Aortic root and valve relationships. Impact on surgical repair.
Aortic root and valve relationships. Impact on surgical repair.
复制标题
主动脉根部和瓣膜的关系。
DOI：
10.1016/s0022-5223(94)70465-1
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发表时间：
1994
期刊：
影响因子：
--
通讯作者：
E. Verrier
中科院分区：
文献类型：
--
作者：
K. Kunzelman;K. Grande;T. David;R. Cochran;E. Verrier
最近描述了一种手术方法，用于治疗由瓣环扩张引起的主动脉瓣关闭不全，但主动脉瓣叶正常的患者。扩张的主动脉根部用涤纶移植物替换，自体主动脉瓣重新悬浮在移植物内。使移植物的尺寸和形状与瓣叶尺寸匹配可能对瓣膜闭合和瓣叶应力产生显著影响，从而影响修复的寿命。为了确定天然主动脉根部结构与瓣叶尺寸的关系，我们对正常人主动脉根部（n= 10）和瓣叶进行了形态学检查，并对结果进行了数学分析。我们的数据表明，根具有一致的形状，具有不同的尺寸，根直径和临床可测量的瓣叶尺寸之间存在可定义的数学关系。我们推导出一个方程，该方程允许根据瓣叶高度和周长计算主动脉窦水平处的根部的适当直径。窦管连接处和基底处的移植物直径应遵循标准化根尺寸的关系，可以通过移植物的定制或新的移植物设计。目前的数据表明，移植物应包含窦，以正确关闭瓣膜并与瓣叶分担应力。这些结果的应用将允许人工移植物设计更接近于天然主动脉。这些新移植物应改善瓣膜的生理功能，降低瓣叶应力，并增加修复的耐久性。（《胸心血管外科杂志》1994;107：162-70）
A surgical procedure has recently been described for patients with aortic incompetence caused by annular dilation, but with normal aortic leaflets. The dilated aortic root is replaced with a Dacron graft, and the native aortic valve is resuspended within the graft. Matching the size and shape of the graft to the size of the leaflets may have significant effects on valve closure and leaflet stress and thus on the longevity of the repair. To define the relationship of native aortic root structure to leaflet size, we morphologically examined normal human aortic roots (n= 10) and valve leaflets and applied mathematic analyses to the results. Our data show that the root has a consistent shape with varying size and that there is a definable mathematic relationship between root diameter and clinically measurable leaflet dimensions. We derived an equation that allows calculation of the appropriate diameter of the root at the sinus of Valsalva level from leaflet heights and perimeters. The diameter of the graft at the sinotubular junction and base should follow the relationship of the normalized root dimensions, either by tailoring of the graft or by new graft design. The current data imply that the graft should incorporate sinuses for proper valve closure and for sharing stress with the leaflets. Application of these results will allow prosthetic graft design to more closely resemble the native aorta. These new grafts should improve physiologic function of the valve, reduce leaflet stress, and increase the durability of the repair. (J THORACCARDIOVASCSURG1994;107:162-70)