BACKGROUND:It is so difficult to have aortic valve replacement with smal aortic annulus. Improper treatment may lead to patients with valvular mismatch phenomenon, and thus make left ventricular outflow tract obstruction, increase transvalvular pressures, cause cardiac hypertrophy secondary to increased left ventricular afterload and even congestive heart failure. OBJECTIVE:To summarize the treatment strategy for preventing valvular mismatch phenomenon caused by smal aortic annulus after aortic valve replacement. METHODS:Eighty-five patients with smal aortic annulus underwent aortic valve replacement surgery. 19 mm SJM Regent valve was applied to the patients with orifice diameter>17 ≤ 19 mm;to the adult patients with orifice diameter ≤ 17 mm, we performed bovine pericardial patch enlargement of the smal aortic annulus and valve replacement using 19 mm SJM Regent valve. For those with orifice diameter>19 ≤ 21 mm, we selected 21 mm Hancock II ultra biological valve for valve replacement. Effective orifice area index, left ventricular mass index, inter-ventricular septal thickness, left ventricular wal thickness, trans-valvular peak velocity, the pressure difference across the valve and trans-valvular mean pressure were measured through echocardiography. After discharge, patients were fol owed up in out-patient clinic and evaluated regularly by echocardiography. RESULTS AND CONCLUSION:There were no early deaths after operation and al cases were cured and discharged. Fol ow-up time was between 6 months and 3 years. The main complications included low cardiac output syndrome in two cases, reoperation due to bleeding in one case, and ventilator dependence in two cases. No cases occurred in cerebral complications such as cerebral hemorrhage or cerebral thrombosis, and no valvular dysfunction or card flap appeared. There was no bovine pericardium tearing, thrombosis, calcification, tumor-like bulge, infection or immune reactions. A total of 81 cases were fol owed up and the fol ow-up rate was 95%(81/85). There were NYHA class grade I in 65 cases, and grade II in 16 cases. Peak velocity across the aortic valve and the mean pressure were significantly decreased, effective orifice area index increased significantly, left ventricular mass index, left ventricular wal thickness and the thickness of the inter-ventricular septum were significantly reduced compared with pre-operation, and no valvular mismatch phenomenon occurred. Compared 21 mm Hancock II ultra biological valve with 21 mm SJM Regent group, the former got a better peak velocity and mean trans-valvular pressure, and better left ventricular remodeling index. Body weight and body surface area were significantly increased in 19 mm Regent valve group after operation. The results suggest that individualized treatment strategies should be taken to prevent the occurrence of postoperative valvular mismatch phenomenon for patients with smal aortic annulus.%背景：小主动脉瓣环主动脉瓣置换是心外科手术的难点，治疗不当可能出现瓣膜与患者不匹配现象，使左室流出道狭窄、跨瓣压差增大，引起左室后负荷增加致心肌肥厚甚至充血性心力衰竭。 目的：总结预防小主动脉瓣环瓣膜置换后发生人工心脏瓣膜与患者不匹配的治疗策略。 方法：小主动脉瓣环均主动脉瓣置换患者85例。瓣口直径>17 mm，≤19 mm的患者，选19 mm SJM Regent瓣；对瓣口直径≤17 mm的患者，用牛心包补片加宽瓣环，再选19 mm SJM Regent 瓣行瓣膜置换；对于瓣口直径>19 mm，≤21 mm，选21 mm Hancock II ultra生物瓣置换。治疗后应用超声心动图测量有效瓣口面积指数、左心室重量指数、室间隔厚度、左心室后壁厚度、跨瓣峰速、跨瓣压差和跨瓣平均压。出院后通过门诊对患者进行随访，定期复查超声心动图。 结果与结论：治疗后早期无死亡病例，均治愈出院。随访时间为6个月-3年。主要并发症为低心排综合征2例、二次开胸止血1例、呼吸机依赖2例。所以患者均未出现脑栓塞或脑出血等脑部并发症。无瓣膜功能失调或卡瓣。未发现牛心包补片撕裂、瘤样膨出、钙化、血栓形成、免疫反应和感染等情况。81例获随访，随访率为95%(81/85)。NYHA心功能分级Ⅰ级65例，Ⅱ级16例。各不同瓣环直径患者治疗后跨主动脉瓣峰速和平均压差均明显降低，有效瓣口面积指数明显增加，左心室重量指数、室间隔厚度和左心室后壁厚度均明显降低，均未出现人工心脏瓣膜与患者不匹配。置换21 mm Hancock II ultra 生物瓣和21 mm SJM Regent 瓣组间的比较，前者获得了更好的跨瓣峰速和平均压差，以及更好的左心室重塑指标。19 mm Regent 瓣患者治疗后体质量和体表面积较治疗前明显增加。结果提示对于小主动脉瓣环的患者应采取个体化的治疗策略预防主动脉瓣置换后瓣膜与患者不匹配的发生。
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