| Bentall operation is the classical method for the treatment of aorta root aneurysm,and it provide a wide space for the treatment of aorta aneurysm or dissection with aortic insufficiency. But the surgical operation replaced the aortic valve,it changed original physiological construction and blood dynamics, and exist its defects---mechanical valve need anticoagulate and biovalve exist the problem of endurance,and both can cause embolism , haemorrhage and endocarditis,so it make us to study the valve-sparing aortic root replacement. Now there are two kinds of valve-sparing aortic root replacement---remodeling of yacoub and replantation of David. In recent years,there are controversy on which kind of operation to take and the long-term effect of these operations. What the surgeon focus on are how to choose reasonab1e operation and how to choose correct diameter of artificial Dacron graft to get the best results.But there are not enough basic evidence, this make study incline to the aorta root finite-element model analysis,in order to get the most nearing to the normal circumstance and guide clinics.In this article ,part I ,we analyzed seventy-five patients underwent Bentall operation in Beijing Anzhen Hospital from Mar.,1998 to Jan.2004 ,to study the indication ,methods and operative technique of Bentall operation.PartII ,with the aids of MRI and finite-element model analysis soft- ware,to construct finite-element model of the aortic root. Part I :Object :To study the indication ,methods and operative technique of Bentall operation.Methods:Seventy-five patients(62 male and 13 famale)with a mean age of 40.6 years (23~68years) underwent Bentall operation.Aortic root aneurysm 53cases,aortic dissection 41cases, DeBakery I 24cases . DeBakery II15cases, DeBakeryIII 2cases.All patients have different grade of aortic insufficiency, which include mitral valve insufficiency 5 cases ,Marfan syndrome 48cases, coronary artery diseases 4cases, rheumatic heart diseasel cases,PDA l cases, rapture of aortic sinus 1 cases and congenital heart disease lcases.The mean diameter of aneurysm is 6.7±1.4cm(4.4～11.0cm). All the patients were diagnosed by UCG, CT and MRI. In dissecting aortic aneurysm or aortic aneurysm involving aortic arch ,the patients were operated with femoral arterial cannulation. Results:The mean duration of arotic cross-clamping was 129± 35.5minutes (43～230 minutes),and the mean duration of cardiopulmonarybypass was 178±50.7 minutes (70~300 minutes).There were three deaths inhospital,the hospital mortality rate was 4.0%.Postoperative complications include bleeding requiring rethoracotomy 7 cases, arrhythmia 5cases, pericardial effusion 2 cases, thoracic effusion 2 cases, haemolytic anaemia 1 cases,infective endocarditis 1 cases.After operation ,there was 1 patient got acute myocardial infarction, there was 1 patient had low-grade perivalve leakage.2 patients got rhinal hemorrhage , maybe related to improper use of anticoagulant.The mean amount of blood transfusion was 663.3±415.6ml (0～2000ml). Three patients were free from blood transfusion.50 cases with UCG show preoperation and postoperation the diameter of the end phase of left ventricular dilation were 71.4±11.1mm (50～ll2mm) and 58.9±10. 7mm(41.1～90. lmm),there are remarkably statistical discrepancy between them. Part II: Object: To Initial reconstruct finite-element model of the aortic root. Methods:Hearts of pigs with ascending aorta which be made of left ventricle obturator, from MRI ,we can get the diameter of aortic root and aortic wall under different pressure(0～120mmHg). We put this data into computer to reconstruct finite-element model of the aortic root.Results:According to the data we got from MRI ,we can use computer to construct the finite-element model of the aortic root. Conclusion: 1, We analyzed seventy-five patients underwent Bentall operation in Beijing Anzhen Hospital from Mar.,1998 to Jan.2004,we found Bentall operation is a satisfied operation, 2, The suitable oper... |
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