闭不全。13年时再次手术的实际无复发率为75%，总体实际生存率为86%。结论是，这些手术技术可成功应用于伴有主要二尖瓣病变的中度风湿性主动脉瓣疾病，当进行二尖瓣重建时尤其如此。
