ROSS手术的进展

自体肺动脉瓣与机械瓣、异种瓣、同种异体瓣相比，有着明显的优越性。近年来，随着以自体肺动脉瓣置换主动脉辨的手术(又称Ross手术)技术的提高、术式的改良，Ross手术的适用范围不断扩大，手术死亡率、再手术率也明显下降，本文就Ross手术的进展作一综述。     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

干下漏斗部室间隔缺损的外科治疗

４６例干下漏斗部室间隔缺损，占同期室缺手术治疗的２３．２％（４６／１９８）。缺损位于肺动脉瓣下３４例，漏斗部１２例。用带垫片褥式缝合修补２１例，补片修补２５例。全组无死亡。术后直接缝合组有主动脉关闭不全２例、残余分流２例，残留杂音３例。笔者认为，适时手术，选择适当的进路、应用补片修补、正确判断和处理主动脉瓣病变及对合并肺动脉狭窄者予以流出道补片加宽，是提高本病手术疗效的关键。     

复合带瓣人工血管替换升主动脉和主动脉瓣(24例报告)

报告２４例升主动脉瘤伴主动脉瓣关闭不全行升主动脉和主动脉瓣替换及冠状动脉开口移植术（Ｂｅｎｔａｌ术２２例，底盘法２例）。１３例伴有升主动脉夹层分离，对其中８例ＤｅＢａｋｅｙＩ型者，以Ｔｅｆｌｏｎ毡条内外加固主动脉切端后吻合。１３例用人工血管周围间隙与右心耳吻合以控制升主动脉吻合之外的出血。３例以人工血管片环包主动脉吻合口控制局部广泛渗血及出血。２例术毕不能脱离体外循环死亡，手术死亡率８３％。随访平均２１８个月，２例死于蛛网膜下腔出血，１例右股动脉栓塞经手术治愈；其余病人康复良好，心功能（ＮＹＨＡ）Ｉ～ＩＩ级。     

先天性二叶式主动脉瓣12例临床分析

应用脉冲多普勒超声心动图诊断１２例先天性二叶式主动脉瓣患者。全组病例主动脉瓣半闭呈一条线状，二叶纵裂式７例，二叶横裂式５例，主动脉瓣赘生物９种，瓣膜钙化８例，收缩期湍流４例，舒张期湍流７例，偏心指数（ＥＩ）≥１．５者７例，≥１．３者９例，本病临床表现无特殊，对诊断意义不大。     

主动脉瓣下孤立性左室憩室合并感染性心内膜炎1例

病儿 男，16岁反复发热、气促1个月，曾行不规则抗炎治疗，症状不能控制并出现心包压塞，心包穿刺引流出大量血性积液。心脏B超示主动脉一左室隧道和大量心包积液。螺旋CT诊断为左室憩室并破入心包(图1）由于病儿不能平卧，未能行主动融和左室造影。     

彩超诊断主动脉瓣二叶畸形1例

患者男,16岁.心慌、气短5 d来诊.查体:生长、发育正常,心界向左下扩大,心尖搏动减弱.     

同种异体主动脉瓣,肺动脉瓣及大隐静脉的采集及保存

同种异体材料应用研究近几年来取得了长足的进展，本文就其采集，贮存，抗菌素的应用，冷冻法，解融等详细的论述，并对目前仍存有的问题提出了看法。