主动脉瓣二叶畸形伴胸主动脉扩张的外科治疗

Surgical Treatment of Bicuspid Aortic Valve Combined with Thoracic Aortic Dilation

目的分析主动脉瓣二叶畸形伴胸主动脉扩张的临床特点及外科治疗。方法回顾性分析我院2010年1月至2014年6月行主动脉瓣二叶畸形伴胸主动脉扩张手术患者68例的临床资料,其中男47例、女21例,年龄26~77(44.5±16.3)岁。手术方式包括Wheat手术22例,主动脉瓣置换+升主动脉成形术10例,Bentall手术13例,主动脉瓣置换+升主动脉置换+右半弓置换术13例,Bentall手术+升主动脉置换+右半弓置换术8例,Bentall手术+升主动脉置换+全弓置换+支架象鼻术2例。结果 68例手术均顺利完成,住院死亡3例(死亡率4.4%)。神经精神系统并发症3例,肺部感染2例,二次开胸2例。术后随访63例,随访时间6个月至4年。术后2年死亡1例,其余患者生活质量良好,无再次手术。结论主动脉瓣二叶畸形合并胸主动脉扩张患者的临床特点多样,应根据患者的主动脉瓣及胸主动脉的病变特点选择合适的手术方式。

Objective To analyze the clinical characteristics and surgical treatment of bicuspid aortic valve combined with thoracic aortic dilation. Methods We retrospectively analyzed the clinical data of 68 patients of bicuspid aortic valve combined with thoracic aortic dilation underwent surgical treatment in our hospital between January 2010 and June 2014. There were 47 males and 21 females at age of 26-77(44.5±16.3) years. Different surgical treatments including Wheat procedure(n=22),aortic valve replacement + ascending aortoplasty(n=10),Bentall procedure(n=13),aortic valve replacement + ascending aortic replacement + right hemi aortic arch replacement(n=13),Bentall procedure +ascending aortic replacement + right hemi aortic arch replacement(n=8),Bentall procedure + ascending aortic replacement + total arch replacement + stented elephant trunk(n=2) were carried out according to the type. Results All 68 patients underwent surgical treatment. The mortality in hospital is at 4.4%(3/68). The postoperative complications were neurological and mental complications(n=3),pneumonia(n=2),and exploratory thoracotomy(n=2). We followed up 63 patients for 6 months to 4 years. A total of 62 patients were well without reoperation except one death at the end of following-up 2 years. Conclusion Bicuspid aortic valve combined with thoracic aortic dilation has diversiform clinical characteristics. The surgical treatment should be chosen according to the aortic valve and thoracic aortic lesion characteristics.