Konno法和改良Manougnian法行主动脉瓣置换术的临床结果

摘要

目的 观察Konno法和改良Manougnian法行主动脉瓣置换术的中期效果.方法 2001年7月～2009年11月对30例小主动脉瓣环青少年患者施行瓣环扩大的主动脉瓣置换术,其中Konno法12例(Konno组),改良Manougnian法18例(Manougnian组),比较术前和出院时、术后3年时超声心动图指标.结果 术后住院死亡1例,随访29例,随访率100％,术后左心室厚度、左心室重量指数均较术前明显改善,术后平均随访3年,心功能恢复程度无明显差别.但动态EOAI差异显著,Konno法较改良Manougnian法有较低的迟发性人工瓣膜不匹配现象发生；两组方法术后中期生存率无差异；术后3年左心室重量指数、左心室厚度、跨瓣压差有显著差异,Konno法较改良Manougnian心律失常发生率高.结论 两种扩大瓣环方式行主动脉瓣置换术在青少年患者中均能达到满意的短期效果和中期生存率,动态EOAI提示Konno法较改良Manougnian法更能减少人工瓣膜不匹配现象.%Objective To evaluate intermediate - term results of Konno and modified Manougnian methods on adolescent patients who underwent enlargement of aortic annulus for aortic valve replacement. Methods From July 2001 to Sep 2009, 30 patients underwent enlargement of aortic annulus to replace the large aortic valve prosthesis by using Konno operation and modified Manougnian operation. The dynamic change of EOAI and other relative indexes were reviewed by echocardiography( UCG) during follow - up. Results One patient had inpalient death in Manougnian group, and 29 cases received mean 3 years follow - up. No significant difference was found between two groups for heart function at discharge. There was significant difference in dynamic change of EOAI between two groups after 3years follow - up. Regression of left ventricular wall thickness, left ventricular mass index were improved after operation,but left ventricular wall thickness, left ventricular mass index,peak aortic gradient, mean aortic gradient had significant difference after 3 years follow -up. There was no difference for clinical symptom and heart function during 3 years follow - up in different groups. Konno group had lower incidence rate of delayed prosthesis - patient mismatch and higher arrhythmia than Manougnian group. Conclusion Both Konno operation and modified Manougnian operation can get satisfactory improvement for short - term survival in adolescent patients with small aortic annulus. In view of the dynamic change of EOAI, Konno operation can provide more enlargement of aortic annulus than modified Manougnian operation in replacement of the bigger prosthetic aortic valves and avoiding delayed prosthesis - patient mismatch during 3 years follow -up.