介入封堵与外科手术治疗主动脉窦瘤破裂的疗效及安全性

Efficacy and safety of interventional closure and surgical of ruptured sinus of Valsalva aneurysm

目的比较介入封堵与外科手术治疗主动脉窦瘤破裂(RSVA)的疗效及安全性。方法选取RSVA患者22例,介入封堵治疗10例(介入组),外科手术治疗12例(手术组)。术后随访6—24个月,比较两组临床症状、是否存在残余分流、有无瓣膜反流、封堵器有无移位、肺动脉压变化及心功能状态。结果介入组均完全封堵;与术中比较,术后肺动脉收缩压、肺动脉平均压均降低,差异均有统计学意义(P均<0.05);术后即刻造影示少量残余分流1例。手术组完全封堵率为91.67%(11/12);术后出现较大的残余分流和严重低心排量综合征各1例。两组随访期内均未发生右心衰竭、栓塞、感染性心内膜炎、主动脉瓣反流、溶血和死亡等。结论介入封堵治疗主动脉窦瘤破裂与外科修补疗效相当,且具有较好的安全性。

Objective To compare the efficacy and safety of interventional closure and surgical repair of ruptured sinus of Valsalva aneurysm （RSVA）. Methods A total of 22 patients with RSVA were enrolled for therapy. Ten patients underwent interventional closure （interventional group）, the other 12 patients underwent surgical repair （surgical group）. All patients were followed for 6—24 months. The clinical symptoms, the existence of residual shunt and valve regurgitation, the displacement of the occluder, the change of pulmonary artery pressure and cardiac function of two groups were compared. Results In interventional group, RSVA had completed closure. Compared with intraoperative pulmonary artery systolic pressure and average pulmonary artery pressure, postoperative pulmonary artery systolic pressure and average pulmonary artery pressure dropped （all P〈0.05）. Immediate postoperative angiography showed a small residual shunt in one case in interventional group. In surgical group, the complete plugging rate was 91.67%（11/12） and there was one patient occurred patch leak and one case of severe low output cardiac syndrome after the operation. There was no right heart failure, embolism, infective endocarditis, aortic regurgitation, hemolysis and death during the follow-up in two groups. Conclusion Compared with surgical treatment, interventional closure of RSVA has comparable efficacy and safty.