Short and midterm results of aortic valve cusp extension in the treatment of children with congenital aortic valve disease
Short and midterm results of aortic valve cusp extension in the treatment of children with congenital aortic valve disease
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DOI：
10.1016/j.athoracsur.2006.04.039
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发表时间：
2006-10-01
影响因子：
4.6
通讯作者：
Caldarone, Christopher A.
中科院分区：
文献类型：
--
作者：
Alsoufi, Bahaaldin;Karamlou, Tara;Caldarone, Christopher A.
背景资料。我们评估了我们的主动脉瓣尖端延长技术的经验，以确定术中修复成功和随后的耐受性的预测因素。从1999年到2005年，22名儿童(年龄5-18岁)接受了自体心包主动脉瓣扩张术。16名儿童以前接受过手术或经皮介入治疗。10名儿童有二尖瓣主动脉瓣。3例患者1个心尖延长，3例2个心尖扩大，16例3个心尖扩大。采用混合线性回归分析方法对心脏瓣膜和主动脉瓣功能的纵向轨迹进行建模。没有住院或晚期死亡。无瓣膜置换术的五年生存率为75%。手术前后的超声心动图比较显示，主动脉瓣关闭不全(喷口宽度/主动脉瓣直径比从0.39+/-0.12降至0.22+/-0.11；P<；0.0001)、主动脉瓣狭窄(主动脉瓣最大梯度从41+/-25 mm Hg降至29+/-15 mm Hg；P=0.04)和左心室舒张末内径Z-Score(从1.39+/-0.38降至1.16+/-0.34；P<；0.001)均有改善。在随访期内，修复后的射流宽度和主动脉瓣直径呈非线性增加(p<；0.001)。术后主动脉峰值压差大于30 mm Hg的患者有进展的趋势，而术后峰值压差较小的患者在随访期间有消退的趋势(p<；0.001)。在随访期内，左室舒张末期内径的Z积分下降保持稳定。主动脉瓣尖端延长可获得可接受的血流动力学结果，并使左心室几何结构稳定。然而，残留病变很常见，根据超声心动图数据可以预测这些病变的进展和消退。
Background. We evaluated our experience with aortic valve cusp extension techniques to identify predictors of successful intraoperative repair and subsequent durability.Methods. Twenty-two children ( ages 5 - 18 years) underwent aortic cusp extension with autologous pericardium between 1999 and 2005. Sixteen children had previous surgical or percutaneous intervention. Ten children had bicuspid aortic valves. Cusp extensions were performed on 1 cusp in 3 patients, 2 cusps in 3, and 3 cusps in 16. Serial echocardiographic measures (n = 81) were obtained during a 5-year period and underwent blinded review. Longitudinal trajectories of ventricular and aortic valve function were modeled using mixed linear regression analysis.Results. There was no hospital or late mortality. Five-year freedom from valve replacement was 75%. Comparison of preoperative and post-repair echocardiograms demonstrated reductions in aortic insufficiency ( decreased in jet-width/aortic valve diameter ratio from 0.39 +/- 0.12 to 0.22 +/- 0.11; p < 0.0001), aortic stenosis (decreased in peak aortic valve gradient from 41 +/- 25 mm Hg to 29 +/- 15 mm Hg; p = 0.04), and left ventricular end-diastolic dimensions Z-score (decreased from 1.39 +/- 0.38 to 1.16 +/- 0.34; p < 0.001). During the follow-up period, post-repair jet-width and aortic valve diameter increased nonlinearly (p < 0.001). Patients with postoperative peak aortic gradients greater than 30 mm Hg had progression of aortic stenosis, whereas those with lesser postoperative peak gradients tended to regress during follow-up (p < 0.001). The decrement in Z-score of the left ventricular end-diastolic dimensions remained stable during the follow- up period.Conclusions. Aortic valve cusp extension can result in acceptable hemodynamic results with stabilization of left ventricular geometry. However, residual lesions are common and progression and regression of these lesions can be predicted based on echocardiographic data.