先天性主动脉窦瘤的外科治疗

Surgical Treatment of Congenital aneurysm of the Sinus of Valsalva

回顾手术治疗先天性主动脉窦瘤（CASV）50例、主动脉左心室通道（ALVT）1例。无手术死亡。主要合并畸形：室间隔缺损31例（60．78％），主动脉瓣脱垂14例（27．45％）。行主动脉瓣成形术12例，主动脉瓣替换术2例。作者认为：心脏超声对CASV、ALVT诊断准确率高。窦瘤破裂或ALVT对心功能影响迅速而严重，预后较差。故一经确诊，宜尽早手术治疗，以及时纠正血液动力学紊乱。窦瘤破口直径＞1．0cm者宜用补片修补。缝合或修补窦瘤时进针方向要与主动脉长轴平行，要穿过主动脉瓣环和上缘的主动脉壁，以防止窦瘤复发或残余分流。术中选用恰当的冷心停捕液灌注方法，做好心肌保护。

Surgical Treatment of 50 cases of congenital aneurysm of the sinus of Vahalva (CASV) and 1 case of aortior-left ventricular tunnel (ALVT) were reviewal. There were no capital deatha. The associated Cardiac anomalies wrer ventricular septal defect (31 cases, 60. 78% ), aortic valve prolapses or incompetence (14 cases,27. 45% ). There were 12 patients who received aortic valvuloplasty and 2 patients receival aortic valve replace ment. The authors suggest that echocardiograph is useful to verify the diagnosis of CASV and ALVT. Rupture of the aneurysms or ALVT causes early and serius damage of Cardiac function with poor prognosis, so it should be operated as am as diagnch is made in order to correct hemodynamic disturbance patch closure of the defect in the sinus of Valsalva shauld be ed if the defect is larger than 1. 0 cm. Sutures should be parallel with the major axis of aorta, and po through the aortic anulus and aortic wall to prevent recurrence or leakage of aneurysm. It's important to use appropriate infusion methods of cold cardioplegopic allution for optimal myocardial protection.