Turina J, Hippenmeyer-Zingg I, Schönbeck M, Turina M
Department für Innere Medizin, Universitätsspital Zürich, Schweiz.
Z Kardiol. 1997 Sep;86(9):676-83. doi: 10.1007/s003920050108.
Severe aortic valve disease is a rare complication of coarctation in adults. Between 1961 and 1990 aortic valve replacement was performed after or combined with the operation of coarctation in 24 adults (4% of entire population operated for coarctation). Bicuspid aortic valves were present in 2/3 of patients. In 10 patients (7/10 with aortic stenosis) coarctation was operated early (mean age 24 years) and aortic valve late (mean age 40 years): in 14 (10/14 with aortic regurgitation, mean age 40 years) aortic valve and coarctation were operated simultaneously (8 patients) or staged within 6 months (6 patients). Additional surgical interventions on the dilated aorta ascendens were performed in 8, mitral valve replacement in 2 and aorto-coronary bypass in 1 patients. Early mortality was 2/24 (8%) and was similar in simultaneously (1/8) and staged (1/14) operated cases: 10 year survival was lower than in an age-matched group of 72 patients with aortic valve disease of similar severity operated during the same period (70% vs 88%, p < 0.01): 6/7 late deaths were cardiac; 5/5 pts with preoperatively severely increased end-diastolic (> 199 ml/m2) and 4/4 with end-systolic (> 90 ml/m2) left ventricular volumes and 2/2 with ejection fraction < 41% died late postoperatively. Severe aortic valve disease arised in 4% of adults with coarctation or after coarctation resection. The results of valve replacement in these patients were less successful due to high late mortality in cases with severe preoperative left ventricular dilatation and/or decrease of ejection fraction. Thus, close surveillance of patients after coarctation surgery, especially those with bicuspid valves, is mandatory for early detection of valvular disease and appropriate timing of valve replacement before left ventricular function begins to deteriorate.
严重主动脉瓣疾病是成人主动脉缩窄的一种罕见并发症。1961年至1990年间，24例成人（占接受主动脉缩窄手术总人口的4%）在主动脉缩窄手术后或与该手术联合进行了主动脉瓣置换。三分之二的患者存在二叶式主动脉瓣。10例患者（10例中有7例为主动脉狭窄）早期进行了主动脉缩窄手术（平均年龄24岁），后期进行了主动脉瓣手术（平均年龄40岁）；14例患者（14例中有10例为主动脉反流，平均年龄40岁）同时进行了主动脉瓣和主动脉缩窄手术（8例）或在6个月内分期进行（6例）。8例患者对扩张的升主动脉进行了额外的手术干预，2例进行了二尖瓣置换，1例进行了主动脉冠状动脉搭桥术。早期死亡率为2/24（8%），同期进行手术（1/8）和分期手术（1/14）的病例相似：10年生存率低于同期接受类似严重程度主动脉瓣疾病手术的72例年龄匹配患者（70%对88%，p<0.01）；7例晚期死亡中有6例为心脏原因；术前舒张末期严重增加（>l99ml/m²）的5/5患者、收缩末期（>90ml/m²）左心室容积增加的4/4患者以及射血分数<41%的2/2患者术后晚期死亡。4%的主动脉缩窄成人或主动脉缩窄切除术后出现严重主动脉瓣疾病。由于术前左心室严重扩张和/或射血分数降低的病例晚期死亡率高，这些患者的瓣膜置换结果不太成功。因此，主动脉缩窄手术后对患者进行密切监测，尤其是对二叶式瓣膜患者，对于早期发现瓣膜疾病以及在左心室功能开始恶化之前适时进行瓣膜置换至关重要。
