室间隔夹层瘤的手术治疗

Surgical treatment of dissecting aneurysm of the interventricular septum

目的介绍室间隔夹层瘤这种临床罕见的心脏病及其治疗经验。方法１９９２～１９９８年，收治不同原因的室间隔夹层瘤４例，其中２例与佛氏窦瘤有关，１例可能为外伤所臻，另１例为主动脉右窦底部穿孔约２ｃｍ大小，形成室间隔夹层瘤。均进行室间隔夹层瘤的处理，同时行主动脉替换术３例，右窦穿孔修补１例。结果２例一次手术成功，另２例为再手术，疗效满意。结论本病病情发展快，预后差，应尽早诊断。超声心动图，心电图及核磁共振对诊断有重要价值。升主动脉和右室切口对暴露病变有利，手术应尽早进行，在处理主动脉瓣病变同时，切除夹层瘤壁，重建室间隔及治疗心律传导阻滞。

Objective To report a kind of extremely rare disease,dissecting aneurysm of the interventricular septum.5HZMethods Between May 1992 and January 1998,4 patients underwent surgical treatment of dissecting aneurysm of the interventricular septum in Fuwai Hospital,Beijing.The cause of the disease was different in these four patients.Two patients may be attributable to the aneurysm of coronary sinus of valsava,1 to the result of trauma, and the other to big perforation (diameter:2 cm) in the bottom of the right coronary sinus of valsava,through which the blood rushed into the cavity of dissecting aneurysm of the interventricular septum.The aneurysm was resected or repaired in these patients. Three of them were subjected to aortic valve replacement and one received repair of the perforation of the right vaslava sinus. Results Two patients had successful reoperation and the other 2 suceeded in the first operation.All of them were uneventfully recovered. ConclusionsThe development of dissecting aneurysm of the interventricular septum is rapid. Its prognosis is poor. Early diagnosis and operation are necessary. The pathogenic mechanism of dissecting aneurysm of the interventricular septum is unknown, but echocardiogram,electrocardiogram and nuclear magnetic resonance(NMR) are valuable for diagnosis. Surgical operation should involve the treatment of aortic valve disease. The wall of the aneurysm should be resected and the interventricular septum should be reconstructed. Good exposure can be obtained from the incision of the ascending aorta and right ventricular outflow tract.The AV block should be treated simultaneously.