主动脉瓣置换术后升主动脉扩张率及人工心脏瓣膜-患者不匹配的探讨

doi:10.6040/j.issn.1671-7554.0.2014.038

摘要/Abstract

摘要： 目的研究主动脉瓣置换术后升主动脉扩张率及人工心脏瓣膜-患者不匹配（PPM）的发生率。方法选取2006年12月至2012年12月在我院就诊的主动脉瓣病变合并升主动脉扩张（升主动脉直径3.5 cm～5.0 cm）患者42例（除外马凡综合症及升主动脉夹层患者），根据瓣叶特点分为主动脉瓣二瓣畸形组（Ⅰ组，n=22例）和三叶式主动脉瓣组（Ⅱ组，n=20例）。另外根据置换瓣膜类型分为机械瓣组（Ⅲ组，n=26例）和生物瓣组（Ⅳ组，n=16例）。均在体外循环（CPB）下行单纯主动脉瓣置换术，未处理扩张的升主动脉。术后测量升主动脉直径，计算人工心脏瓣膜有效开口面积指数（EOAI）。根据EOAI将PPM分为3类：轻度PPM为EOAI>0.85 cm²/m²；中度PPM为0.652/m²；重度PPM为EOAI≤0.65 cm²/m²。结果 Ⅰ组升主动脉直径扩张率：主动脉瓣狭窄患者（0.6±1.09）mm/年、主动脉瓣狭窄伴关闭不全患者（0.5±0.6）mm/年、主动脉瓣关闭不全患者（0.3±0.8）mm/年；Ⅱ组中升主动脉直径扩张率：主动脉瓣狭窄患者（-0.2±1.2）mm/年、主动脉瓣狭窄伴关闭不全患者（-0.2±0.9）mm/年、主动脉瓣关闭不全患者（-0.1±0.6）mm/年。Ⅲ组中度PPM发生率15.38%，Ⅳ组中度PPM发生率43.75%。结论主动脉瓣二瓣畸形伴升主动脉扩张（升主动脉直径3.5 cm～5.0 cm）患者，仅行主动脉瓣置换术，术后升主动脉有一定的扩张率。PPM在主动脉瓣置换术后发生率较高，更易在置换生物瓣患者中出现。

关键词: 人工心脏瓣膜患者不匹配, 主动脉瓣病变, 升主动脉扩张, 主动脉瓣置换术

Abstract: Objective To investigate changes of diameter of ascending aorta and the prosthesis-patient mismatch (PPM) after aortic valve replacement. Methods A total of 42 patients with aortic valve disease and ascending aortic dilatation (ascending aorta diameter 3.5 cm~5.0 cm) treated in our hospital during Dec. 2006 to Dec. 2012 were selected (cases with Marfan syndrome and ascending aortic dissection were excluded). The subjects were divided into bicuspid aortic valve group (group Ⅰ, n=22) and tricuspid aortic valve group (group Ⅱ, n=20) according to the features of aortic valves. According to the different types of valves, the subjects were divided into the mechanical valve group (group Ⅲ, n=26), and bioprosthetic valve group (group Ⅳ, n=16). All cases underwent simple aortic valve replacement surgery under cardiopulmonary bypass, without dealing with the dilated ascending aorta. The diameter of ascending aorta was measured and the effective orifice area index (EOAI) was calculated. According to EOAI, PPM was divided into three categories: mild (EOAI>0.85 cm²/m²), moderate (0.652/m²), and severe (EOAI≤0.65 cm²/m²). Results The ascending aorta change rates in group Ⅰ were: patients with aortic stenosis (0.6±1.09) mm/year, patients with aortic stenosis and regurgitation (0.5±0.6) mm/year, patients with aortic regurgitation(0.3±0.8) mm/year; the ascending aorta change rates in group Ⅱ were: patients with aortic stenosis (-0.2±1.2) mm/year, patients with aortic stenosis and regurgitation (-0.2±0.9) mm/year, patients with aortic regurgitation (-0.1±0.6) mm/year. Moderate PPM accounted for 15.38% in group Ⅲ and 43.75% in group Ⅳ. Conclusion Aortic valve replacement surgery is not adequant for BAV patients with aortic dilatation of the ascending aorta (aortic diameter 3.5 cm~5.0 cm), because postoperatively the ascending aorta will dilate to a certain degree. PPM occurs more often after aortic valve replacement and is likely to affect patients with bioprosthetic valve.

Key words: Aortic valve disease, Ascending aorta dilatation, Aortic valve replacement, Prosthesis-patient mismatch

中图分类号:

R654

陈雷, 邹承伟, 张海洲, 朱小龙, 韩波. 主动脉瓣置换术后升主动脉扩张率及人工心脏瓣膜-患者不匹配的探讨[J]. 山东大学学报（医学版）, 2014, 52(8): 43-46.

CHEN Lei, ZOU Chengwei, ZHANG Haizhou, ZHU Xiaolong, HAN Bo. Study of diameter of ascending aorta and prosthesis-patient mismatch after aortic valve replacement[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(8): 43-46.

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