主动脉瓣置换术后发生主动脉夹层的临床分析

Clinical research on dissection of aorta after aortic valve replacement

目的总结主动脉瓣病变行主动脉瓣置换（AVR）术后远期发生主动脉夹层的可能原因以及再次手术的方式选择和临床体会。方法收集2009年6月至2010年11月收治的AVR术后形成主动脉夹层患者12例的临床资料进行回顾性分析。其中升主动脉夹层8例，升主动脉＋主动脉弓部夹层2例，升主动脉＋主动脉弓＋降主动脉夹层2例；10例原发病为主动脉瓣关闭不全，2例为主动脉瓣狭窄。结果12例患者中1例二次手术前死亡；3例拒绝再次手术，8例接受二次手术，1例术后由于多脏器功能衰竭死亡，余患者恢复良好。术后3个月复查，假腔闭合良好，无新发夹层，窦部大小正常，包裹腔内无异常分流。结论AVR术后主动脉夹层多发生于术前主动脉瓣关闭不全合并升主动脉扩张的患者，同时与首次手术时未积极处理升主动脉，以及手术操作技巧有关，同时再次手术的方式选择也至关重要。

Objective To summarize the re-operation experience of dissection of aorta after aortic valve replacement. Methods Twelve eases of dissect!on of arota after aortic valve replacement（AVR） were collected from June 2009 to November 2010. Among the 12 cases, 8 cases were ascending aortic dissection, 2 cases were ascending and arch aortic dissection and 2 cases were ascending, arch and descending aortic dissection. 8 patients were treated with operation on cardiopulmonary bypass（CPB）. Results Primary diseases of 10 cases were aortic insufficiency and 2 cases were aortic stenosis. 1 case died before reoperation, 3 cases refused to perform reoperation and 1 died of multiple organ failure after operation. The false lumen closed after 3 months. No new dissection occurred. Conclusion Aortic dissection after AVR occurred in patients whose primary disease is AI with ascending aortic dilatation, which is possibly related to the first procedure and improper treatment of ascending aorta, however the selection of reoperation mode is also important.