Bentall术后冠状动脉吻合口残余动脉瘤的二次手术

Reoperation for residual aneurysm of coronary anastomosis after Bentall procedure Xue Jinrong

目的介绍一种新的Bentall术后冠状动脉吻合口残余动脉瘤手术处理方法。方法2011年3月至2012年12月，北京安贞医院心脏外科中心6例Bentall术后冠状动脉吻合口残余动脉瘤（CT显示左右冠状动脉开口金鱼眼样表现）的患者，均在低温体外循环下行同心圆环形补片法隔绝手术。剪一圆形补片，直径略大于动脉瘤口径，补片中心剪一圆形孔，孔径大小相当于冠状动脉开口；用4／0 prolene连续缝合将补片外缘与动脉瘤外缘（即初次手术人工血管开口）相吻合，用5／0 prolene连续缝合将补片内孔缘与冠状动脉口相吻合。结果6例患者均无术后并发症及死亡，所有患者顺利康复出院，术后随访2年，复查残余动脉瘤完全消除（CT显示“金鱼眼”征消失）。结论同心圆环形补片法能够较为有效地去除冠状动脉吻合口残余动脉瘤，术后早期并发症发生率及病死率明显减低，并且随访期疗效均确切满意。

Objective To introduce a new operative method for residual aneurysm of coronary anastomosis after Bentall procedure. Methods Between March 2011 and December 2012, six patients in Beijing Anzhen Hospital with residual aneurysm of coronary anastomosis （ CT showed goldfish eye sign at the openings of coronary） after Bentall procedure underwent the operation of concentric circular patch procedure under eardiopulmonary bypass. Femoral artery, right atrium and upper right pulmonary artery eannulation were used for eardiopulmonary bypass, and the artificial vessel was transeeted after cardiac arrest. A concentric circular patch was pruned, whose outside diameter was slightly larger than the aneurysm and the inside diameter was equal to the openings of coronary. The outer edge of the patch was anastomosed to the outer edge of the aneurysm （ opening of artificial vessel in primary surgery） with 4-0 prolene. The inner edge of the patch was anastomosed to the openings of coronary with 5-0 prolene. Results All patients had clinical recovery. Postoperative CT demonstrated the disappearance of residual aneurysm during follow-up （the goldfish eye sign disappeared）. Conclusion The concentric circular patch procedure is a feasible treatment for residual aneurysm of coronary anastomosis.