摘要
目的 总结主动脉瓣置换术中处理小主动脉瓣环的体会.方法 我院在2000年至2010年期间收治主动脉瓣环细小的主动脉瓣病变18例,均采取改良Manouguian方法扩大主动脉瓣环,再置入较合适的机械主动脉瓣.同期行二尖瓣置换6例,室间隔修补1例,三尖瓣成形5例.结果 17例有效开口面积指数（EOAI）均达到0.85cm2/m2以上,1例0.80cm2/m2.术后严重低心排综合征1例,室性心律失常3例,心脏压塞1例.18例痊愈出院,随访1～10年,术后6个月复查发现EOAI为0.80cm2/m2的患者主动脉跨瓣压差较高,室间隔及左室壁厚度恢复较慢,左室射血分数较低;而比值在0.85～1.0之间与大于1.0的患者相比,主动脉跨瓣压差、室间隔及左室壁厚度平均值稍高,但差异无统计学意义.2例术后6年因身高、体重增加EOAI分别下降到0.79、0.81cm2/m2,出现活动后心慌,心电图提示左室高电压,经扩管等药物治疗和一般处理,症状明显改善.结论 改良Manouguian方法扩大主动脉瓣环安全、有效,可置入合适的机械主动脉瓣,有利于提高手术疗效.
Objective To summarize the experiences of aortic annulus enlargement in aortic valve replacement for small aortic annulus. Methods From Jan. 2000 to Sept, 2010, 18 cases of aortic valve disease with small aortic annulus received improved Manouguian procedure to enlarge the small aortic annulus before implanting appropriate mechanical aortic valve. Complicated heart lesion were treated surgically simultaneously. Results Complications in early stage including ventricnlar arrhythmia, severe low cardiac output syndrome and cardiac tamponade were cured. All cases were discharged without operative mortality. All cases were improved in cardiac function and ventricular wall mass. No death or other severe events occurred in follow - up. Conclusion Aortic annulus enlargement with improved Manougnian method is effective and safe in patients with small aortic annulus in order to implant appropriate mechanical aortic valve.
出处
《临床外科杂志》
2012年第5期349-350,共2页
Journal of Clinical Surgery
