82例主动脉窦瘤破裂的外科治疗研究

Surgical treatment of ruptured sinus of Valsalva aneurysm in 82 patients

目的:总结主动脉窦瘤的临床特点和外科手术治疗方法。方法:82例主动脉窦瘤破裂患者均于体外循环下行主动脉窦瘤修补术。其中右冠窦破入右室48例,右冠窦破入右房16例,无冠窦破入右房18例。本组包括室间隔缺损39例,主动脉瓣关闭不全23例。除修补窦瘤外,同时行室间隔缺损修补术39例,主动脉瓣置换术5例,主动脉瓣成形术16例,右心室流出道疏通术5例,二尖瓣置换术1例,三尖瓣成形术8例,肺动脉瓣穿孔修补1例,主动脉瓣下狭窄切除1例。结果:本组患者全部治愈出院。术后1例因残余分流行二次手术矫治,术后主动脉瓣中度反流再次成型术1例,轻度主动脉瓣关闭不全4例,微量残余分流2例。随访患者无死亡,手术治疗效果良好,心功能改善明显。结论:主动脉窦瘤破裂明确诊断即为手术指征。应尽早手术,采取适当、有效的手术方法,疗效满意。

Objective：To review retrospectively the surgical repair of sinus of Valsalva aneurysm（SVA） in 82 patients and summarize the clinic character and the surgical process of the SVA.Methods： Between May 1982 and May 2011,82 patients with SVA underwent surgical repair by the aid of general anesthesia and cardiopulmonary bypass,there were 63 male and 19 female patients aged from 12 to 59 years（mean,32.66 ± 14.28 years）.The aneurysms originated from right sinus ruptured into the right ventricle in 48 patients,into the right atrium in 16 patients respectively.The aneurysms originated from noncoronary sinus ruptured into the right atrium in 18 patients.There were no aneurysms originated from left sinus ruptured into the left ventricle by now.The most common associated cardiovascular abnormality was ventricular septal defect（VSD,n = 39）,and the other is aortic valve regurgitation（n = 23）.Repairs were achieved through an incision in right atriotomy,right ventriculotomy or aortotomy only or both aortotomy and right atriotomy（or right ventriculotomy）.The defects in the sinus of Valsalva was repaired with either direct sutures（n = 27） or a patch（n = 55）.The aortic valve was replaced in 5 patients.The plasty of aortic valve was done in 16 patients.The mitral valve was replaced in 1 patient.The plasty of tricuspid valve was done in 8 patients.Results： There was no hospital mortality and all patients were cured.Twenty-seven patients underwent the repair surgery by direct suture.Fifty-five patients underwent the surgery by the patch.Five patients underwent the aortic valve replacement,and sixteen underwent aortic valve plasty.One hemoglobinuria was cured after the AVR operation.There was one reoperation for closure of recurrent fistula at the first day after the original operation.The patients who had reoperation had right sinus of Valsalva-to-right atrium fistulas.Another two mild fistulas were still in clinical observation.There are still four patients with mild aortic insufficiency after the surgery.There was another aortic valve plasty for the morderate aortic insufficiency after the surgery.There was no late mortality in the follow-up.Seventy-five patients are in operatively New York Heart Association class I,and 8 are in class II.Conclusions： The ruptured sinus of Valsalva aneurysm with or without the other cardiac abnormal should be repaired surgically as soon as the diagnosis was confirmed.The operative procedure depends on the size of the aneurysm,the direction of the tistula and the toughness of the surrounding tissue.It is necessary to close the defect of the aneurysm with the direct suture or the patch,from inside the aorta or the cardiac chamber,or from both sides of the tistula.Long-term results are excellent by the effective,appropriate operative procedure.