小主动脉根部的主动脉瓣置换临床经验（英文）

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1、小主动脉根部的主动脉瓣置换临床经验Weng,Yuguo,MD,PhD,RolandHetzer,MD,PhDDeutschesHerzzentrumBerlinClinicalExperience（毫米必争）SelectionoftheProsthesis(ext.2mm)SurgicalTechniqueImplantation(ext.1mm)ExtendedAortoplasty(ext.2mm)Konno-RastanAortoventriculoplasty(ext.4mm)ApexLeftVentricletodes.AortaConduitTransc

2、atheterAorticValveReplacementSelectionofProsthesisVALVESIZEvsHEARTVALVEDIAMETERSNominalValvesizeprovidesanindicationeitheroftheValve’sTissueAnnulusDiameter(TAD)orInternalOrificeDiameter(IOD)Orificetotissueannulusratio(GeometricOrificeArea/MountingArea)Intra-annularPartiallySupra-annula

3、rTotallySupra-annularSewingringthicknessHousingthicknessHousingthicknessNoobstruction60-65%80-85%100%NativeAorticOrificeAreaSelectionofProsthesisReducedPressureGradientCarbomedicsTopHat:newsizersOuterDiameterInternalDiameterImplantationTechniqueintra-annularvs.supra-annularTotallysupra

4、-annularvalve:100%orifice-to-annulusratio.SelectionofProsthesisReducedPressureGradientSelectionofProsthesisHelpfulforDoubleValveSurgeryExtendedAortoplasty(ext.2mm)ValveReplacementinSmallAorticRootManougianandSeybild-Epting·JThoracCardiovascSurg1979;78:402-12TypesofAorticStenosisValvula

5、rSubvalvular(muscular,fibrotic,mixed)SupravalvularSubvalvularIdiopathicAccessorymitraltissueShonecomplex(aortic+mitralstenosis+coarctation)#3WireMovedToFromCenterToSide,CreatingCentralOpeningforLVOTVisibilityCarbomedicsTopHat:newsizersSubvalvular(muscular,fibrotic,mixed)Subvalvular(m

6、uscular,fibrotic,mixed)Subvalvular(muscular,fibrotic,mixed)SubvalvularMembranousAorticStenosisAngiographySubvalvularLeftVentricularOutflowObstructioninAVSD1993–IAVSDcorrection1996–resectionofLVOTobstruction2005–reoperationforLVOTobstructionPreOPPostOPSupravalvularAorticStenosisWilliam

7、s-BeurenSyndromeReducedintelligenceMuscularandsceletalanomaliesDentalmalocclusionElfinfaciesInfantilehypercalcinemiain5%ofptsInvolementofpulmonary,renalarteriesandaorticarchbranchesWilliamsetal.Circulation1961;24:1311-18·BeurenetalCirculation,1962;26:1235-40SupravalvularAorticSteno