Does the pulmonary autograft in the aortic position in adults increase in diameter? An echocardiographic study
Does the pulmonary autograft in the aortic position in adults increase in diameter? An echocardiographic study
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DOI：
10.1016/s0022-5223(97)70223-x
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发表时间：
1997-04-01
影响因子：
6
通讯作者：
Bos, E
中科院分区：
文献类型：
--
作者：
Hokken, RB;Bogers, AJJC;Bos, E
目的：本研究的目的是了解成人自体肺移植物直径随时间的变化及其与主动脉根部置换术中主动脉瓣反流的关系。方法：自1989年1月至1995年5月，连续36例成人患者因主动脉瓣疾病接受自体肺动脉根部置换术。 20 名男性和 16 名女性患者的平均年龄为 29.1 岁（范围 19.3 至 52.1 岁）。平均随访时间为 2.3 年（范围 0.3 至 6.0 年）。两名患者在医院死亡。另一位患者因肺位同种异体移植物远端缝合线狭窄而接受了第二次手术。在体外循环之前（仅瓣环）和之后通过心外膜超声心动图测量自体肺移植瓣环和窦直径，在出院时通过经胸超声心动图测量，并在随访期间通过经食管超声心动图测量。结果：体外循环后自体移植环的平均直径并未立即增加（体外循环前平均直径为 26.2 毫米，体外循环后为 26.4 毫米）。体外循环后自体移植窦的平均直径为 36.5 毫米。随访时自体移植物环平均直径增加至 31.5 毫米，增加了 5.1 毫米 (19%)。随访时自体移植窦平均直径增加至 43.9 毫米，增加了 7.4 毫米（20%）。出院时（术后7至10天）已达到瓣环直径增加的59%和窦直径增加的40%；另一部分增加发生在随访期间。直径增加与随访时间长短（与较长随访时间相比，随访时间少于一年）或主动脉瓣关闭不全的严重程度均无关。结论：用自体肺移植物进行主动脉根部置换后第一年，自体肺移植物环和窦直径增加。这种情况在术后10天内迅速发生，随访期间进一步增加，中期随访时未引起明显的主动脉瓣关闭不全。
Objective: The objective of this study was to discern the fate of the pulmonary autograft diameter over time in adults and its relation to aortic regurgitation in the setting of aortic root replacement. Methods: From January 1989 to May 1995, 36 consecutive adult patients underwent aortic root replacement with a pulmonary autograft for aortic valve disease. The mean age of 20 male and 16 female patients was 29.1 years (range 19.3 to 52.1 years). The mean follow-up was 2.3 years (range 0.3 to 6.0 years). Two patients died in the hospital. One other patient had a second operation for stenosis at the distal suture line of the allograft in the pulmonary position. Pulmonary autograft anulus and sinus diameters were measured with epicardial echocardiography before (only anulus) and after cardiopulmonary bypass, with transthoracic echocardiography at hospital discharge, and with transesophageal echocardiography during follow-up. Results: The mean autograft anulus diameter did not increase immediately after cardiopulmonary bypass (mean diameter 26.2 mm before and 26.4 mm after cardiopulmonary bypass). The mean autograft sinus diameter after cardiopulmonary bypass was 36.5 mm. The mean autograft anulus diameter increased to 31.5 mm at follow-up, an increase of 5.1 mm (19%). The mean autograft sinus diameter increased to 43.9 mm at follow-up, an increase of 7.4 mm (20%). Fifty-nine percent of the anulus diameter increase and 40% of the sinus diameter increase was already reached at hospital discharge (7 to 10 days after the operation); the other part of the increase occurred during follow-up. Diameter increase was associated with neither the length of follow-up (follow-up less than 1 year compared with a longer follow-up) or severity of aortic regurgitation. Conclusion: Pulmonary autograft anulus and sinus diameters increase the first year after aortic root replacement with a pulmonary autograft. This occurs rapidly within 10 days after the operation, with a further increase during follow-up, without causing significant aortic regurgitation at medium-term follow-up.