张金萍，江勇，吴伟春，王建德，徐楠，李建蓉，王浩



主动脉瓣机械瓣置换术后远期升主动脉内径变化随访研究

张金萍，江勇，吴伟春，王建德，徐楠，李建蓉，王浩

摘要

关键词心脏瓣膜假体植入； 超声心动描记术；随访研究

作者单位：100037 北京市，中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 超声影像中心

Long-term Follow-up Study of Ascending Aortic Diameter Changes in Patients After Mechanical Aortic Valve Replacement

ZHANG Jin-ping,JIANG Yong,WU Wei-chun,WANG Jian-de,XU Nan,LI Jian-rong,WANG Hao.
Department of Echocardiography,Cardiovascular Institute and Fu Wai Hospital,CAMS and PUMC,Beijing(100037),China
Corresponding Author:WANG Hao,Email:fwwangh@163.com

Abstract

Objective:To retrospectively analyze the ascending aortic diameter(AAD)changes in patients after mechanical aortic valve replacement(AVR).

Methods:The medical records and echocardiography reports in patients who received AVR or bivalve valve replacement(BVR)in our hospital from 2000-01 to 2001-12 were retrieved,the retrieval conditions were as aortic valve structure must be mechanical and the follow-up echocardiography examination should be more than 9 years.The clinical information,pre- and post-operative 2-dimentional transthoracic echocardiography reports were collected,the follow-up echocardiography periods were ≤3-year,3-year<-≤6-year,6-year<-≤9-year and >9-year.AAD changes at different periods were compared.According to baseline AAD,the patients were divided into AAD<35 mm group and AAD≥35 mm group in order to observe the ascending aortic events.

Results:A total of 141 patients were enrolled form 595 echocardiography reports which included 75 male,the patients were at the mean age of(45.5 ± 11.2)years with mean follow-up time of(7.59 ± 3.38)years.Compared with baseline level,the follow-up AAD was similar between ≤3-year and 3-year<-≤6-year patients,P>0.05;while the follow-up AAD was different between 6-year<-≤9-year and >9-year patients,P<0.05.The patients with second operation in AAD≥35 mm group were much higher than those in AAD<35 mm group(24.0% vs 12.9%).There were 5(20%)patients suffered from ascending aortic eventsin AAD≥35 mm group.

Conclusion:AAD dilatation were gradually occurring after mechanical AVR,the patients with AAD≥35 mm had the higher risk for ascending aortic events,therefore special attention should be taken in patients with aortic valve disease combining AAD dilatation during surgical treatment.

Key words Heart valve prosthesis implantation;Echocardiography;Follow-up study

(Chinese Circulation Journal,2016,31:267.)

主动脉瓣膜病变常常伴发升主动脉内径的改变，无论是主动脉狭窄导致的血流动力学异常，还是主动脉瓣关闭不全引起的左心室心搏量增加，都或多或少增加升主动脉管壁的压力或剪切力，进而影响升主动脉内径，甚至伴发升主动脉瘤或主动脉夹层形成。由于主动脉瓣三叶形态和结构的特殊性，其成形的效果很差，往往行主动脉瓣置换术（AVR）来改善因瓣膜疾患引起的血流动力学异常。目前，AVR后升主动脉内径进程情况尚不确定，而国内外相关方面的研究颇少，外科医师在临床决策中无据可循。在对国外文献的检索中，相关研究因其观察年限的不同，关于AVR后升主动脉内径变化趋势也颇有争议[1-5]。本研究回顾性分析了我院2000-01至2001-12手术病历及术后长期超声心动图随访资料，观察AVR后升主动脉内径的变化情况，为主动脉瓣膜疾患的手术术式选择提供参考。

1　资料与方法

研究对象：检索我院2000-01至2001-12行AVR或主动脉瓣联合二尖瓣置换术（BVR）病历（包含同期行三尖瓣成形术、冠状动脉球囊扩张支架植入术或冠状动脉搭桥术患者）。排除条件：（1）先天性二叶、四叶或瓣下/上隔膜，弓缩窄等先天性畸形；……