55例主动脉窦瘤的外科治疗

Surgical treatment of aneurysm of aortic sinus

探讨先天性动脉窦瘤（ＣＡＳＶ）的外科治疗方法。方法：对５５例动脉窦瘤行外科治疗，其中窦瘤切除修补术２２例（４０％），窦瘤切除加房、室间隔缺损修补２５例（４２％），窦瘤切除加主动脉成形３例，窦瘤切除修补加主动脉瓣置换５例。结果：全组手术死亡２例，其中１例死于手术后急性肾功衰竭，另１例死于手术后纵隔感染致心脏大出血，余患者均痊愈出院。结论：心脏超声（ＵＣＧ）具有确诊和手术指导意义，窦瘤的破裂对心功能影响迅速而严重且愈后较差，可致急性心功能衰竭，故一经诊断应早期手术治疗，在缝合或修补窦瘤时进针方向要与主动脉长轴方向平行，并通过主动脉瓣环及其上缘的主动脉壁，以防止窦瘤复发或残余分流。

Objective: To review the surgical treatment of aneurysm of the sinus of valsalva (CASV). Method: Fiftyfive cases with CASV were treated surgically from 1981 to 1998. There were 35 males and 30 females. The aneurysm ruptured into right ventricle in 39 cases, into right ventricle associated with cardiac anomalies including ventricular septal defect (VSD) in 22(40%), aortic valve prolapse in 7(13%), atrial septal defect (ASD) in 3cases. Repair was achieved through right atrial incision in 17, right ventricular in 13, aorfic together with right atrial and right ventricular in 21 and aortic incision in 4 cases. Result: Two patients died postoperatively. Patients were followed up for 6 months to 14 years. Clinical condition and cardiac function were improved significantly. Conclusion: Echocardiography is a very useful diagnosis tool for CASV. The CASV should be operated as early as possible to correct hemodynamic disturbance. Rupture of the aneurysm can result in serious deterioration of cardiac function and poor prognosis.