Zusammenfassung
Die Aortoventrikuloplastik (AVP) ist eine etablierte operative Methode zur Erweiterung verschiedener Formen von angeborenen und erworbenen Aortenstenosen besonders der linksventrikulären Ausflußbahnobstruktionen. Zwischen 1974 und März 1992 wurden 96 AVP bei 93 Patienten durchgeführt. Die Frühmortalität betrug 8,3% (8/96). Unter den letzten 55 Patienten war kein Todesfall. 66% (64/96) der Patienten hatten eine diffuse Subaortenstenose (SAS) oder eine Multilevel-Stenose. Der mittlere präoperative Gradient von 88±27 mm Hg (50 bis 160 mm Hg) wurde nach AVP auf 12±12 mm Hg gesenkt. 3 Patienten mußten reoperiert werden: dissezierendes Aortenaneurysma (1), rechtsventrikuläre Ausflußhahneinengung (1), „ausgewachsene” Prothese (1). Die meisten Patienten (68/96) hatten nach AVP einen Sinusrhythmus; bei 3 Patienten mußte wegen eines permanenten atrioventrikulären Blocks ein permanenter transvenöser Schrittmacher implantiert werden.
Die Vor- und Nachteile anderer alternativer Operationsmethoden werden diskutiert und mitder AVP verglichen.
Summary
The aortoventriculoplasty (AVP) is an established operative procedure for enlargement of different types of congenital and aquired aortic stenosis especially left ventricular outflow tract obstructions. Between 1974 and March 1992, 93 patients underwent 96 AVPs. The early mortality was 8.3% (8/96). There was no death out of the last 55 patients. 66% (64/96) of the patients had a type subaortic stenosis (SAS) or a multilevel stenosis. The mean preoperative gradient of 88±27 mm Hg (50 to 160 mm Hg) was reduced by AVP to 12±12 mm Hg. 3 patients underwent subsequent operations: aortic aneurysm dissecans (1), right ventricular outflow tract obstruction (1), out-grown prosthesis (1). Most of the patients (68/96) had sinoidal rhythm after AVP; 3 required pacemakers for a permanent atrioventricular block.
The advantages and disadvantages of other surgical methods are discussed and compared with those of AVP.
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Literatur
Bernhard WF, Poirier V, La Farge CG: Relief of congenital obstruction to left ventricular outflow with a ventricular aortic prosthesis. J Thorac Cardiovasc Surg 1975;69:223.
Bigelow WG, Trimble AS, Auger P, Marquis J, Wigle ED: The ventriculomyotomy operation for muscular subaortic stenosis. J Thorac Cardiovasc Surg 1966;52:514.
Bigelow WG, Trimble AS, Wigle ED, Adelmann AG, Felderhof CH: The treatment of muscular subaortic stenosis. J Thorac Cardiovasc Surg 1974:68:384.
Clarke DR: Extended Aortic Root Replacement With Cryopreserved Allograft: Do They Hold Up. Ann Thorac Surg 1991;52:669–675.
Cooley DA, Norman JC: Apical left ventricular-abdominal aortic composite conduits for left ventricular outflow obstructions. Cardiovasc Dis Bull Tex Heart 1975;5:112.
Gerosa G, McKay R, Davies J, Ross DN: Comparison of the aortic homograft and the pulmonary autograft for aortic valve or root replacement in children. J Thorac Cardiovasc Surg 1991;102:51–61.
Kono S, Imai Y, Iida Y, Nakajima M Tetsuno KA: New method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia for the aortic valve ring. J Thorac Cardiovasc Surg 1975;70:909.
Manouguian S, Seybold-Epting W: Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. J Thorac Cardiovasc Surg 1979;78:402.
Matsuki O, Robles A, Gibbs S, Bodnar E, Roos DN: Longterm performance of 555 aortic homografts in the aortic position. Ann Thorac Surg 1988;46:187–191.
Morrow AG, Brockenbrough EC: Surgical treatment of idiopathic hypertrophic subaortic stenosis: technique and hemodynamic results of subaortic ventriculomyotomy. Ann Surg 1961;154:181.
Morrow AG, Fogarty TJ, Hamah H, Braunwald E: Operative treatment in idiopathic hypertrophic subaortic stenosis: techniques and the results of preoperative and postoperative clinical and hemodynamic assessments. Circulation 1968;37:589.
Nicks R, Cartmill T, Bernstein L: Hypoplasia of the aortic root. Thorax 1970;25:339.
Rastan H, Koncz J: Aorto-ventriculoplasty, a new technique for the treatment of left ventricular outflow tract obstructions. J Thorac Cardiovasc Surg 1976;71: 920.
Ross D, Somerville J: Total aortic valve and root replacement with aortic homograft and reimplantation of the coronary arteries for diffuse left ventricular outflow tract obstructions. First World Congress of Pediatric Cardiology, London, 1980 (abstr 313).
Ross D, Jackson M, Davies J: The pulmonary autograft—a permanent aortic valve. Eur J Cardiothorac Surg 1992;6:113–117.
Somerville J, Ross D: Homograft replacement of aortic root with reimplantation of coronary arteries. Br Heart J 1982;47:473.
Vivie de ER, Hellberg K, Heisig B, Rupprath G, Vogt J, Beuren AJ: Surgical Treatment of Various Types of Left Ventricular Outflow Tract Stenosis by Aorto-ventriculoplasty—Clinical Results. Thorac Cardiovasc Surgeon 1981;29:265.
Vivie de ER, Koncz J, Vogt J, Ruschewski W, Rupprath G, Beuren AJ: Ten Years Experience with Aortoventriculoplasty—Long-term Results of 75 Operations, in Doyle, Engle, Gersony, Rashkind, Talner (eds): Pediatric Cardiology. Berlin-Heidelberg-New York-Tokyo. Springer 1986, pp 1311–1314.
Vivie de ER, Rastan H, Vogt J, Rupprath G, Koncz J: Aortoventriculoplasty in Small Aortic Annulus, in Dunn JM (ed). Cardiac Disease in Children. Amsterdam, Elsevier, 1988.
Vogt J, Vivie de ER, Rupprath G, Beuren AJ: Hemodynamic Findings before and after aorto-ventriculoplasty (AVP): Thorac Cardiovasc Surgeon 1981;29:381.
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de Vivie, E.R., Borowski, A. Die Aortoventrikuloplastik (AVP): ein etabliertes Verfahren zur Erweiterung von komplexen Formen der linksventrikulären Ausflußbahnstenosen. Acta Chir Austriaca 25, 96–100 (1993). https://doi.org/10.1007/BF02602136
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DOI: https://doi.org/10.1007/BF02602136
Schlüsselwörter
- Aortoventrikuloplastik
- linksventrikuläre Ausflußbahnstenose
- Aortenwurzel-Homograft-Ersatz
- dorsale Anuloplastik