表现为单纯主动脉瓣关闭不全的主动脉夹层的外科治疗

Surgical Treatment for Aortic Dissection Manifesting as Pure Aortic Regurgitation

目的探讨表现为单纯主动脉瓣关闭不全的主动脉夹层的临床特点及外科治疗方法，避免术前误诊，为临床诊治提供参考。方法回顾性分析2005年1月至2012年5月北京阜外心血管病医院5例术前诊断为主动脉瓣关闭不全的主动脉夹层患者的临床资料，其中男4例，女1例；中位年龄4l（34～53）岁。5例均在术中诊断为主动脉夹层，1例行单纯主动脉瓣成形术，1例行Wheat手术，3例行Bentall手术。对其临床表现、辅助检查、术中所见、手术方式及随访结果进行分析总结。结果本组患者均无手术死亡及无手术相关并发症，例1出院前超声心动图提示升主动脉及窦部横径均较术前减小，主动脉瓣对合良好，无明显反流；余4例患者复查超声心动图及CT均提示机械瓣启闭良好，人工血管通畅。5例患者得到随访，中位随访时间4（1～5）年，均生存。4例患者复查超声心动图均提示机械瓣启闭良好，无明确瓣周漏，人工血管通畅；1例主动脉瓣有少量反流。结论表现为单纯主动脉瓣关闭不全的主动脉夹层少见，术前易误诊，仔细分析病史结合辅助检查可在一定程度上避免误诊，手术中宜根据主动脉内膜撕裂及窦部破坏程度决定手术方式。

Objective To explore clinical features and surgical strategies for patients with aortic dissection （AD） manifesting as pure aortic regurgitation （AR）, avoid preoperative misdiagnosis, and provide reference for clinical diagnosis and treatment. Methods Clinical data of 5 AD patients who were preoperatively diagnosed as pure AR in Beijing Fu Wai Hospital from January 2005 to May 2012 were retrospectively analyzed. There were 4 male and 1 female patients with their median age of 41 （ 34-53 ） years. All the 5 patients were diagnosed as AD during the operation. One patient received aortic val- vuloplasty, 1 patient received Wheat procedure, and 3 patients received Bentall procedure. Clinical manifestations, accessory examinations, intraoperative findings, surgical strategies and follow-up results were summarized. Results No postop- erative death or complication occurred in this study. Echocardiogram of patient 1 before discharge showed that transverse diameters of the ascending aorta and aortic sinus decreased with satisfactory closure of aortic valves but no AR. Echocar- diogram and CT all showed normal function in mechanical valves and patent blood vessel prosthesis in the other 4 patients. All the 5 patients were followed up for 4 （ 1-5 ） years and were alive during follow-up. Echocardiogram showed normal function in mechanical valves and patent blood vessel prosthesis without paravalvular leak in 4 patients and mild AR in J 1 patient. Conclusion AD manifesting as pure AR is rare and easily misdiagnosed preoperatively. Careful analysis of medical history and accessory examinations can reduce the risk of misdiagnosis. Appropriate surgical strategies should be chosen according to intraoperative findings of intimal tears and aortic sinus damage of AD.