The evaluation in the valve sparing aortic root reconstruetion, with the cardio vascnlar endoscopy

1.窦管结（STJ）与主动脉反流（AR）的关系(1)实验方法用Tyrode’s溶液经主动脉根部和左心房灌注制备跳动心脏模型。在STJ水平的每个连接和每个Valsalva窦处放置6条缝合线。通过向外收缩缝合线，模拟主动脉根部扩张。在改变收缩部位的同时，在内窥镜下记录瓣膜闭合的直接图像。此外，缝线的应变随重力的变化而变化。(2)结果随着缝线应变的增加，无论是全部缝线还是合拢，主动脉瓣开口都被放大。在仅绘制三个Valsalva鼻窦的情况下，主动脉瓣的适应保持不间断。本研究证实了STJ扩张引起ar。(1)实验方法取心脏跳动模型，方法与1-(1)相同。采用心脏内窥镜和高速视频（200帧/秒）对主动脉瓣在正常情况下（1组）和主动脉根部重构手术（2组）的行为模式进行了研究。组2记录最大主动脉压时主动脉瓣的最大开度。结论：主动脉根重建术是一种有价值的保留主动脉瓣功能的技术。临床实验至今，7例主动脉根重建保留了原有瓣膜。其中6例采用内窥镜对主动脉瓣进行评估。心脏内窥镜检查对瓣膜功能不全的病因、手术方法的选择和成形术效果的评估是有用的技术。

1.The relationship of the sinotubular junction (STJ) with aortic regurgitaion (AR)(1) Experimental methodUsing mongrel dogs, the beating heart models were made with perfusion through the aortic root and left atrium with the Tyrode's solution. A six sutures were placed in each commissure and each sinus of Valsalva at the level of STJ.By restracting the sutures outwaeds, delatation of aortic root was simulated. While changing retraction sites, direct images of valve coaptation were recorded with endoscope. Additionally, the strain of the sutures were changed by the gravity.(2) ResultWith the increase on the strain of the sutures, the opening of the aortic valve was exaggerated when either all sutures or the commissures was retracted. In cases of the drawing only three sinuses of Valsalva, the coaptation of the aortic valve was kept uninterrupted. This study validated that the dilatation of STJ cause AR.2.The behavior of the aortic valve under remodeling procedure(1) Experimental methodThe beating heart model was made with same method as 1-(1). Using the cardeac endoscopy and high speed video (200frames/second), the behavior of the aortic valve was investigated under noumal condition (Group 1) and the aortic root reconstruction with remodeling procedure (Group 2)Experimental resultThe pattern of the behavior of the aortic valve was almost equal between Group 1 and 2. With Group 2, the maximum opening of the aortic valve was recorded at the time of maximum aortic pressure. It was concluded that the aortic root reconstruction with remodeling procedure was valuable technique in preserving the aortic valve function.3.Clinical experimentsTo date, seven aortic root reconstructions preserving native valve were perfoumad. In six cases, the evaluation of aortic valve was performaed with endoscopy. Cardiec endoscopy was useful technique in evaluation of the etiology of the valeve imcopetence, selection of the procedure and the result of the plasty.