摘要
目的：评价行CarboMedics Top Hat Supra-Annular Aortic机械瓣置换后小主动脉瓣环成年患者的心功能变化, 并与20例正常主动脉瓣环常规机械瓣置换患者进行对比，判断是否存在置入瓣膜与患者不匹配现象。
方法：甘肃省心血管病研究所2000-03/2007-02收治的40例患者分为两组观察对象。小瓣环组20例，男7例，女13例，平均年龄(45±15)岁，平均体表面积（1.61±0.12）m2，术前心功能Ⅳ级1例，Ⅲ级12例，Ⅱ级7例。单纯主动脉瓣置换5例，主动脉瓣及二尖瓣置换15例。主动脉瓣均置换CarboMedics Top Hat Supra-Annular Aortic机械瓣，21 mm瓣8枚，23 mm瓣11枚，25 mm瓣1枚。正常瓣环组20例，男9例，女11例，平均年龄(47±8)岁，平均体表面积（1.64±0.13）m2，术前心功能Ⅲ级16例，Ⅱ级4例。单纯主动脉瓣置换3例，主动脉瓣及二尖瓣置换17例。主动脉瓣号及型号：23号瓣17枚、25号瓣3枚，其中 Medtronic-Hall瓣7枚、CL-Ⅲ瓣13枚。置入人工机械瓣前后用彩色多普勒超声仪对左心功能进行评价。
结果：CarboMedics Top Hat Supra-Annular Aortic机械瓣置换后左室射血分数、左室缩短分数明显改善,室间隔厚度/左室后壁厚度、左室腔半径/左室壁厚度、主动脉瓣有效瓣口面积指数及主动脉跨瓣压差接近正常主动脉瓣环常规机械瓣置换患者。
结论：小主动脉瓣环成年患者置换CarboMedics Top Hat Supra-Annular Aortic机械瓣后左心功能指标接近正常主动脉瓣环常规机械瓣置换患者,无置入瓣膜与患者不匹配现象。
关键词：心脏瓣膜，人工；小主动脉瓣环；瓣膜与患者不匹配现象；医学植入体

于涛，谢定雄，董燕. CarboMedics Top Hat Supra-Annular Aortic机械瓣在小主动脉瓣环成年患者中的应用[J].中国组织工程研究与临床康复，2008，12(9):1632-1634 [www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1632(ps).pdf]

CarboMedics Top Hat Supra-Annular Aortic valve replacement for adult patients with small aortic root

Abstract
AMI: To evaluate the changes of left heart function in adult patients with small aortic root after CarboMedics Top Hat Supra-Annular Aortic valve replacement, and compare them with 20 people receiving conventional mechanical prosthetic valve to identify whether there is prosthesis-patient mismatch.
METHODS: From March 2000 to February 2007, 40 patients with heart valve disease were selected from Gansu Institute of Cardiovascular Diseases and divided into 2 groups. Small aortic root group consisted of 20 patients including 7 males and 13 females with an average age of (45±15) years and average surface area of (1.61±0.12) m2. Their heart function was 1 case of grade Ⅳ, 12 of grade Ⅲ, and 7 of grade Ⅱ. Five cases underwent aortic valve replacement alone and the others received mitral valve replacement besides aortic valve replacement. CarboMedics Top Hat Supra-Annular Aortic valve prosthesis were replaced including 8 valves of 21 mm, 11 valves of 23 mm, and 1 valve of 25 mm. Normal valve group consisted of 20 cases including 9 males and 11 females with an average age of (47±8) years and average surface area of (1.64±0.13) m2. Their heart function was 16 cases of grade Ⅲ, and 4 of grade Ⅱ. Of them, 3 cases underwent aortic valve replacement alone and the others received mitral valve replacement besides aortic valve replacement. The aortic valve prosthesis included 17 valves of No. 23, 3 valves of No. 25, 7 valves of Medtronic-Hall, and 13 of CL–Ⅲ. Before and after surgery, the heart function was assessed by Doppler echocardiography.
RESULTS: After CarboMedics Top Hat Supra-Annular Aortic valve prosthesis replacement, left ventricular ejection fraction and fractional shortening were significantly improved, and left ventricular cavity radius/left ventricular posterior wall thickness, effective orifice area index and peak pressure gradients across aortic valve were similar to those in patients receiving conventional mechanical prosthetic valve.
CONCLUSION: Following CarboMedics Top Hat Supra-Annular Aortic valve replacement, the heart functional indexes of adult patients with small aortic root are restored to patients undergoing conventional mechanical prosthetic valve. In addition, no prosthesis-patient mismatch is found.

Yu T, Xie DX, Dong Y.CarboMedics Top Hat Supra-Annular Aortic valve replacement for adult patients with small aortic root. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(9):1632-1634(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-9/9k-1632(ps).pdf]