主动脉窦瘤破入右心房的外科治疗效果

Surgical repair of ruptured sinus of Valsalva aneurysm to right atrium

目的 总结主动脉窦瘤破入右心房的外科治疗经验,比较经右心房切口、右心房联合主动脉切口两种途径修补的结果.方法 2004年1月至2009年12月共对53例主动脉窦瘤破入右心房的患者进行了外科手术,其中男性35例,女性18例;年龄15～63岁,平均（33±9）岁.其中经右心房途径修补40例（Ⅰ组）;经右心房联合主动脉切口修补13例（Ⅱ组）.比较两组在心肺转流时间、主动脉阻断时间、呼吸机辅助时间、ICU时间、术后住院时间方面的差异.结果 两组在心肺转流时间[（86±29）min比（96±30）min]、主动脉阻断时间[（59±29）min比（71±25）min]、呼吸机辅助时间[（9±4）h比（161±23）h]、ICU时间[（35±23）h比（35±23）h]、术后住院时间[（7.1±0.9）d比（7.8±2.8）d]方面的差异无统计学意义（P＞0.05）.随访1～64个月,平均（32±21）个月.术后随访无死亡,1例术前合并感染性心内膜炎的患者,术后6个月出现主动脉瓣大量反流需手术治疗;1例术后44个月查出冠状动脉粥样硬化性心脏病应用药物治疗,其余患者心功能（NYHA分级）Ⅰ～Ⅱ级.结论 外科治疗主动脉窦瘤破入右心房可取得良好的疗效,经右心房切口、右心房联合主动脉切口两种途径修补效果相当.

Objectives To summarize the experience of surgical repair of ruptured sinus of Valsalva aneurysm to right atrium and to compare the difference between through right atrium repair and transaortic combined with right atrium approach. Methods Between January 2004 and December 2009, 53 patients with ruptured sinus of Valsalva aneurysm to right atrium underwent surgical repair. There were 35 male and 18 female, aged from 15 to 63 with a mean of （33 ±9） years. Repair through right atrium had undergone in 40 patients （group Ⅰ ） , while transaortic combined with right atrium approach in 13 patients （group Ⅱ ）. Surgical results between the two group and group were compared in cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, ICU time and postoperative stay time. Results There were no significant differences between two groups in cardiopulmonary bypass time [（86 ±29） min vs. （96 ±30） min] , clamp aorta time [（59 ±29） min vs. （71 ±25） min], mechanical ventilation time [（9 ±4） h vs. （16±23） h], ICU time [（35 ±23） h vs. （35 ±23） h], postoperative stay time [（7.1 ±0.9） d vs. （7.7±2.8） d] （P〉0.05）. Follow-up was performed from 1 to 64 months, with a mean of （32 ±21） months. There was no death during follow up. One needed operation due to severe aortic valve regurgitation. One combined with coronary artery disease used medication. Heart function （NYHF） of the other patients were Ⅰ and Ⅱ degree during follow up. Conclusions Surgical repair of ruptured sinus of Valsalva aneurysm to right atrium shows good result.There is no significant difference between through right atrium repair and transaortic combined with right atrium approach.