主动脉根部瘤合并二尖瓣病变的外科治疗

Surgical treatment of aortic root aneurysms combined with mitral valve diseases

目的:总结主动脉根部瘤合并二尖瓣病变的外科治疗经验。方法:2009年2月至2011年12月,我科实施主动脉根部替换手术合并二尖瓣置换/成形术38例。主动脉根部2例行Wheat术,其余均行Bentall术;二尖瓣6例行二尖瓣成形术(MVP),32例行二尖瓣置换术(MVR)。同期行冠状动脉旁路移植术(CABG)2例,孙氏手术4例。结果:围手术期死亡1例,病死率2.6%(1/38);1例患者发生Ⅲ°房室传导阻滞,术后植入永久起搏器;1例患者接受主动脉内球囊反搏(IABP)治疗,2例患者接受连续性肾脏替代治疗(CRRT),1例患者并发真菌感染。2例患者因术后引流多行二次开胸探查术。术后超声心动图:左心室舒张末期内径(55±11)mm(36-83mm),较术前明显缩小。结论:主动脉根部联合二尖瓣手术治疗是安全有效的,对于主动脉瓣环较大的患者,经主动脉瓣口行二尖瓣手术能够取得满意的结果。

Objective： To summarize the experiences in surgical treatment of aortic root aneurysms combined with mitral valve diseases. Methods： From Feb. 2009 to Dec. 2011, aortic root repair combined with mitral valve surgery were performed in 38 patients. For the aortic root, 2 patients were performed with Wheat operation, the others with Bentall procedure. For the mitral valve, 6 cases with mitral valvuloplasty （ MVP）, and 32 cases with mitral valve replacement （MYR）. Concomitant operations included coronary artery bypass grafting （ CABG, 2 cases） and Sun＇ s Procedure （4 cases）. Results： Perioperative mortality was 2. 6% （ 1/38 ） , 1 patient occurred with complete atrioventricular block, which implanted with permanent pacemaker. One patient received IABP treatment for low cardiac output syndrome, 2 patients received continuous renal re- placement therapy （CRRT） for renal insufficiency. Reexploration of the chest for bleeding was performed in 2 patients. Conclusion： Aortic root combined with mitral valve procedure is safe and effective. Mitral valve re- pair or mitral valvuloplasty through aortic is feasible in patients with enlarged aortic valve annulus.