• 医学文献
  • 知识库
  • 评价分析
  • 中外期刊
  • 学位
  • 会议
  • 专利
  • 成果
  • 标准
  • 法规
  • 临床诊疗知识库
  • 中医药知识库
  • 机构
  • 作者
论文 期刊
高级检索

检索历史 清除

小主动脉瓣环行主动脉瓣置换术的临床研究

Clinical research of aortic valve replacement in small aortic annulus

摘要:

目的 对比研究小主动脉瓣环患者行主动脉根部扩大后主动脉瓣置换术和不行根部扩大而直接植入St.Jude Regent人工瓣膜的手术疗效.方法 2008年6月至2012年6月共有62例重度主动脉瓣狭窄合并小主动脉瓣环(瓣环直径为15 ~ 21 mm)患者接受单纯主动脉瓣置换术.其中行主动脉瓣根部扩大后主动脉瓣置换术27例(扩大组),不行根部扩大而直接植入17 mm St.JudeRegent人工瓣膜15例(17 mm瓣膜组)、19 mm St.Jude Regent 20例(19 mm瓣膜组),共35例(未扩大组).主动脉瓣环加宽采用改良Nicks法8例,改良Manougnian法19例.术后3和12个月行超声心动图复查,采用配对t检验进行统计比较.结果 采用改良Nicks法治疗的1例患者因主动脉根部出血二次开胸、术后纵隔感染死亡,采用改良Manougnian法治疗的1例患者植入永久心脏起搏器;未扩大组低心排血量综合征1例.超声心动图随访显示,两组患者术后3、12个月分别与术前比较,有效瓣口面积指数(EOAI)均显著增加、主动脉瓣跨瓣压差和瓣口流速均显著降低(均P=0.000),扩大组和19 mm瓣膜组左心室内径(LVDd)也均显著缩小(均P=0.000),但17 mm瓣膜组LVDd无显著缩小(P>0.05).未扩大组中,19 mm较17 mm瓣膜组,术后3、12个月EOAI较高、跨瓣压差和瓣口流速较低、LVDd较小(t=2.449 ~ 12.291,P=0.000~0.029).术后3、12个月扩大组较17 mm瓣膜组的EOAI、跨瓣压差、瓣口流速及LVDd的差异均有统计学意义(t=2.278 ~ 17.860,P=0.000~0.028);扩大组较19 mm瓣膜组上述4项指标差异均无统计学意义(P>0.05).结论 当小主动脉瓣环行主动脉瓣置换术时,能植入19 mm及以上的St.Jude Regent瓣膜时,可直接行主动脉瓣置换术,能获得良好的血流动力学.否则可行主动脉根部扩大术后再行置换术.

更多
abstracts:

Objective To compare the effect aortic valve replacement(AVR) combined with aortic root enlargement and simple St.Jude Regent AVR in small aortic annulus patients.Methods From June 2008 to June 2012,62 severe aortic valvular stenosis patients with small aortic annulus (annulus diameter of 15-21 mm) entered the study.Twenty-seven cases received AVR combined with aortic root enlargement (enlargement group) and 35 cases received simple St.Jude Regent AVR(non-enlargement group),17 mm St.Jude Regent in 15 cases(17 mm group) and 19 mm in 20 cases(19 mm group).Aortic root enlargement techniques included Nicks in 2,modified Nicks in 6 cases,modified Manouguian in 19 cases.Patients were followed up and received ultrasonic cardiogram (UCG) 3,12 months postoperatively and t-test was used for statistical comparison.Results In enlargement group,1 Nicks patient received reoperation due to aortic root hemorrhage,and died of mediastinal infection,1 Manouguian patient received permanent pacemaker.In non-enlargement group,low cardiac output syndrome in 1 case.Three months and 12 months postoperative UCG showed,comparing to preoperation,effective orifice area (EOAI) increased significantly,postoperative transvalular pressure gradient and flow rate decreased significantly in each group (P =0.000).Left ventricular diastolic diameter (LVDd) decreased significantly in both enlargement group and 19 mm group (P =0.000),but no significant change in 17 mm group (P > 0.05).In non-enlargement group,19 mm compared to 17 mm group,3 months and 12 months postoperative EOAI increased significantly,pressure gradient,flow rate and LVDd decreased significantly (t =2.449-12.291,P =0.000-0.029).Comparing to enlargement group,there were significant differences in EOAI,pressure gradient,flow rate and LVDd in 17 mm group(t =2.278-17.860,P =0.000-0.028),but no significant differences in 19 mm group(t =0.118-1.630,P =0.110-0.907).Conclusions For small aortic annulus AVR patient,19 mm and larger St.Jude Regent prosthetic valves may produce satisfied hemodynamic,otherwise,aortic root enlargement is recommended.

More
  • 浏览:151
  • 下载:49

加载中!

相似文献

  • 中文期刊
  • 外文期刊
  • 学位论文
  • 会议论文

加载中!

加载中!

加载中!

加载中!

扩展文献

特别提示:本网站仅提供医学学术资源服务,不销售任何药品和器械,有关药品和器械的销售信息,请查阅其他网站。

充值 订阅 收藏 移动端 使用
帮助