升主动脉-降主动脉人工血管旁路移植术在复杂主动脉缩窄中的应用5例

The application of ascending to descending aorta bypass technique for patient with aortic coarctation

目的探讨正中开胸行升主动脉-降动脉人工血管旁路移植术治疗复杂主动脉缩窄的手术细节。方法 5例复杂型主动脉缩窄患者正中开胸行升主动脉-降主动脉旁路手术,其中4例行膈肌上吻合(其中1例经左心缘路径,3例经右心缘路径),1例行膈肌下吻合。分别观察术后上下肢压差及并发症情况。结果 5例患者均无死亡,术后上下肢压差均降低至20 mmHg以下,恢复可,术后并发症包括咳嗽1例及黑朦2例。结论正中开胸行升主动脉-降动脉人工血管旁路移植术治疗主动脉缩窄效果可,但手术细节对术后并发症的影响仍需进一步研究。

Objective To explore the practical application of ascending-to-descending aortic bypass for complex aortic coarctation. Methods Five patients with complex aortic coarctation underwent ascending-to-descending aortic bypass via median stemotomy. Among them, the bypass graft was positioned on the right side along the right atrial fiee wall in one patient and along the left side anterior to the puhnonary artery in three patients. Results None of the 5 patients died. The pressure gradient between upper and low-er extremity w-as lower than 20 mmHg in all patients postoperatively. Postoperative complications included cough and visual field defect. Conclusion Satisfied result can be achieved in complex aortic coarctation treated with ascending-to-descending aortic bypass through median sternotomy. However, further study about surgical details should be pefformed.