经心尖途径行主动脉瓣置换手术2例报告

Exploration of aortic value replacement by apexway

目的探讨经心尖途径行主动脉瓣置换术治疗高危重症主动脉瓣病变的手术疗效。方法回顾性分析河南省胸科医院2017年9月24日至2017年10月13日开展的2例经心尖途径行主动脉瓣置换术患者的围术期情况。结果术前严格评估患者的各脏器功能及冠脉和外周血管情况,术中全身麻醉、单腔气管插管,准确定位左侧小切口进胸(3~5cm),平行切口切开心包,心包裸区缝荷包线,穿刺导入绿色导丝跨过主动脉瓣到达各级水平脏器动脉,经导丝植入J-Valve输送系统精确释放人工主动脉瓣,食道超声显示主动脉瓣轻微返流。1例患者术后出现阵发房颤,中度肝肾功能不全、血小板下降,经治疗后好转;1例患者术中出现室颤,行股动静脉插管体外循环辅助下完成经心尖途径行主动脉瓣置换手术。本组2例患者手术成功,近期临床疗效良好。结论经心尖途径行主动脉瓣置换术是治疗高危重症主动脉瓣病变的有效方法,是安全可行的,远期效果需进一步评价。

Objective Explore the apex way line of aortic valve replacement treatment at high risk of severe aortic valve lesions surgical curative effect.Methods Henan chest hospital were retrospectively analyzed in 2017 to September 24 to October 13,2017 in Henan province before 2 cases through apex line of perioperative in patients with aortic valve replacement.Results Each viscera function and strict preoperative evaluation of patients with coronary and peripheral vascular surgery in general anaesthesia,single lumen endotracheal intubation,accurate positioning on the left side of the small incision into the chest（3-5 cm）,parallel incision through pericardium,pericardial bare area seam pocket line,puncture import green thread across the aortic Valve reaches level organs at all levels artery,the thread implant J-release exactly artificial aortic Valve conveyer system,and the esophagus ultrasound revealed aortic regurgitation.1 patients had the array atrial fibrillation,moderate kidney dysfunction,decreased platelet,improved after treatment; Intraoperative ventricular fibrillation,in 1 patients femoral arteriovenous extracorporeal circulation intubation assisted to finish line through apex aortic valve replacement surgery.This group of successful operation,2 cases with recent clinical curative effect is good.Conclusion Line through the apex of aortic valve replacement is an effective method for treatment at high risk of severe aortic valve lesions,is safe and feasible,long-term effect need further evaluation.