Midterm results of aortic root enlargement with AVR in patients with narrow aortic root and AS

협소 대동맥 판륜을 가진 환자에서의 대동맥치환술시 판륜 확장술의 중기 성적

  • 박광훈 (인제대학교 의과대학 부산 백병원 흉부외과학 교실) ;
  • 김하늘루 (인제대학교 부산백병원 흉부외과 교실) ;
  • 최강주 (인제대학교 부산백병원 흉부외과 교실) ;
  • 이양행 (인제대학교 부산백병원 흉부외과 교실) ;
  • 황윤호 (인제대학교 부산백병원 흉부외과 교실) ;
  • 조광현 (인제대학교 부산백병원 흉부외과 교실)
  • Published : 2000.04.01

Abstract

Background: For AVR using conventional prosthetic valves in adult patients with a narrow aortic root, aortic root enlargement is necessary to reduce postoperative pressure gradient across the aortic valve (ΔP). An evaluation of early and mid-term results of aortic root enlargement with AVR and echocardiographic follow up of ΔP and left ventricular function was performed. Method: From Aug. 1991 to Feb. 1998, eighteen patients aged 17 to 59 years(mean, 38$\pm$12 years) underwent Manouguian procedure with AVR. Aortic annular circumstance was enlarged 10.0mm to 18.0mm(mean, 12.6$\pm$6.3mm). Eight patients(44.0%) had NYHA class III status before operation, and seven cases of them underwent concomitant MVR. Valve pathology was ASr in 6 cases, AS in 4 cases, nd ASr+MSr in 8 cases. Replaced valve size was 21mm in 8 cases and 23 mm in 10 cases, and St. Jude Medical mechanical valve was used in 10 cases and Carbomedics in 8 cases. Result: Follow-up duration was 6 to 57 months (mean, 26$\pm$18 months), and total follow-up was 287 patient-year. There were one hospital death and one late death, therefore, actuarial survival rate was 85.7% at 56 months. Peak ΔP wad decreased significantly at postoperative mid-term period as 13$\pm$5mmHg, compared with thepreoperative one (42$\pm$8mmHg) (p<0.01). LVM(gm/$m^2$) was also diminished as 35.8%(115$\pm$36gm/$m^2$)at postoperative mid-term period, compared with preoperative one (179$\pm$56gm/$m^2$)(p<0.05). Conclusion: There were no specific complications related to the procedure. And we could have adequate enlargement of aortic annulus to suitable prosthetic valve that have no effect of patient-prosthese mismatch.

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