先天性主动脉窦瘤破裂及合并畸形的外科治疗方法探讨

Surgical Treatment of Ruptured Aneurysm of Valsalva Sinus Accompanied by Ventricular Septum Defect or Aortic Valvular Insufficientcy

目的:探讨先天性主动脉窦瘤破裂及合并室间隔缺损(VSD)和主动脉瓣关闭不全(AJ)的手术方法。方法:36例主动脉窦瘤破裂(RASV)合并VSD 26例,AI 15例。补片修补35例,其中合并VSD的均以一片修补,合并AI的主动脉瓣置换(AVR)6例,主动脉瓣成形3例。手术取材作病理检查5例。结果:本组36例中手术死亡2例(5.6％)。存活的34例病人均经门诊复查或信访随访0.3-18年,其中2例死亡。病理检查见RASV合并VSD的瘤壁为纤维坏死或玻璃样变性。结论:先天性主动脉窦瘤破裂合并VSD以一片修补法较好;若合并主动脉瓣关闭不全时应探查其病变程度,酌情一期矫正,瓣膜损伤明显时宜行主动脉瓣置换,对主动脉瓣环细小的病例,可借修补VSD和RASV的补片扩大主动脉瓣环。

Objective To study surgical treatment of ruptured aneurysm of Valsalva sinus (RAVS) accompanied by ventricular septum defect (VSD) or aortic valvular insufficientcy(AVI) .Methods Of 36 patients with RAVS undergoing surgery between 1980 and 2003,26 with RAVS were accompanied by VSD and 15 by AVI. The surgical procedures included direct suture of RAVS in 1 patient,patch repair of RAVS in 35,of whom,26 with RAVS accompanied by VSD received mere one patch repair,6 by AVI replacement of aortic valve, 4 by AVI valvuloplasty. Results Of 36 patients with RAVS, 2 died of the operation (5.6%) and 34 survived . Of the 34 patients followed up from 3 to 156 months, 1 died of infectious endocarditis, 1 died of refractory ventricular fibrillation and 32 did not underweat re - operation due to AVI and recurrence or residual shunt of RAVS and VSD. Conclusion The patients with RAVS accompanied by VSD should be treated by one patch repair. The patients with RAVS accompanied by AVI should be treated by replacement of aortic valve or valvaloplasty according to different AVI in the degree.