国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2011年
16期
1995-1997
,共3页
小主动脉瓣环%主动脉瓣置换%主动脉瓣环扩大%左心室功能%左心室形态
小主動脈瓣環%主動脈瓣置換%主動脈瓣環擴大%左心室功能%左心室形態
소주동맥판배%주동맥판치환%주동맥판배확대%좌심실공능%좌심실형태
Small aortic root%Aortic valve replacement%Aortic annulu enlarge%Left ventricular function%Left ventricular morphology
目的 探讨小主动脉瓣环者接受机械瓣膜置换术后的远期疗效.方法 2003年7月-2005年12月间,对36例成人小主动脉瓣环(直径≤19 mm)者行人工机械瓣膜置换术,其中主动脉瓣置换25例,主动脉瓣、二尖瓣双瓣置换11例.主动脉瓣置换采用改良Manougnian法瓣环扩大后植入23 mm CarboMedics 瓣14例(CM组);采用瓣环上瓣膜置换法植入19 mm CarboMedics Top Hat Supra-Annular Aortic瓣22例(CMSA 组),分析两组术前和术后第6年的临床及超声心动图资料.结果 与术前比较,术后第6年两组患者的心功能明显改善,左心室的射血分数、短轴缩短率明显上升,舒张末内径、主动脉跨瓣压差明显降低,CM组的室间隔厚度、左心室后壁厚度明显缩小,差异具有显著性(P＜0.05);组间比较,CM组的主动脉跨瓣压差较CMSA组降低更加明显(P＜0.05),而室间隔厚度和左心室后壁厚度的均数值也小于CMSA组,已达健康成年人水平.结论 小主动脉瓣环者机械瓣膜置换术后远期左心室功能恢复良好,行瓣环扩大而植入较大内径瓣膜者,更有利于左心室形态的逆转.
目的 探討小主動脈瓣環者接受機械瓣膜置換術後的遠期療效.方法 2003年7月-2005年12月間,對36例成人小主動脈瓣環(直徑≤19 mm)者行人工機械瓣膜置換術,其中主動脈瓣置換25例,主動脈瓣、二尖瓣雙瓣置換11例.主動脈瓣置換採用改良Manougnian法瓣環擴大後植入23 mm CarboMedics 瓣14例(CM組);採用瓣環上瓣膜置換法植入19 mm CarboMedics Top Hat Supra-Annular Aortic瓣22例(CMSA 組),分析兩組術前和術後第6年的臨床及超聲心動圖資料.結果 與術前比較,術後第6年兩組患者的心功能明顯改善,左心室的射血分數、短軸縮短率明顯上升,舒張末內徑、主動脈跨瓣壓差明顯降低,CM組的室間隔厚度、左心室後壁厚度明顯縮小,差異具有顯著性(P＜0.05);組間比較,CM組的主動脈跨瓣壓差較CMSA組降低更加明顯(P＜0.05),而室間隔厚度和左心室後壁厚度的均數值也小于CMSA組,已達健康成年人水平.結論 小主動脈瓣環者機械瓣膜置換術後遠期左心室功能恢複良好,行瓣環擴大而植入較大內徑瓣膜者,更有利于左心室形態的逆轉.
목적 탐토소주동맥판배자접수궤계판막치환술후적원기료효.방법 2003년7월-2005년12월간,대36례성인소주동맥판배(직경≤19 mm)자행인공궤계판막치환술,기중주동맥판치환25례,주동맥판、이첨판쌍판치환11례.주동맥판치환채용개량Manougnian법판배확대후식입23 mm CarboMedics 판14례(CM조);채용판배상판막치환법식입19 mm CarboMedics Top Hat Supra-Annular Aortic판22례(CMSA 조),분석량조술전화술후제6년적림상급초성심동도자료.결과 여술전비교,술후제6년량조환자적심공능명현개선,좌심실적사혈분수、단축축단솔명현상승,서장말내경、주동맥과판압차명현강저,CM조적실간격후도、좌심실후벽후도명현축소,차이구유현저성(P＜0.05);조간비교,CM조적주동맥과판압차교CMSA조강저경가명현(P＜0.05),이실간격후도화좌심실후벽후도적균수치야소우CMSA조,이체건강성년인수평.결론 소주동맥판배자궤계판막치환술후원기좌심실공능회복량호,행판배확대이식입교대내경판막자,경유리우좌심실형태적역전.
Objective To evaluate the long-term effect after mechanical valve replacement in adult patients with small aortic root, and guide clinical practice. Methods From July 2003 to December 2005, 36 patients with small aortic root (diameter ≤ 19 mm) received aortic prostheses; among which 25 cases underwent aortic valve replacement alone, and the other received mitral valve replacement besides aortic valve replacement. 23mm CarboMedics valve were implantated in 14 patients(CM group) by using of Manougnian's annulus enlarging technique; 22 patients received implantation of 19mmCarboMedics Top Hat Supra-Annular valve(CMSA group). All of patients were followed up with echocardiography and cardiac functions Pre-operation ang 6th Year post-operation. Results Comparing with those before operation, cardiac function(NYHA) improved obviously, Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) increased significantly, left ventricular end-diastolic diameter(LVDD)and pressure gradients across aortic valve(PGav) decreased obviously. Comparison Between groups, PGav, interventricular septal thickness(IVST)and left ventricular posterior wall thickness(LVPWT)of CM group reduced more obvious than CMSA group, has reached healthy adult level. Conclusion The long-term effect after surgery is satisfied in adult patients with small aortic root, especially in left ventricular function. Implant ing a larger prosthesis is more beneficial for left ventricular morphology reversal.
