Duran C M, Gometza B
Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
J Card Surg. 1994 Mar;9(2 Suppl):204-8. doi: 10.1111/j.1540-8191.1994.tb00927.x.
Aortic valve replacement in the young patient, and particularly in women of child-bearing age, still represents a problem. Between July 1988 and August 1993, 644 aortic valve patients (mean age 32.5 years) were operated in our institution. Aortic valve reconstruction was performed in 274 (42.5%). A variety of repair techniques (valvuloplasty) was used in 202 patients (mean age 21.5 years). Concomitant mitral surgery was performed in 103 (51%). In 72 patients (mean age 27.7 years), a cusp extension was undertaken with glutaraldehyde treated bovine (27 pts) or autologous (45 pts) pericardium. In the "plasty" group, there were 8 (4%) hospital deaths and 8 (4.1%) late deaths with an actuarial survival of 86.05% +/- 3.97%. No thromboembolic events were detected in patients with isolated aortic surgery. There were 32 reoperations without mortality, 22 due to progressive rheumatic disruption of the mitral repair. There was severe aortic dysfunction in 17 (8.76%) cases. There was no hospital mortality among the 72 patients with cusp extensions. There were two (2.8%) late deaths and no thromboembolic events. No patient was anticoagulated. Four patients required reoperation on the aortic valve without mortality. The last echocardiographic follow-up showed stability of the reconstruction. These techniques offer a valid alternative to valve replacement in this difficult category of patients.
对于年轻患者，尤其是育龄期女性，主动脉瓣置换术仍然是一个难题。1988年7月至1993年8月期间，我院对644例主动脉瓣疾病患者（平均年龄32.5岁）进行了手术。其中274例（42.5%）实施了主动脉瓣重建术。202例患者（平均年龄21.5岁）采用了多种修复技术（瓣膜成形术）。103例（51%）同时进行了二尖瓣手术。72例患者（平均年龄27.7岁）采用戊二醛处理的牛心包（27例）或自体心包（45例）进行瓣叶延长术。在“成形术”组中，有8例（4%）患者在住院期间死亡，8例（4.1%）患者出现晚期死亡，精算生存率为86.05%±3.97%。单纯主动脉手术患者未检测到血栓栓塞事件。有32例患者进行了再次手术，无死亡病例，其中22例是由于二尖瓣修复的进行性风湿性破坏。17例（8.76%）出现严重主动脉功能障碍。72例进行瓣叶延长术的患者中无住院死亡病例。有2例（2.8%）晚期死亡病例，无血栓栓塞事件。所有患者均未进行抗凝治疗。4例患者对主动脉瓣进行了再次手术，无死亡病例。最后一次超声心动图随访显示重建结构稳定。这些技术为这类困难患者提供了一种有效的瓣膜置换替代方案。
