Growth of the pulmonary autograft after the Ross operation in childhood
Growth of the pulmonary autograft after the Ross operation in childhood
复制标题
DOI：
10.1016/s1010-7940(00)00638-2
复制
发表时间：
2001-02-01
影响因子：
3.4
通讯作者：
Wollenek, G
中科院分区：
文献类型：
--
作者：
Simon, P;Aschauer, C;Wollenek, G
目的：如D. Ross.然而，在儿科人群中，存在自体移植物生长和体循环晚期扩张的问题。方法：自1991年以来，30例儿童（平均年龄11.3 ± 3.1岁）接受了主动脉瓣置换术，其中自体肺动脉瓣作为非置换物。所有儿童每年进行临床和超声心动图随访。结果：无围手术期死亡，1例患儿死于车祸。末次随访时（平均随访时间为4.3 ± 2.6年），所有患者均为NYHA I级。有1例早期再次手术，由于瓣叶穿孔，必须重建自体移植物。无重大瓣膜相关事件。所有儿童均表现出正常的身体发育。瓣环直径从手术时的18 ± 2 mm显著增加至末次随访时的20 ± 3.5 mm（P < 0.004）。窦的直径也显著增加，从手术时的29 +/- 4 mm增加到末次随访时的34 +/- 2 mm（P < 0.001）。瓣环和窦的自体移植物尺寸的增加与体表面积的增加无关，没有证据表明存在不成比例的扩张。血流动力学测量结果显示，在这一快速增长的患者人群中，95%的患者的生理峰值压差为6.8 +/- 2.9 mmHg，无或轻微主动脉瓣关闭不全。结论：这些数据表明肺自体移植物的生长与体细胞生长平行，体循环没有过度扩张。血流动力学在生理梯度方面非常好，主动脉瓣关闭不全没有增加。(C)2001 Elsevier Science B. V.保留所有权利。
Objective: Excellent hemodynamic performance has been demonstrated after aortic valve replacement using the autologous pulmonary valve as described by D. Ross. However, in the pediatric population there is concern in regard to growth of the autograft and late dilatation in the systemic circulation. Methods: Since 1991, 30 children (mean age, 11.3 +/- 3.1 years) had aortic valve replacement with the pulmonary autograft as a Not replacement. All children had yearly clinical and echocardiographic follow-up. Results: Then were no perioperative deaths; one child died late in a car accident. At the last follow-up (mean follow-up, 4.3 +/- 2.6 years), all patients: were in NYHA class I. There was one early reoperation, in which the autograft had to be reconstructed due to a leaflet perforation. There were no major valve related events. All children showed normal somatic growth. The annulus diameter increased significantly from 18 +/- 2 at surgery to 20 +/- 3.5 mm at the latest follow-up (P < 0.004). The sinus also increased significantly in diameter from 29 +/- 4 at surgery to 34 +/- 2 mm at the last follow-up (P < 0.001). This increase in autograft size, both for the annulus and the sinus, paralleled the increase in body surface area with no evidence for unproportional dilatation. Hemodynamic measurements demonstrated physiological peak gradients of 6.8 +/- 2.9 mmHg and no or trivial aortic insufficiency in 95% of this rapidly growing patient population. Conclusion: These data demonstrate growth of the pulmonary autograft parallel to somatic growth without undue dilatation in the systemic circulation. The hemodynamics are excellent with regard to physiological gradients and no increase in aortic insufficiency. (C) 2001 Elsevier Science B.V. All rights reserved.