目的:总结先天性主动脉瓣二瓣化畸形外科治疗的临床特点及中、远期随访结果,初步探讨手术适应证、方式及应注意问题.方法:本院2003年2月至2007年12月,对先天性主动脉瓣二瓣化畸形患者施行手术治疗共114例,年龄8～91岁,平均(45.6±18.3)岁;男性89例,女性25例.手术均在气管插管全麻低温(28～32℃)体外循环下进行.主动脉瓣机械瓣替换106例,生物瓣替换4例,主动脉瓣成型3例,ROSS术1例,主动脉根部替换1例.同期行升主动脉替换2例、升主动脉包裹2例、冠状动脉旁路移植术1例.结果:术后早期死亡1例,病死率0.88%,死亡原因为心力衰竭.术后并发症8例,其中二次开胸止血1例,低心排出量综合征6例,呼吸功能衰竭1例,均经住院治疗痊愈出院.随访103例,随访时间20～77个月,平均(31±24)个月,非心脏原因死亡1例,无二次手术,所有存活的患者心功能分均为I或Ⅱ级.结论:主动脉瓣二瓣化畸形患者的临床特点具有多样性,在掌握适应证的条件下应根据患者的不同临床特点选择合适的术式.%Objective :To summarize the clinical characteristics of congenital bicuspid aortic valve and mid-long term results of surgical treatment congenital bicuspid aortic valve. Methods: From February 2003 to December 2007,114 patients underwent surgical treatment. These included 89 men and 25 women, with age ranging from 8-91 years old [ mean, (45. 6±18. 3) years old]. All operations were performed with cardiopulmonary bypass(CPB) with mid-low temperature(28 ℃ -32 ℃ ) , including 106 mechanical aortic valve replacement, 4 bio-aortic valve replacement, 3 aortic valve plasty, 1 Ross procedure and 1 aortic root replacement.The concomitant surgical management included 2 ascending aortic replacement, 2 ascending aortic plasty and 1 coronary artery bypass grafting. Results:1 patient died from heart failure, the mortality is 0. 88％ . 8 cases had complications , including reoperation for excessive postoperative bleeding (2 cases) , respiratory failure (1case)and low cardiac output syndrome (6 cases) . All of the 8 patients were cured. The follow up was 20-77months ( mean (31 ±24) months) in 103 patients. One patient (0. 97％ ) died of non-cardiac event during the follow-up period and no patients received redo-heart valve replacement. The survivals are in good condition with New York heart association (NYHA) classification Ⅰ - Ⅱ . Conclusion :The clinical characteristics of bicuspid aortic valve is variable and the surgical management should adopt flexible strategy for patients.
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