| 主动脉瓣二瓣化畸形合并升主动脉扩张的外科治疗 |
| Alternative Title | The Surgical Management of Bicuspid Aortic Valve with the dilated Ascending Aorta
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| 朱开蒙 |
| Subtype | 硕士
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| Thesis Advisor | 宋兵
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| 2019-02-01
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| Degree Grantor | 兰州大学
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| Place of Conferral | 兰州
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| Degree Name | 硕士
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| Degree Discipline | 外科学
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| Keyword | 主动脉瓣二瓣化畸形
主动脉置换术
主动脉瘤
主动脉
生存
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| Abstract | 目的 主动脉瓣二瓣化畸形（BAV）是最常见的先天性心脏瓣膜异常，常伴有钙化性主动脉瓣疾病、胸主动脉瘤以及主动脉夹层，其中相关主动脉瓣疾病往往需要行主动脉瓣置换术（AVR）。对于心脏协会指南推荐的适合行主动脉修复或切除的主动脉尺寸数值，能够支持这一推荐的证据目前很少。因此我们试图确定当主动脉瓣二瓣化畸形的患者行主动脉瓣置换术时，同期修复扩张的主动脉或主动脉瘤是否能够显著改善患者术后的发病率和死亡率。方法 收集并选取2010年1月至2017年12月期间兰州大学第一医院首次接受主动脉瓣手术治疗成人主动脉瓣二瓣化畸形患者36例，其中男性30例，女性6例，按照手术方式的不同分为单纯行主动脉瓣置换术（AVR）组和主动脉瓣置换和升主动脉修复（AVR-AR）组。通过观察和随访收集并比较两组患者术前和术后的心脏彩超等相关检查、患者身体一般情况以及术后随访再次手术发生率或死亡率。结果 通过对比两组患者的病人相关体征特征、主动脉瓣膜功能和主动脉的直径大小，我们发现了一些临床上存在的重要的差异。然而相关事件的发生率很低，1年内再次手术和（或）死亡率两组均为0,5年内再次手术和（或）死亡率分别为0.1％（2例）和0.125％（2例），并且在随访期间并未发现主动脉夹层。所以单纯主动脉瓣置换组和主动脉瓣置换瓣主动脉修复组之间的再次手术和（或）死亡率结果上未出现明显的差异。两组之间对比之下术后结果的好转或恶化与患者年龄、主动脉直径或两者数据的组合均无明显的相关关系。结论 我们推断单纯行主动脉置换组和主动脉置换同期主动脉修复组的手术治疗都具有较低的再次手术发生率和死亡率，并且对于较大范围内年龄范围和主动脉直径大小都是适用的。同时我们研究观察的结果暂时不能为目前指南中主动脉直径大小为45 mm阈值时行主动脉瓣置换术的推荐甚或是其他特定的主动脉直径大小提供支持。 |
| Other Abstract | OBJECTIVES Bicuspid aortic valve (BAV) is the most common congenital valvular abnormality and frequently presents with accelerated calcific aortic valve disease, requiring aortic valve replacement (AVR) and thoracic aortic aneurysm and dissection. Supporting evidence for Association Guidelines of aortic dimensions for aortic resection is sparse. We sought to determine whether concurrent repair of dilated or aneurysmal aortic disease during AVR in patients with BAV substantially improves morbidity and mortality outcomes.METHODS Collect and choose between January 2010 and December 2010, for the first time, the first hospital of Lanzhou University during aortic surgery treatment of adult patients with aortic valve disc 2, deformity 36 cases, 30 cases of men, women and 6 cases in accordance with the operation method of divided into pure lines of aortic valve replacement (AVR) group and aortic valve replacement and repair the ascending aorta (AVR - AR) group.After observation and follow-up, the patients were collected and compared the preoperative and postoperative cardiac color ultrasound examination, the general condition of the patient and the postoperative follow-up rate or mortality.RESULTS Clinically important differences in patient characteristics, aortic valve function and aortic dimensions were identified between cohorts. Event rates were low, with rates of reoperation and death within 1 year of only 1.8% and 5.4%, respectively, and no aortic dissection observed during follow-up. There were no significant differences in reoperation or mortality outcomes between the AVR-only and AVR-AR cohorts. Age, aortic dimension or a combination thereof was not associated with better or worse outcomes after each AVR-AR compared with AVR.CONCLUSIONS We conclude AVR-only and AVR-AR surgery have low morbidity and mortality and have utility over a wide range of age and aortic sizes. Our results do not provide support for the 45-mm aortic dimension recommended in the current guidelines for aortic resection while performing AVR or any other specific dimension. |
| Pages | 41
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| URL | 查看原文
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| Language | 中文
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| Document Type | 学位论文
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| Identifier | https://ir.lzu.edu.cn/handle/262010/338785
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| Collection | 第一临床医学院
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| Affiliation | 第一临床医学院
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| First Author Affilication | First Clinical School
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Recommended Citation
GB/T 7714 |
朱开蒙. 主动脉瓣二瓣化畸形合并升主动脉扩张的外科治疗[D]. 兰州. 兰州大学,2019.
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