Analysis of the aortic root performance in valve-sparing aortic root reconstruction.

直到最近，对于合并主动脉环扩张或升主动脉瘤的主动脉瓣反流患者，最好的外科治疗方法是用复合带瓣管道替换主动脉根部，然而，合并升主动脉或升主动脉根部动脉瘤的主动脉瓣反流主要是由于窦管连接扩张、一个或多个Valsalva窦变形、环状主动脉扩张症或这些问题的综合所致。目前，临床上使用这一原理进行主动脉根部再植和重塑以保留固有的主动脉瓣。然而，主动脉根部是一个动态单元，可以方便地打开和关闭，并分担瓣叶的压力。当用人工材料替换主动脉根部时，可能会失去正常的主动脉根部状况，并损害保存下来的主动脉瓣的开启和关闭特性。这些移动可能会对修复的耐久性以及可能的le…产生重要影响更多的心功能，从而产生长期的效果。虽然这些手术的短期和长期效果都很好，但哪一种手术产生的结果更具生理性和更持久还没有得到很好的确定。本文报道了超声心动图对主动脉瓣开放和关闭的间接观察和临床结果的对比研究。然而，使用这两种技术对瓣膜运动的直接观察并没有进行。因此，我们利用心脏内窥镜直接成像技术观察了主动脉瓣重建和再植入手术后的行为，并探讨了哪种手术更具生理学意义。在目前的临床情况下，最初的再植术称为David-I很少进行：然而，我们在本研究中使用了最初的再植术，因为我们想要清楚地分析重塑和再植术之间的基本概念差异。重建组保留的主动脉瓣开闭灵活、对称，与对照组相似。此外，保存的瓣膜的游离缘在一个心动周期中伸直。相比之下，再植组保留的主动脉瓣表现为屈曲和不对称运动。再植术保存的主动脉瓣的开启和关闭行为受到损害。此外，据推测，与再植“手术”相比，重塑手术可能会保留更多的生理主动脉根部功能。较少

Until recently, the best surgical treatment for patients with aortic regurgitation, associated with annuloaortic ectasia or an ascending aortic aneurysm, was replacement, of the aortic root with a composite valved conduit, However, aortic regurgitation with an ascending or aortic root aneurysm is mainly due to 'dilatation of the sinotubular junction, distortion of one or more of the sinuses of Valsalva, annuloaortic ectasia, or a combination of these problems. Currently, aortic root reimplantation and remodeling are performed clinically to preserve the native aortic valve using this rationale. However, the aortic root is a dynamic unit that allows easy opening and closing and shares, stress for the valve leaflets. When the aortic root is replaced with artificial material the normal aortic root condition may be lost, with impaired preserved aortic valve opening and closing characteristics. These movements could have important implications for the durability of the repair and possibly le … More ft ventricular function, and thus long-term results. Although the short-term and long-term outcomes of these operations have been good, which operation yields results that are more physiologic and more durable has not been well established. Comparative studies, including clinical results and indirect observation of opening and closing of the aortic valve using echocardiography, were reported. However, direct observation of valve motions with the two techniques was not performed. Therefore, we observed the behavior of the aortic valve after the remodeling and reimplantation procedures with direct imaging using cardiac endoscopy, and investigated which procedure is more physiologic. In the current clinical situation, the original reimplantation procedure, called "David-I", is rarely performed: However, we used the original reimplantation procedure in this study because we wanted to clearly analyze the basic conceptual differences between the remodeling and reimplantation procedures. In the remodeling group, the preserved aortic valve opened and closed flexibly and symmetrically, similar to what was seen in the control group. Also, the free margins of the preserved valve straightened through one cardiac cycle. In contrast, in the reimplantation group, the preserved aortic valve showed buckling and asymmetric motion. the opening and closing behavior of the aortic valve preserved by the reimplantation procedure was impaired. In addition, it was speculated that the remodeling procedure may preserve more physiologic aortic root function compared to the reimplantation " procedure. Less