手术治疗先天性主动脉窦瘤30例临床分析

目的:总结先天性主动脉窦瘤临床治疗经验,探讨手术要点。方法:对我院1997年11月～2007年12月30例先天性主动脉窦瘤手术治疗进行回顾分析。结果:1例行窦瘤切除并补片修补+室间隔缺损补片修补+主动脉瓣置换术患者,术后3d时突发室性颤动死亡,1例患者主动脉瓣成形术后残余轻度主动脉瓣关闭不全,随访3年时,渐加重为中度主动脉瓣关闭不全,心功能(NYHA)Ⅲ级,失访1例,其余27例患者随访2个月～10年,心功能Ⅰ级20例,Ⅱ级7例。结论:对窦瘤破裂者,应积极手术治疗,以免延误手术时机,并发病变应同时矫治,合理的处理主动脉瓣关闭不全有利于患者长期预后。     

主动脉窦瘤破裂的手术治疗

目的总结主动脉窦瘤破裂的手术治疗经验。方法 30例主动脉窦瘤破裂患者(右冠窦破入右心室15例、破入右心房6例,无冠窦破入右心房9例),于体外循环下行主动脉窦瘤修补术,同时行室间隔缺损修补术14例、主动脉瓣替换术4例、主动脉瓣成形术2例、右心室流出道疏通术2例、二尖瓣置换术1例、三尖瓣成形术2例、肺动脉瓣穿孔修补术1例、主动脉瓣下狭窄切除术1例。结果本组患者全部治愈出院。术后1例因残余分流行二次手术矫治,轻度主动脉瓣关闭不全4例,微量残余分流2例。结论主动脉窦瘤破裂应尽早手术,采取适当、有效的手术方法,疗效满意。     

手术治疗主动脉窦瘤216例的疗效分析

目的通过长期的随访,分析总结手术治疗主动脉窦瘤的疗效.方法1960年11月～1999年6月间,216例主动脉窦瘤进行了手术治疗.其中143例(66.2%)合并室间隔缺损(CSD),60例(28.0%)伴主动脉瓣关闭不全,12例(5.6%)同时进行主动脉瓣置换术.结果死亡8例(3.7%),随访资料显示无远期死亡,效果好.1例再次作主动脉瓣置换术.结论患主动脉窦瘤应早期手术,并使用补片修补缺损,提高手术效果.     

主动脉窦瘤破裂的外科治疗

目的:总结1981年1月～2005年6月156例主动脉窦瘤破裂(RSVA)的外科治疗经验。方法:156例RSVA患者,男102例,女54例,平均年龄27(8～59)岁。其中并发室间隔缺损91例,主动脉瓣关闭不全(AI)86例,感染性心内膜炎8例,右室流出道狭窄或右室双腔心16例,瘤破裂直接结扎11例,直接缝合43例,补片修补102例。室间隔缺损均采用补片修补,主动脉瓣整形15例,主动脉瓣置换28例。余并发症均同期予以处理。结果:围术期死亡1例,远期死亡4例。再次手术5例,其中急诊2次手术1例。RSVA修补术后残余分流3例,室间隔缺损修补术后残余分流5例。其余患者心功能明显改善,AI减轻,临床效果良好。结论:RSVA是少见的心脏疾病,手术是惟一有效的治疗方法。采用主动脉及心腔双切口利于心肌保护和确切修补主动脉窦瘤,纠正并发畸形;并发AI时应注意探查,大多数重度AI患者最终需行主动脉瓣置换术。     

主动脉窦瘤破裂的外科治疗

目的:总结我院1992年12月至2004年2月13例主动脉窦瘤破裂的外科治疗经验,进一步探讨其疾病特点及手术方法.方法:13例病人(男性7例、女性6例)在中低温体外循环下行主动脉窦瘤修补术,7例病人同期行室间隔缺损修补术,2例同期行房间隔缺损修补术,1例同期行主动脉瓣成形术,2例同期行主动脉瓣替换术,其他1例.阻断时间(67.46±26.13)分,体外循环时间(103.29±38.05)分.结果:本组病例无死亡.1例病人术后早期出现频发室性早搏、室性二联律,静脉滴注利多卡因有效.所有病人治愈出院,随诊无一例复发.结论:主动脉窦瘤破裂是罕见的心脏疾病,尽早手术是唯一有效的治疗方法.采用主动脉及右心房或主动脉及右心室双切口利于心肌保护和确切修补主动脉窦瘤、纠正合并畸形.     

42例主动脉窦瘤破裂急诊手术的临床经验

目的 总结主动脉窦瘤破裂急诊外科治疗的临床经验。方法 我院自2006年1月至2016年8月对42例主动脉窦瘤破裂患者施行急诊手术，男23例，女19例；年龄18岁～60岁，平均（38.1±5.3）岁；体重36.9～72.7kg，平均（50.7±6.1）kg；病程8h～96h，平均（40.1±5.2）h；破入右室26例，破入右房14例，同时破入右房右室者2例；合并室间隔缺损者21例，主动脉瓣关闭不全者12例，三尖瓣关闭不全13例，二尖瓣关闭不全2例，感染性心内膜炎2例。全组均在全麻体外循环下行窦瘤修补术同时矫正心内畸形。结果 全组无手术死亡，术后1例迟发性出血，2例出现低心排综合症，2例出现肾脏功能不全，经积极有效治疗后均痊愈出院。随访2～96个月（59.7±11.1），结果满意。 结论 主动脉窦瘤破裂急性心力衰竭患者，内科保守治疗无效时急诊手术能够挽救患者生命，同时积极防治并发症。     

主动脉窦瘤破裂170例手术治疗及疗效

本文总结手术治疗主动脉窦瘤破裂170例。男性占73.5%,平均年龄30.2岁。全组41.2%的患者合并室间隔缺损,21.2%的患者合并主动脉瓣关闭不全。窦瘤起自右冠状窦者占80%;无冠状窦者占20%。窦瘤破入右室占73.5%;破入右房占25.3%;破入左室占0.6%。手术总死亡率为4.1%。手术效果主要与术前心功能状态、是否合并主动脉瓣关闭不全以及畸形修复技术密切相关。本组采用缝合窦瘤破口及补片加固窦外侧壁的方法,手术效果满意。术前心功能Ⅲ～Ⅳ级的死亡率(13.3%),高于Ⅰ～Ⅱ级(0.8%)。术后长期随诊率71.8%,平均随诊5年8个月。效果分级:优88.9%,良8.5%,差2.6%。不合并主动脉瓣关闭不全的效果好。本文着重介绍了窦瘤修补方法及合并主动脉瓣关闭不全的处理。     

先天性主动脉窦瘤的外科治疗

回顾手术治疗先天性主动脉窦瘤（CASV）50例、主动脉左心室通道（ALVT）1例。无手术死亡。主要合并畸形：室间隔缺损31例（60．78％），主动脉瓣脱垂14例（27．45％）。行主动脉瓣成形术12例，主动脉瓣替换术2例。作者认为：心脏超声对CASV、ALVT诊断准确率高。窦瘤破裂或ALVT对心功能影响迅速而严重，预后较差。故一经确诊，宜尽早手术治疗，以及时纠正血液动力学紊乱。窦瘤破口直径＞1．0cm者宜用补片修补。缝合或修补窦瘤时进针方向要与主动脉长轴平行，要穿过主动脉瓣环和上缘的主动脉壁，以防止窦瘤复发或残余分流。术中选用恰当的冷心停捕液灌注方法，做好心肌保护。     

主动脉窦瘤133例临床分析

目的 探讨主动脉窦瘤的临床特点、诊断、治疗和预后。方法 回顾性分析133例主动脉窦瘤患的临床资料。结果 主动脉右冠窦瘤111例(83．5％)，无冠窦瘤16例(12．0％)，破入右房22例(16．5％)，破入右室87例(65．4％)，合并室间隔缺损67例(50．4％)，主动脉关闭不全32例(33．8％)；行主动脉窦瘤修补术或加固术115例，室间隔缺损修补术68例，主动脉瓣置换术32例，手术效果好。全组死亡5例。结论 超声心动图是确诊的主要手段，一经确诊尽早手术，术后预后良好。     

45例主动脉窦瘤破裂的外科治疗体会

目的:总结主动脉窦瘤破裂(RASV)的外科治疗经验。方法:回顾总结2000年12月至2010年5月先天性主动脉窦瘤破裂患者45例,所有患者均在全麻低体温体外循环下行主动脉窦瘤破裂修补术,同时行室缺修补术31例,主动脉成形术5例,主动脉瓣置换术6例,右心室流出道疏通6例。结果:全组死亡1例,痊愈出院44例,术后复查彩色超声心动图均未发现主动脉瘤复发或残余分流,随访3个月至6年所有患者心功能均有明显改善。结论:先天性主动脉窦瘤破裂患者一经确诊应积极尽早手术,手术过程中对窦瘤准确修复,加强心肌保护,以及对合并畸形的彻底矫治是手术成功的关键。     

Giant extracardiac unruptured aneurysm of the sinus of Valsalva: a case report

Extracardiac unruptured aneurysm of the sinus of Valsalva (ASV) is rare and difficult to diagnose accurately by echocardiography or cardiac catheterization preoperatively. A 63-year-old woman, with dyspnea and palpitations, diagnosed with aortic regurgitation (AR) with congestive heart failure and extracardiac unruptured ASV, was referred to our hospital for surgical repair. The unruptured ASV was well visualized by magnetic resonance imaging (MRI), and diagnosed as an extracardiac type. Surgical repair was performed by aortic valve replacement and aneurysmectomy. It was concluded that early surgical repair of extracardiac ASV should be considered to prevent sudden death, and MRI is an accurate and useful method for preoperative diagnosis. Received: February 15, 2001 / Accepted: May 22, 2001     

Aortic Valve Repair: Indications and Outcomes

Aortic valve replacement has traditionally been the treatment of choice for patients with aortic valve insufficiency with or without aortic root pathology. Aortic valve repair is emerging as an attractive treatment alternative that avoids the long-term risks associated with prosthetic valve implantation including thromboembolism, endocarditis, prosthetic valve deterioration, and anticoagulation related hemorrhage. Important achievements in this discipline have occurred over the past decade including development and refinement of valve preserving aortic root replacement techniques, development of a classification system for aortic insufficiency, surgical approaches to cusp disease with varying cusp anatomy. As surgical techniques for aortic valve repair continue to evolve, clinical outcomes up to and beyond the first decade are promising with excellent survival and low risk of valve related events.     

Reconstructive procedures in heart valve disease

The percentage of patients who undergo valve repair has increased considerably during the past decade. Valve repair is particularly important in patients with atrioventricular valve disease since it provides better results than replacement. Aortic valve repair is presently performed only in selected patients with aortic stenosis and insufficiency. There is a renewed interest in aortic valve debridement in patients with calcific aortic stenosis. Mitral valve repair can be performed in most patients with mitral insufficiency and in many with mitral stenosis. The surgical techniques for mitral valve repair are well established and are reproducible. The tricuspid valve is almost always reparable in patients with tricuspid disease associated with mitral valve disease.     

室间隔缺损修补术后中远期主动脉瓣关闭不全的外科治疗分析

目的:探讨室间隔缺损(VSD)修补术后中远期主动脉瓣关闭不全(AI)的外科治疗方法.方法:总结1996-01至2007-12我院22例VSD术后AI的外科治疗经验.主动脉瓣病变以穿孔为主,本组主动脉瓣置换13例,主动脉瓣成形9例.结果:22例患者中手术死亡1例.出院检查与术前比,心胸比率(0.52±0.04 vs 0.57±0.07,P<0.05)及左心室舒张末径[(46.7±5.8)mm vs(54.5±10.2)mm,P<0.05 ]均有明显缩小,差异有统计学意义.超声心动图检查3例患者主动脉瓣少量反流,余未见明显异常.结论:本病的主要原因可能为手术损伤造成,外科治疗效果满意.     

Early and long-term results of surgical treatment of type A aortic dissection

BACKGROUND: Acute aortic dissection is one of the most serious life-threatening conditions, with mortality during the first 48 hours reaching 50%. AIM: To assess short and long-term effects as well as safety of surgical treatment of aortic dissection combined with aortic valve repair. METHODS: The study group consisted of 57 patients (38 males, 19 females, mean age 47.9 +/- 13 years) with dissection of the ascending part of the aorta (type A aortic dissection) who underwent surgery in our institution between 1985 and 1999. Follow-up duration ranged from 2 to 16 years -- mean 6 years. Control transthoracic or transesophageal echocardiography was performed in 37 patients. RESULTS: Early mortality was 21%. There were 12 perioperative deaths and 3 late non-cardiovascular deaths. Three patients underwent repeated surgery due to (1) aortic valve insufficiency, (2) pseudoaneurysm at the site of the anastomosis between proximal part of the vascular prosthesis and the aorta, and (3) fistula between aorta and right atrium. CONCLUSIONS: Aortic dissection type A is more frequent in males than females. The main causative factor is hypertension. Early mortality is significantly higher in patients undergoing emergency surgery compared with elective procedures. Heart failure symptoms (NYHA class) improve postoperatively in the majority of patients. Aortic valve repair is effective and relatively safe, and is an alternative to the aortic valve replacement with coronary arteries reimplantation.     

主动脉根部瘤合并二尖瓣病变的外科治疗

目的:总结主动脉根部瘤合并二尖瓣病变的外科治疗经验。方法:2009年2月至2011年12月,我科实施主动脉根部替换手术合并二尖瓣置换/成形术38例。主动脉根部2例行Wheat术,其余均行Bentall术;二尖瓣6例行二尖瓣成形术(MVP),32例行二尖瓣置换术(MVR)。同期行冠状动脉旁路移植术(CABG)2例,孙氏手术4例。结果:围手术期死亡1例,病死率2.6%(1/38);1例患者发生Ⅲ°房室传导阻滞,术后植入永久起搏器;1例患者接受主动脉内球囊反搏(IABP)治疗,2例患者接受连续性肾脏替代治疗(CRRT),1例患者并发真菌感染。2例患者因术后引流多行二次开胸探查术。术后超声心动图:左心室舒张末期内径(55±11)mm(36-83mm),较术前明显缩小。结论:主动脉根部联合二尖瓣手术治疗是安全有效的,对于主动脉瓣环较大的患者,经主动脉瓣口行二尖瓣手术能够取得满意的结果。     

Valve-Sparing Aortic Root Replacement and Tricuspidization in a Patient with an Asymmetric Bicuspid Aortic Valve

Aortic valve replacement is the standard surgical procedure for severe aortic regurgitation. Due to advances over the past decade, there have been substantial improvements in aortic root graft design, in aortic valve repair techniques, and in the understanding of valvular function in the remodeled aortic root. Herein, we describe the case of a dyspneic patient with an asymmetric bicuspid aortic valve who underwent valve-sparing aortic root replacement and tricuspidization. The patient subsequently resumed strenuous physical activity and was asymptomatic 2 years after the operation.Key words: Aortic diseases/pathology/surgery/ultrasonography, aortic valve/abnormalities, aortic valve insufficiency/complications/surgery/ultrasonography, cardiac surgical procedures/methods, suture techniques, treatment outcomeThe conventional surgery for severe aortic regurgitation has been aortic valve replacement. This procedure, however, may soon become obsolete due to advances in aortic valve repair. Over the past decade, there have been substantial improvements in aortic root graft design, in aortic valve repair technique, and in the understanding of valvular function in the remodeled aortic root.^1–7 Herein, we describe the case of a patient with complex aortic root disease who underwent surgical repair.     

Valve repair in aortic regurgitation without root dilatation--aortic valve repair

BACKGROUND: Aortic valve repair was established in the context of aortic root remodeling. Variable results have been reported for isolated valve repair. We analyzed our experience with isolated valve repair and compared the results with those of aortic root remodeling. METHODS: Between October 1995 and August 2003, isolated repair of the aortic valve was performed in 83 patients (REP), remodeling of the aortic valve in 175 patients (REMO). The demographics of the two groups were comparable (REP: mean age 54.4 +/- 20.7 yrs, male-female ratio 2.1 : 1; REMO: mean age 60.8 +/- 13.6 yrs, male-female ratio 2.4 : 1; p = ns). In both groups the number of bicuspid valves was comparable (REP: 41 %, REMO: 32 %; p = ns). All patients were followed by echocardiography for a cumulative follow-up of 8204 patient months (mean 32 +/- 23 months). RESULTS: Overall in-hospital mortality was 2.4 % in REP and 4.6 % in REMO ( p = 0.62). Systolic gradients were comparable in both groups (REP: 5.8 +/- 2.2, REMO: 6.5 +/- 3.1 mm Hg, p = 0.09). The mean degree of aortic regurgitation 12 months postoperatively was 0.8 +/- 0.7 after REP and 0.7 +/- 0.7 after REMO ( p = 0.29). Freedom from significant regurgitation (> or = II degrees ) after 5 years was 86 % in REP and 89 % in REMO ( p = 0.17). Freedom from re-operation after 5 years was 94.4 % in REP and 98.2 % in REMO ( p = 0.33). CONCLUSIONS: Aortic regurgitation without concomitant root dilatation can be treated effectively by aortic valve repair. The functional results are equivalent to those obtained with valve-preserving root replacement. Aortic valve repair appears to be an alternative to valve replacement in aortic regurgitation.     

Resultados a corto y medio plazo de la técnica de Florida Sleeve en la dilatación de raíz aórtica

Introduction:

Aortic root dilatation is a frequent disease affecting mostly young patients that often requires surgical repair. Surgical techniques in young patients include aortic valve-sparing procedures to avoid prosthetic valve implant.

Objective:

The aim of this paper is to describe the results obtained in three patients with aortic root dilatation using the Florida Sleeve technique.

Methods:

From November 2015 to January 2017, three patients with severe aortic regurgitation due to aortic anuloectasic were intervened applying the Florida Sleeve technique.

Results:

Excellent postoperative results were obtained in the three cases including freedom of aortic regurgitation and any cause re-operation during three years of follow-up.

Conclusion:

The Florida Sleeve technique is a safe, reproducible technique with a learning curve and lower surgical times than traditional techniques. The medium-term clinical outcomes in terms of morbidity and mortality are good.Key words: Florida Sleeve, Aortic root dilatation, Aortic regurgitation     

Intraoperative echocardiography for surgical repair of the aortic valve and left ventricular outflow tract

Valve conservation surgery represents an exciting advance in the evolution of valve surgery. Recent studies have shown the significant advantages of mitral valve repair over valve replacement. While there are significant advantages for valve repair, the surgeon requires a greater understanding of the mechanism of valvular dysfunction prior to repair and requires an accurate means to assess the adequacy of the repair in the operating room immediately following the repair. Intraoperative echocardiography with color flow Doppler mapping provides immediate and accurate assessment of cardiac anatomy, hemodynamics, and valve integrity. These data are vital for optimal intraoperative surgical decision making. Intraoperative echocardiography has an important role in the evaluation in patients undergoing surgery to the aortic valve and left ventricular outflow tract by the delineation of presence and mechanism of left ventricular outflow tract obstruction, the quantification of severity of the left ventricular outflow tract gradient, the severity and mechanism of aortic regurgitation, the distribution and severity of left ventricular hypertrophy, and identification of associated lesions such as mitral regurgitation. Aortic valve conservation surgery is more complex than mitral valve surgery. The surgical techniques for aortic valve repair have been slower to evolve than mitral repair with a much smaller percentage of patients currently suitable for valve repair. However, with the aid of intraoperative echocardiography, the future shows similar promise that has already been fulfilled with mitral valve repair. Even in its infancy, intraoperative echocardiography has become indispensable to the innovative cardiac surgeon. However, without consideration of adequate echocardiographic training, incorrect echocardiography diagnoses can lead to inappropriate surgical decisions.