室间隔夹层瘤的超声诊断(附4例报告)

目的 总结室间隔夹层瘤的超声心动图诊断及临床应用价值。方法1985～2005年超声诊断罕见的室间隔夹层瘤4例。超声主要取左室长轴、四腔心、五腔心、大动脉短轴及非标准切面，观察主动脉窦的形态及结构：如扩张窦瘤的大小、窦壁厚度、窦瘤破口的部位、窦瘤破口与室间隔之间的关系，主动脉窦瘤与室间隔夹层瘤之间交通口的大小，测量形成室间隔夹层瘤的大小及夹层瘤左、右室面的厚度，结合彩色多普勒观察心动周期夹层瘤与主动脉窦瘤血流动态变化，频谱多普勒测量窦瘤与室间隔夹层瘤之间的血流速度。结果4例室间隔夹层瘤均为主动脉右窦破人室间隔基底段，且均行手术治疗证实超声诊断。结论超声心动图对室间隔夹层瘤可直接做出诊断，超声诊断价值在于早发现、早诊断、及早治疗，并可为外科选择手术方式提供重要的有价值的依据。     

主动脉窦瘤破裂的治疗体会

本文报告主动脉窦瘤１３例，突然发病１０例，隐伏起病１例，无症状２例。窦瘤破入右室４倒，右房７例，突入右房和右室流出道未破各１例。全部病例在低温体外循环下行直接缝合修补或补片修补术，窦瘤合并室间隔缺损３例，同时予以修补。１３例均康复出院。     

25例主动脉窦破裂的手术修复及合并畸形处理

作者报告２５例主动脉窦瘤破裂修复手术，术前２２例经主动脉造影确诊。主要合并畸形有室间隔缺损１８例，主动脉瓣关闭不全１０例。手术死亡２例，作者强调：（１）重视术中心肌保护，（２）用同一补片修复破裂的主动脉窦瘤和室间隔缺损；（３）重度主动脉瓣关闭不全倾向作了主动脉瓣置换（４）加强重危病人围术期处理。     

主动脉窦瘤破裂12例外科治疗

本文报道12侧主动脉窦瘤破裂的外科治疗体会。表组合并室间隔缺损5例,主动脉关闭不全5例,细菌性心内膜炎2例。11例为右冠窦瘤破入右室或右房,1例为左和无冠窦瘤破入左室流出道。全组病例行直接或补片修补窦瘤,并补片修补室间隔缺损,对主动脉瓣关闭不全采取成形2例,2例主动脉瓣置换术。手术死亡1例。文中对其诊断、手术时机、心肌保护、手术方法进行了讨论。     

主动脉窦瘤破裂12例外科治疗

本文报道12例主动脉窦瘤破裂的外科治疗体会。本组合并室间隔缺损5例，主动脉关闭不全5例，细菌性心内膜炎2例。11例为右冠窦瘤破入右室或右房，1例为左和无冠窦瘤破入左室流出道。全组病例行直接或补片修补窦瘤，并补片修补室间隔缺损，对主动脉瓣关闭不全采取成形2例，2例主动脉瓣置换术。手术死亡1例。文中对其诊断、手术时机、心肌保护、手术方法进行了讨论。     

主动脉窦瘤的外科治疗

主动脉窦瘤的外科治疗王介康，龚宝生，王晓舟，邱兆昆我们自１９８３年１月至１９９３年１２月共手术治疗８１例主动脉窦瘤破裂病人。临床资料本组８１例中男６１例，女２０例。年龄１５～６５岁。８１例中仅２例无症状，３例为外院手术后复发，２３例有心衰，并发室间隔...     

感染性心内膜炎外科治疗60例

１９８０年３月以来,我们手术治疗感染性心内膜炎６０例,无手术死亡,现总结治疗体会如下：临床资料６０例中男４１例,女１９例。年龄７～５０岁,平均３０岁。其中先天性心脏病１９例,包括室间隔缺损１３例,主动脉窦瘤３例（２例窦瘤破裂,１例伴主动脉瓣狭窄关闭不...     

主动脉窦瘤破裂52例手术治疗

我们对 52例主动脉窦瘤病人的手术方法及手术效果作了回顾性分析 ,现报道如下。资料和方法　 1 994年 6月至 2 0 0 1年 6月 ,我们收治主动脉窦瘤破裂病人 52例 ,其中男 31例 ,女 2 1例 ;年龄 7～ 66岁 ,平均 2 9岁。主动脉右冠状动脉窦瘤 46例 ,无冠状动脉窦瘤 5例 ,左冠状动脉窦瘤 1例。窦瘤破入右室 46例 ,破入右房 5例 ,破入左室 1例。主动脉窦瘤合并主动脉瓣关闭不全 31例 ,合并室间隔缺损 2 3例 ,房间隔缺损 2例 ,三尖瓣关闭不全 2例 ,二尖瓣关闭不全 1例 ,ＩＩＩ度房室传导阻滞 1例 (有多种畸形同时并存 )。发生感染性心内膜炎 7例。…     

50例先天性主动脉窦瘤的外科治疗

总结先天性主动脉窦瘤外科治疗经验。方法：先天性主动脉窦瘤５０例,合并室间隔缺损３１例,主动脉瓣脱垂１４例。行窦瘤切除修补术１７例,窦瘤切除加定夺缺修补１９例,窦瘤切除加主动脉瓣成形１２例,主动脉瓣替换２例。结果：全组无手术死亡,无残余分流。结论：心脏超声对ＣＡＳＶ诊断准确率高。     

主动脉窦瘤破裂的诊断与治疗

目的:探讨主动脉窦瘤破裂的诊断和手术治疗的临床经验。方法:回顾性分析总结收治的12例主动脉窦瘤破裂的临床经验,其中合并室间隔缺损2例,主动脉瓣关闭不全5例。手术时窦瘤直接缝合4例,补片修补8例,其中同一补片修补主动脉窦瘤破口和室间隔缺损2例,同期行主动脉瓣悬吊成形术2例。结果:全组无死亡,随访1～5年,恢复良好。结论:主动脉窦瘤破裂一旦确诊,应尽早手术治疗。     

Surgical treatment of dissecting aneurysm of the interventricular septum.

OBJECTIVE: We reviewed our experience in the surgical treatment of an extremely rare disease, dissecting aneurysm of the interventricular septum (DAIS). The definition of DAIS is that the interventricular septum is dissected and forms an aneurysm which bulges into both the left and right ventricles, causing obstruction of both ventricular outflow tracts. It communicates with the aortic root, and may communicate with the ventricle. It is usually associated with aortic valve regurgitation and aortic annular enlargement. DAIS might also be related to the sinus of Valsalva aneurysm [Ann Thorac Surg 65 (1998) 735; Ann Thorac Surg 51 (1991) 996; Eur J Thorac Surg 12 (1997) 759]. But in three of our six patients DAIS was not associated with sinus of Valsalva enlargement or aneurysm. METHODS: Between May 1992 and November 2000, six of 30,701 patients were diagnosed with DAIS, and underwent surgery at Fu Wai Hospital in Beijing. Aortic valve replacement was performed in five patients, and the perforation at the bottom of the right sinus of Valsalva was repaired in one. The aneurysm was resected simultaneously in all these patients. RESULTS: One of the six patients required re-operation. And all patients recovered uneventfully without hospital mortality. CONCLUSIONS: DAIS has a progressive course and poor prognosis. Early diagnosis and surgical treatment are mandatory.     

Congenital aneurysm of the sinus of Valsalva dissecting into the interventricular septum

The case of a 57-year-old man with a congenital aneurysm of the right sinus of Valsalva dissecting into the interventricular septum is presented. The patient had a previous heart block and aortic insufficiency. The diagnosis was made by echocardiography and cardiac catheterization. Open-heart surgery was performed, closing the entrance of the aneurysm and replacing the aortic valve. The patient survived surgery and is in New York Heart Association functional class II 3 years after surgical repair. Other cases of this uncommon congenital heart disease are reviewed.     

主动脉窦瘤破裂的外科治疗及远期疗效

目的 总结主动脉窦瘤破裂的临床特点及外科疗效,讨论对合并感染性心内膜炎及主动脉瓣关闭不全患者的处理.方法 回顾性分析1997年9月至2007年9月43例主动脉窦瘤破裂患者的临床资料.其中男性32例,女性11例;年龄11～50岁,平均年龄(29.0±11.5)岁.破口源于右冠状动脉窦34例,无冠状动脉窦9例.破入有心室30例,右心房8例,右心室及右心房3例,破人室间隔2例.合并室间隔缺损26例,主动脉瓣关闭不全15例,感染性心内膜炎8例,三尖瓣反流6例,房间隔缺损4例,二尖瓣反流2例,动脉导管未闭2例,肺动脉赘牛物1例.全部患者于心肺转流下行窦瘤修补及合并畸形矫治术.结果 无围手术期死亡.并发症5例,包括急性左心功能衰竭3例,Ⅲ度房室传导阻滞2例.随访6～120个月,平均(68.0±17.7)个月;2例分别于术后第6、8年行主动脉瓣置换术,2例进展为Ⅱ级主动脉瓣父闭小全.结论 主动脉窦瘤破裂外科治疗可获得满意效果.对合并主动脉瓣关闭小全及感染性心内膜炎的患者应早期手术,积极防治术后并发症并长期随访.     

Surgical treatment of aortic root aneurysm associating with infectious endocarditis

From 1979 to 1989, aortic root aneurysms were encountered in 6 of the 30 patients who underwent surgical treatment for infectious endocarditis. Four patients underwent aortic valve replacement and direct or patch closure of the orifice of aortic root aneurysm. In additional 2 patients with infected aneurysm of right coronary sinus of Valsalva rupturing into the right ventricle, the aneurysm and infected tissue in the right ventricular outflow tract were completely resected and the defect of aortic sinus and VSD were closed with double Teflon fabric patches. All patients survived postoperatively, however, one patients died 1.5 months after the operation probably due to rupture of mycotic aneurysm of cerebral artery. Another late death seemed to be concerned with recurrent aortic root aneurysm, in which case direct closure of aneurysm had been performed. We believe that even if the aneurysm seems to be small, its orifice should be closed with the use of a fabric patch to prevent recurrent aneurysm formation.     

冠状动脉瘤的外科治疗

目的 介绍冠状动脉瘤的临床表现及治疗经验。方法 1996年10月－2000年5月,对6例患者行冠状动脉瘤手术,3例为川崎病,3例为冠状动脉瘘;均行冠状动脉旁路移植术,3例冠状动脉瘘患者同时切除冠状动脉瘤,修补冠状动脉瘘口,1例行主动脉瓣置换术。结果 6例患者无住院死亡和严重并发症。随访无异常。结论 冠状动脉瘤是一较为罕见的心脏病,预后差,应尽早手术治疗。手术原则是切除冠状动脉瘤,行冠状动脉旁路移植术并处理好合并病变。     

Surgical repair of postoperative left sinus of Valsalva aneurysm dissecting into the interventricular septum

We describe the dissection of the interventricular septum by unruptured aneurysm of the left sinus of Valsalva in a patient who had undergone aortic valve replacement for rheumatic aortic valve insufficiency 5 years previously. The patient had worn a permanent pacemaker for 1 year to manage complete atrioventricular block. Sufficient information was provided by echocardiography and aortography to confirm the diagnosis. Operative correction consisted of obliteration of the aneurysm sac and closure of the outward orifice with a Dacron patch from the side of the aortic sinus.     

Aneurysm of the right sinus of Valsalva after aortic valve replacement in Takayasu arteritis

We herein report a case with an aneurysm of the right sinus of Valsalva, which developed 14 years after an aortic valve replacement (AVR) for aortic regurgitation caused by Takayasu arteritis. The aortic wall around the right coronary artery ostium showed calcification, as a result, the modified Bentall procedure and coronary artery bypass to the right coronary artery were successfully performed. A pathological study of the resected aortic sinus wall showed a disruption of the elastic fibers in the media, granuloma formation, and a marked proliferation of the collagen fibers in the adventitia, and these findings were compatible with Takayasu arteritis. The development of an aneurysm of the sinus of Valsalva late after AVR indicates the necessity of a close and lifelong follow-up for patients with Takayasu arteritis, especially focusing on the aortic root morphology.     

Sinus of valsalva aneurysm in Blau's syndrome

Blau syndrome is a rare granulomatous disorder inherited in an autosomal dominant manner characterized by the early appearance of granulomatous arthritis, skin rash and anterior uveitis. There are very few data on the cardiovascular manifestations of Blau syndrome. Here we report the first case of sinus of valsava aneurysm in Blau syndrome. In isolated unruptured aneurysms of a sinus of Valsalva without compromise of the aortic valve and/or the coronary ostia, repair may be accomplished by simple placation of the aneurysm or excision of the aneurysm(s) and patch closure of the defect(s) between the aortic annulus and the sinu-vascular ridge. Because of the particular conditions in our case, the repair was performed with replacement of the aortic valve and root using a composite graft employing a modified Bentall's technique.     

外科治疗主动脉窦瘤70例的远期疗效分析

目的　总结 70例主动脉窦瘤的外科治疗经验。方法　 1988年 9月～ 2 0 0 3年 10月收治主动脉窦瘤患者 70例 ,占同期所有体外循环手术病例的 1 4 % ( 70 /496 0 ) ,其中男性 4 5例 ,女性 2 5例 ,年龄 3～ 6 9岁 [平均 ( 2 9± 15 )岁 ]。窦瘤突入右心室 4 6例、右心房 2 3例、左心室 1例。起源于右冠状动脉窦者 6 1例 ( 87% ) ,无冠状动脉窦者 9例 ( 13% )。最常见的合并畸形为室间隔缺损 ( 34例 )和主动脉瓣关闭不全 ( 2 1例 )。手术采用单一右心房、右心室或主动脉切口或主动脉切口与右心房、右心室联合切口 ,直接缝合 ( 4 3例 )和补片修补 ( 2 7例 )闭合主动脉窦部缺损 ,术中行主动脉瓣置换术6例。结果　无术后早期死亡。 1997年以前术后住院天数为 8～ 33d[平均 ( 14 3± 6 4 )d],1997年以后术后住院天数为 6～ 15d[平均 ( 9 1± 2 6 )d]。术后并发切口感染 4例、出血 3例、气胸 1例、心律失常 4例和室间隔缺损修补术后残余漏 1例。随访 5 3例 ( 76 % ) ,随访时间 2个月～ 13年 [平均( 6 6± 3 8)年 ],除 1例术后 7年死于主动脉夹层破裂外 ,全部存活 ,心功能为NYHA分级Ⅰ～Ⅲ级 ;合并主动脉瓣关闭不全者 ( 15例 )较未合并主动脉瓣关闭不全者 ( 38例 )心功能差 ( χ2 =8 30 ,P <0 0 1) ,主动脉窦