【摘要】 目的　总结我院自体肺动脉瓣移植术 (Ross手术 )在主动脉瓣病变治疗中的临床经验。方法　从 1994年 10月至 2 0 0 2年 9月 ,共完成Ross手术 15例 ,其中 ,男 12例 ,女 3例 ,年龄 30± 14岁 ;术前诊断 :主动脉瓣病变 13例 ,老年退行性病变 1例 ,为重度主动脉瓣狭窄。亚急性细菌性心内膜炎 (SBE)合并主动脉瓣关闭不全 1例 ,术前UCG示主动脉瓣病变 ,狭窄和 /或关闭不全 (中重度 ) ,主动脉瓣环径 (AVD) :2 4± 0 4cm ;肺动脉瓣发育正常 ,功能良好 ,肺动脉瓣环径 (MPAD) :2 3± 0 2cm ;术前心功能 (纽约心脏协会NYHA)Ⅱ级 11例 ,Ⅲ级 4例 ,平均 :2 3级 ;所有病例均在全麻中度低温体外循环下进行 ,手术分三步进行 :(1)采取自体肺动脉瓣 ;(2 )切除病变的主动脉瓣并移植自体肺动脉瓣于主动脉位 ,采用主动脉根部移植法 ;(3)利用同种动脉瓣重建右室流出道 ;结果全组患者无手术死亡 ;术后主动脉平均跨瓣压差在正常范围 (7 2 3± 0 14mmHg) ,左室舒张未径 (LVDD)明显缩小 (P <0 0 0 1) ,LVEF :0 4 8± 0 2 2 ,心功能Ⅰ～Ⅱ级。所有患者均接受随访 ,随访 1～ 9年 ,心功能Ⅰ级 ,主动脉瓣、肺动脉瓣均功能良好 ,末见瓣膜狭窄或关闭不全。结论　Ross是一种临床疗效好的治疗主动脉瓣病变的手术方法。更多还原

【Abstract】 Objective To summarize the clinical experience of Ross procedure in treatment of aorta valve diseases. Methods The clinical data of 15 patients with aorta valve diseases, 12 men and 3 women, aged 30±14, including 13 cases of congenital aorta valve disease, 1 case of senile degenerative aortic valve disease, and 1 case of subacte bacterial endocarditis complicated by aortic stenosis(AS), with the heart function (NYHA) of class Ⅱ in 11 cases and class Ⅲ in 4 cases, underwent Ross procedure from October 1994 to September 2002 in Anzhen Hospital. Before operation, ultrasound cardiography showed moderate to severe AS and/or aortic insufficiency (AI) with an average aortic valve annulus diameter (AVD) of 2.4±0.4 cm and normal pulmonary valve. Operation was performed on all patients under cardiopulmonary bypass and moderate hypothermia. The operation procedure was as follows: (1) to take off the auto-pulmonary artery valve;(2) to remove the dysfunctional aortic valve and auto-transplant the pulmonary valve on the aortic root; and (3) to put a pulmonary homograft so as to re-establish on the right ventricular outflow tract. Results The perieoperative mortality is 0. After the operation, the mean pressure gradient of aortic valve was in the normal limitation (7.23±0.14 mm Hg), the left ventricular diastolic diameter decreased significantly (P<0.001), the left ventricular ejection fraction was 0.48±0.22, and the heart function (NYHA) was at the classes Ⅰ～Ⅱ in all the patients. All cases received follow-up of 1～9 years, their heart function was all in Class Ⅰ, and the function of their aortic and pulmonary valves remained well. Conclusion Ross procedure is a kind of effective alterative operation in treating patients with aortic valve disease.更多还原