The Treatment Strategies Of Small Aortic Annulus Aortic Valve Replacement

Objective To explore the patients of small aortic annulus (SSA), those who have the aortic valve replacement after the aortic annular enlargement.so as to research it’s application and operation effect.Methods From 2006 April --2014 December,we use different ways to operation on 15 cases of small aortic annulus patients(The annulus diameter:14.0～19.8mm)by doing the aortic valve replacement and aortic annulus enlargement operation.including 13 Nicks operation,1 Manouguian operation, IKonno operation.Results There was no operative and hospitalization death occurred in all of the 15 cases with small aortic root through the aortic annulus enlargement+ artificial aortic valve replacement surgery, early postoperative frequent ventricular premature beats in 3 patients (1 patients underwent Manouguian surgery,2 patients underwent Nicks surgery), pulmonary infection and respiratory insufficiency in 1 cases, treatment recovery. After 2 weeks, the heart color Doppler ultrasoundshows across the aortic valve peak velocity and cross valve average pressure difference decreased obviously, effective orifice area index significantly increased after 6 month review of Doppler echocardiography left ventricular mass index, thickness of interventricular septum and left ventricular posterior wall thickness were obviously decreased. The indexes of hemodynamics and left ventricular remodeling parameters were significantly improved. Compared with preoperative P< 0.05; 1mmHg=0.133 kPa. Postoperative follow up 6-60 months,there was no late death5no anticoagulation related complications,no mid-term and long term operative death,no infective endocarditis and other complications occurred.Conclusion With the development the biological engineering technology, cardiac surgical operation technology, CPB anesthesia, operation device design technology. The safety of aortic annular enlargement operation is improved. The aortic annular enlargement operation provides patients with SSA operation with large enough type artificial valve’s opportunity, witch greatly avoided the risk of "prosthesis patient mismatch (prosthesis-patient mismatch, PPM)". After the operation,patients could get a good hemodynamic effects.The classical Nicks operation has been improved in recent years.This method is relatively simple and safe,And few complications,can also be combined with other types of special design of valve implantation.It is preferred in the choice of aortic annulus enlargement molding operation.