Rubay J E, Shango P, Clement S, Ovaert C, Matta A, Vliers A, Sluysmans T
Department of Cardiac Surgery, UCL St-Luc, Brussels, Belgium.
Eur J Cardiothorac Surg. 1997 Jan;11(1):92-9. doi: 10.1016/s1010-7940(96)01017-2.
From April 1990 to August 1995, 121 patients (median age 42 years) underwent aortic valve replacement with allografts (69 patients) or autografts (52 patients). In this latter group, 24 Ross procedures have been performed in congenital patients since November 1991 (median age 10 years, range five months to 27 years): aortic incompetence (n = 17), isolated aortic stenosis (n = 5), small stenotic prosthesis (n = 2). Transthoracic echocardiography was obtained preoperatively in all patients and serially after surgery with the aim of measuring aortic and pulmonary annuli and evaluate gradients and incompetence and to study the left ventricular function. Intraoperative transoesophageal echocardiography was routinely used. Complete root replacement was performed in all patients.
One patient died in the early postoperative period (4%). There was no late death. All survivors remained in NYHA class I and were free of complications and medications. No gradient nor any significant aortic incompetence could be demonstrated. In 17 patients with predominant aortic incompetence before surgery, the left ventricular function was followed prospectively, end-diastolic left ventricular dimensions diminished drastically from 2 +/- 3.4 S.D. above normal to -0.63 +/- 2.4 S.D. at one week postoperatively (day 10) to reach a normal value one to three months after surgery. Left ventricular mass remained abnormal at day 10 (from 4.7 +/- 3.3 S.D. to 5.3 +/- 3.8 S.D.) and diminished more progressively to reach a normal value (0.14 +/- 1.4 S.D.) at three months. This resulted in a significant decrease of end-systolic wall stress (-3.6 +/- 2.1 S.D.) and in a hyperdynamic function in the immediate postoperative days except in two patients. These two patients were characterized preoperatively by more severely dilated left ventricle (end diastolic dimension 5.3 +/- 0.03 versus 1.6 +/- 3 S.D.) with decreased left ventricular wall thickness (1.19 +/- 0.7 versus 3.44 +/- 1.9 S.D.), decreased ratio between end diastolic wall thickness and end diastolic dimension (0.14 +/- 0.06 versus 0.2 +/- 0.06) and a decreased velocity of shortening. Unlike the other 15 patients, the left ventricular function did not recover completely at mid term follow-up in those two patients.
The Ross operation is a safe procedure and allows us to suppress completely the abnormal loading conditions of the left ventricle, resulting in a complete recovery of left ventricular function in most patients.
1990年4月至1995年8月，121例患者（中位年龄42岁）接受了同种异体主动脉瓣置换术（69例）或自体主动脉瓣置换术（52例）。在后一组中，自1991年11月以来，24例先天性患者接受了Ross手术（中位年龄10岁，范围为5个月至27岁）：主动脉瓣关闭不全（n = 17）、孤立性主动脉瓣狭窄（n = 5）、小的狭窄人工瓣膜（n = 2）。所有患者术前均行经胸超声心动图检查，并在术后定期进行，目的是测量主动脉和肺动脉瓣环，评估压力阶差和关闭不全情况，并研究左心室功能。术中常规使用经食管超声心动图。所有患者均进行了完整的根部置换。
1例患者在术后早期死亡（4%）。无晚期死亡病例。所有存活患者均保持纽约心脏协会I级心功能，无并发症且无需药物治疗。未发现压力阶差及任何明显的主动脉瓣关闭不全。在术前以主动脉瓣关闭不全为主的17例患者中，对左心室功能进行了前瞻性随访，左心室舒张末期内径从高于正常2±3.4标准差急剧降至术后1周（第10天）的-0.63±2.4标准差，术后1至3个月恢复正常。左心室质量在第10天时仍异常（从4.7±3.3标准差降至5.3±3.8标准差），并逐渐降低，在3个月时恢复正常（0.14±1.4标准差）。这导致收缩末期壁应力显著降低（-3.6±2.1标准差），术后即刻除2例患者外均表现为高动力功能。这2例患者术前的特点是左心室更严重扩张（舒张末期内径5.3±0.03对1.6±3标准差），左心室壁厚度降低（1.19±0.7对3.44±1.9标准差），舒张末期壁厚度与舒张末期内径之比降低（0.14±0.06对0.2±0.06），缩短速度降低。与其他15例患者不同，这2例患者在中期随访时左心室功能未完全恢复。
Ross手术是一种安全的手术方法，能使我们完全消除左心室的异常负荷情况，使大多数患者左心室功能完全恢复。
