目的:对于孤立性主动脉瓣反流患者,与单瓣下瓣膜成形术相比,双瓣下和瓣上瓣膜成形术可减少主动脉瓣修复术后主动脉瓣膜返流的复发.这项研究的目的是比较体外模型中单环和双环瓣环成形术的几何和动态特性。
方法:将80公斤猪的18个主动脉根部随机分为对照组,单环,和双环组。实验在脉冲体外模型中进行。流体力学,在环形和窦管水平的径向力测量,并获得2D回波成像。
结果:单环和双环瓣环成形术均使主动脉瓣环和窦管交界处明显缩小,并增加了接合高度。与单环相比,双环瓣环成形术显示出接合高度的额外显着增加(8.5(0.9)mm至9.8(0.8)mm,p<0.01)。单环瓣环成形术减少了两个层面的径向力,而双环瓣环成形术显示出最大的窦管连接处的力降低。
结论:通过治疗整个功能性主动脉瓣环,包括主动脉瓣环和窦管交界处,观察到更大的力减少。单用瓣膜下瓣环成形术可有效减小主动脉瓣环直径并增加接合高度。然而,通过治疗窦管交界处,观察到对接合高度的额外影响,创造更有效的稳定。与天然对照相比,使用双环瓣环成形术的环形力-扩张性比降低表明了持续的稳定作用。
For patients with isolated aortic regurgitation, a double sub- and supravalvular annuloplasty has been shown to reduce recurrent aortic regurgitation after aortic valve repair compared with a single subvalvular annuloplasty. The objective of this study was to compare the geometrical and dynamic properties of single- and double-ring annuloplasties in an in vitro model.
Eighteen aortic roots from 80 kg pigs were randomized into a control, single-ring and double-ring group. Experiments were conducted in a pulsatile in vitro model. Hydrodynamics, radial force measurements at annular and sinotubular level and 2D echographic imaging were obtained.
Both the single- and double-ring annuloplasties downsized the aortic annulus and sinotubular junction (STJ) significantly and increased the coaptation height. The double-ring annuloplasty showed an additional significant increase in coaptation height compared with the single ring [8.5 (0.9)-9.8 (0.8) mm, P < 0.01]. The single-ring annuloplasty reduced radial forces at both levels, whereas the double-ring annuloplasty showed the greatest force reduction of the STJ.
By treating the whole functional aortic annulus, encompassing both the aortic annulus and the STJ, a greater force reduction is observed. A subvalvular annuloplasty alone is efficient in reducing aortic annulus diameter and increasing coaptation height, however, by treating the STJ as well, an additional effect is observed on coaptation height, creating a more efficient stabilization. Reduction of annular force-distensibility ratio with the double-ring annuloplasty compared with the native controls indicates a sustained stabilizing effect.