主动脉窦瘤破裂的外科治疗及远期疗效

Long-term results of surgical repair of ruptured sinus of aortic sinus aneurysm

目的总结主动脉窦瘤破裂的临床特点及外科疗效，讨论对合并感染性心内膜炎及主动脉瓣关闭不全患者的处理。方法回顾性分析1997年9月至2007年9月43例主动脉窦瘤破裂患者的临床资料。其中男性32例，女性11例；年龄11～50岁，平均年龄（29．0±11．5）岁。破口源于右冠状动脉窦34例，无冠状动脉窦9例。破入右心室30例，右心房8例，右心室及右心房3例，破入室间隔2例。合并室间隔缺损26例，主动脉瓣关闭不全15例，感染性心内膜炎8例，三尖瓣反流6例，房间隔缺损4例，二尖瓣反流2例，动脉导管未闭2例，肺动脉赘生物1例。全部患者于心肺转流下行窦瘤修补及合并畸形矫治术。结果无围手术期死亡。并发症5例，包括急性左心功能衰竭3例，Ⅲ度房室传导阻滞2例。随访6～120个月，平均（68．0±17．7）个月；2例分别于术后第6、8年行主动脉瓣置换术，2例进展为Ⅱ级主动脉瓣关闭不全。结论主动脉窦瘤破裂外科治疗可获得满意效果。对合并主动脉瓣关闭不全及感染性心内膜炎的患者应早期手术，积极防治术后并发症并长期随访。

Objective To summarize the clinic characteristics and effect of surgical repair of ruptured aortic sinus aneurysm. Methods From September 1997 to September 2007, 43 patients with ruptured aortic sinus aneurysm underwent surgical procedures. There were 32 male and 11 female patients. The age ranged from 11 to 50 years old with a mean of （29. 0 ±11.5 ） years old. The origins of rupture were the fight coronary sinus in 34 patients and the noneoronary sinus in 9 patients. The aneurysms ruptured into the right ventricle in 30 patients, the fight atrium in 8 patients, the fight ventricle and fight atrium in 3 patients, and the ventricular septum and then the fight ventricle in 2 patients. Associated cardiac anomalies included ventricular septal defect in 26 patients, aortic regurgitation in 15 patients, infectious endocarditis in 8 patients, tricuspid regurgitation in 6 patients, atrial septum defect in 4 patients, mitral valve regurgitation in 2 patients, patent ductus arteriosus in 2 patients, and pulmonary valve vegetation in 1 patient. All the patients underwent the repair of ruptured aortic sinus aneurysm and correction of associated anomalies with cardiopulmonary bypass. Results There were no deaths after the operation and during the follow-up. The complications, including acute heart failure and Ⅲ atrioventricular block, occurred in 5 patients. Follow-up was 6 to 120 months with a mean of （68.0 ±17.7） months. Two patients underwent reoperation for aortic valve replacement at the 6^th and 8^th year after the first operation. There were 2 patients which the aortic regurgitation deteriorated from grade Ⅰ to Ⅱ . Conclusions Repair of ruptured aortic sinus aneurysm presents a satisfactory result. Aggressive treatment in early time, prevention of post-operative complications and long-term follow-up are recommended in the treatment for patients of ruptured aortic sinus aneurysm with infectious endocarditis and aortic regurgitation.