Part Of The Autologous Pulmonary Valve Transplantation Procedure In Surgery For Children Aortic Value Disease

Congenital aortic valve lesions are children of aortic valve stenosis or insufficiency the most common cause. Current surgical treatment mainly includes the aortic valve forming, aortic valve replacement, autologous pulmonary valve of autologous transplantation, etc.Aortic valve forming on the structural abnormalities of the valves surgical correction, improve the hemodynamic abnormal state. Aortic valve forming purpose is to create satisfactory valvular function as far as possible, time delay valve replacement or reduce the possibility of replacement valves. Aortic valve forming methods varied, the different types of valve lesions need to use different forming methods, the operation effect is closely related to the disease types and forming methods. Aortic valve forming avoid anticoagulation after valve replacement. The success rate of aortic valve forming and durability is still not ideal.When the valve forming cannot be successful or is difficult to improve hemodynamic state, is the need for aortic valve replacement. Risk of aortic valve replacement in children compared with adult increased significantly. All types of artificial valve on children has its inherent shortcomings and the insufficiency. Mechanical valve can ensure that use for a long time, but as the children’s physical development will inevitably face again and even multiple replacement valve. Mechanical valve need lifelong anticoagulation, long-term anticoagulation is considerable risks. Biological valve replacement valve does not like children, because early will appear at aortic valvular degeneration was damaged.Autologous pulmonary valve of autologous transplantation, i.e., Ross. Because the autologous pulmonary valve is able to survive, to grow, without anticoagulation, not degeneration excellent features and showed good hemodynamic status, especially suitable for the growth of children. Ross surgery has the embryology, anatomy and biomechanics of basic research support, Ross has major cases and long-term follow-up of clinical validation. Ross surgery is the main problem with pulmonary valve autografts and pulmonary valve replacements’ secondary change at present.This study uses part of the autologous pulmonary artery transplantation with front valve replacement lesions of single aortic valve, and use of autologous pericardial patch forming the pulmonary artery. Surgical design derived from the basic research and clinical application of Ross surgery. Autologous pulmonary valve is able to survive, to grow, without anticoagulation, not degeneration excellent features. Autologous pericardial patch forming the pulmonary artery, the greatest degree of maintain their structural integrity. Operation is relatively simple, better security, recent and median follow-up effect is good.ObjectiveTo study the partial autologous pulmonary artery with front valve for aortic root autograft transplantation in the treatment of children congenital aortic valve of a single valve lesions surgical method and clinical value.MethodsIn September 2010-September 2014, complete animal experiments in vitro pig heart valve model 18 cases.10 cases of aortic valve group:using part of the autologous pulmonary artery with front disc, a single aortic valve replacement for aortic root transplantation.8 cases pulmonary valve group:Taking part the autologous pulmonary artery with front disc, autologous pericardial patch shape after pulmonary artery.In September 2010-September 2014, complete 39 cases of congenital lesions in the aortic valve surgery.15 cases of group A:using the part of autologous pulmonary artery with front valve autograft transplantation replacement lesions of single aortic valve, and autologous pericardial patch forming the pulmonary artery.6 cases of group B:using autologous pulmonary artery valve transplantation lesion of aortic valve replacement, and allograft arteries with disc pipe right ventricular outflow tract reconstruction.18 cases of group C:using autologous pericardium extension forming individual aortic valve lesions, Using other aortic valve forming technology dealing with the other two aortic valve lesions.ResultsAortic valve group of aortic cross valve pressure difference before and after surgery had no significant change (P> 0.05). Pulmonary valve groups across pulmonic valve differential pressure than before surgery had no significant change (P > 0.05). Aortic valve and pulmonary valve function well after the surgery, no more than mild reflux.A, B, C three groups no deaths, no bleeding, myocardial infarction, malignant arrhythmia, infective endocarditis, severe aortic regurgitation and other serious complications. echocardiography showed aortic valve activity, pulmonary valvular function is good, the good are not more than mild stenosis and regurgitation.A, B, C three groups of children were followed up for 1 to 48 months, growth significantly improve, every 3 to 6 months review echocardiography, aortic regurgitation than before surgery was significantly improved, aortic cross valve differential pressure than before surgery was significantly lower than before the operation, left ventricular end-diastolic diameter significantly reduced (P< 0.05). At the same time, the new no significant change in pulmonary valve regurgitation is before the operation, pulmonary valve across valve pressure difference than before surgery had no significant change (P> 0.05).ConclusionPart of the autologous pulmonary artery with front disc to survive, to be able to grow, without anticoagulation, not degeneration, showed good hemodynamic status. Autologous pericardial patch forming the pulmonary artery, and maintain the structural integrity. Simple operation, good safety. Part of the pulmonary artery with front disc for aortic root autograft single valve can be used as a treatment of children congenital aortic valve lesions mode of operation.