医源性主动脉瓣反流的手术治疗

Surgical treatment of aortic valve regurgitation caused by iatrogenic impair

目的 总结由于外科修补或导管封堵室间隔缺损（VSD）所导致主动脉瓣反流的手术经验.方法 2011年2月到2014年2月,手术治疗7例外科修补或导管封堵室间隔缺损导致的主动脉瓣中度以上反流患儿,男4例,女3例,平均年龄7.2岁,平均体质量24.9 kg.膜周部VSD导管封堵术后损伤主动脉瓣2例;外科手术损伤主动脉瓣5例,其中3例为修补肺动脉瓣下VSD时损伤右冠瓣（2例瓣叶穿孑,1例瓣叶缺失）,1例为修补膜周部VSD时损伤无冠瓣导致瓣叶穿孔,1例右室双出口修补主动脉瓣下VSD时缝合线牵拉主动脉瓣环导致对合不佳.主动脉瓣成形手术距VSD修补或封堵手术10天～1.5年,自体心包补片修补穿孔的瓣叶4例,自体心包补片行瓣叶延长2例,拆除VSD缝线重新修补VSD 1例.结果 无手术死亡.随访2个月～3年,主动脉瓣成形效果满意,1例瓣叶缺失做瓣叶延长患儿主动脉瓣轻中度反流,余6例反流程度均为轻度以下.1例VSD封堵患儿合并双束支传导阻滞,心功能指数低于正常,余者心功能恢复正常.结论 对于外科修补或导管封堵室间隔缺损所导致主动脉瓣反流,用自体心包补片做主动脉瓣成形术的效果满意.

Objective To review and summarize the experiences of aortic valveplasty gaused by surgical repair or transcatheter closure.Methods Seven patients with moderate or severe aortic valve insuffience underwent aortic valveplasty caused by surgical repair or transcatheter closure.Two patients underwent transcatheter closure for menbrame VSD previously.Five patients underwent surgical repair previously.Surgical procedure include patch repair of perforative aortic valve,valve leaflet extension and re-repair of VSD by remove previously suture line.Results No patient died,aortic valve insuffience was mild in six patients and moderate in one patient,six patients have good cardiac function.Conclusion Patch repair of perforative aortic valve and valve leaflet extension of lacerated leaflet have excellent result.