自体肺动脉瓣移植术治疗先天性主动脉病变的麻醉体会

我院自1994年10月至2004年5月,完成了28例先天性主动脉病变行自体肺动脉瓣移植术（ROSS）的麻醉,此类手术在麻醉处理上有其特点,现将麻醉体会报道如下。     

应用自体肺动脉瓣置换主动脉瓣二例

1998年 3月～ 1999年 1月 ,我们对 2例先天性主动脉瓣狭窄患者施行了自体肺动脉瓣置换主动脉瓣、同种肺动脉瓣(HPV)原位右心室流出道重建 (Ross)手术 2例 ,取得了良好的临床效果。1　临床资料与方法1.1　一般资料　 2例中男、女各 1例 ;年龄分别为 12岁和 16岁。均为先天性主动脉瓣狭窄。 1例有心前区疼痛和头晕史。心电图示左心室肥厚 ,ST- T改变。心胸比率 0 .49和 0 .5 6。超声心动图示主动脉瓣中度至重度狭窄 ,均为二瓣化畸形。1.2　手术方法　开胸后测量主、肺动脉瓣环外径 ,分离主、肺动脉间隔至左、右肺动脉分叉处。在主动脉瓣上 …     

自体肺动脉瓣替换主动脉瓣

自体肺动脉瓣替换主动脉瓣伍火志述李温仁审校由于人工合成瓣膜的缺点［１］和同种瓣膜的缺点［２］，使自体瓣膜成为有吸引力的代用品。１９６０年Ｌｏｗｅｒ等［３］将狗的肺动脉瓣移植到降主动脉并获得成功。Ｐｉｌｌｓｂｕｒｙ等［４］用动物自体的肺动脉瓣替换主动脉...     

应用自体肺动脉瓣替换主动脉瓣3例

应用自体肺动脉瓣替换主动脉瓣３例程沛周其文陈英淳韩玲曹嘉湘作者单位：１０００２９首都医科大学附属北京安贞医院小儿心外科１９９４年１０月至１９９６年１０月期间我们共完成３例自体肺动脉瓣替换病变的主动脉瓣手术，现报告如下：临床资料３例病人中男２例，女１例...     

自体肺动脉瓣替换主动脉瓣手术配合

自体肺动脉瓣替换主动脉瓣术 (ＲＯＳＳ手术 )是将病人自体肺动脉瓣移植替换其病变的主动脉瓣的方法。该术式操作较复杂 ,对术者的手术技巧要求甚高。我院 1998年 3月至 2 0 0 1年 9月共完成ＲＯＳＳ手术 10例 ,现将手术配合报告如下。1　资料与方法1.1　一般资料10例中 ,男 5例、女 5例 ,年龄 4～ 34岁 ,平均13 6岁。均因发现心脏杂音入院。诊断为主动脉瓣二瓣化畸形伴狭窄 4例 ,主动脉瓣狭窄合并室间隔缺损 1例 ,主动脉瓣狭窄合并动脉导管未闭 2例 ,单纯主动脉瓣狭窄 3例。1.2　手术方法①取肺动脉瓣。建立体外循环后不阻断升主动脉 ,于左…     

自体肺动脉瓣替换主动脉瓣手术226例临床分析

自体肺动脉瓣替换病变主动脉瓣(Ross)手术自1967年被首次应用于临床并取得了长期效果。本研究对吕贝克医科大学心脏外科11年来Ross手术临床经验进行总结。     

主动脉瓣四叶瓣畸形伴主动脉瓣病变的外科治疗

主动脉瓣四叶瓣畸形伴主动脉瓣功能障碍的病例罕见 ,现对我们外科治疗的 4例主动脉瓣四叶瓣畸形伴主动脉瓣狭窄或 (和 )关闭不全病例报道如下。临床资料　 4例中男 3例 ,女 1例。年龄 2 7～ 39岁。劳累后心悸、气短病程 1～ 5年。 3例主动脉瓣第 2听诊区均闻及舒张期泼水样杂音 ,脉压差 5 0～ 10 0ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ) ,1例主动脉瓣听诊区可闻及收缩期喷射样杂音。心电图显示均为窦性心律 ,3例左室扩大 ,1例左室劳损。Ｘ线胸片显示 3例左室扩大 ,心胸比率 0 5 3～ 0 71。多普勒超声心动图提示 ,3例左室明显扩大 ,1例左室向…     

自体肺动脉瓣移植术的手术配合

<正>自体肺动脉瓣移植术治疗主动脉瓣患者,包括主动瓣病变狭窄和关闭不全(ROSS手术)远期效果好于人工瓣膜(机械瓣、生物瓣)置换术,手术的最大优点为术后不用抗凝药治疗,可以随机体的发育而生长,无明显血栓栓塞并发症,使病人生活质量大大提高,尤其适应儿童和育龄妇女,是主动脉瓣病变的最理想的替代物。但手术操作复杂,难度大,2003年2月23日我院成功实施了1例ROSS手术,现将手术配合体会报告如下:     

自体主动脉瓣移植纠治完全性大血管错位伴肺动脉瓣狭窄

目的探讨解剖纠治完全性大血管错位（TGA）伴肺动脉瓣狭窄的手术方法。方法1例8月龄、体重6．5kg的TGA伴肺动脉瓣狭窄男病婴，术中将原主动脉瓣移植至肺动脉瓣处形成新的主动脉；再行Switch术，同种带瓣管道连接右心室与肺动脉。另1例10月龄、体重9．8kg的该病男病婴，术中将整个主动脉瓣取下，保留左、右冠状动脉，向后移植，后半部分直接与原肺动脉瓣环连续缝合，前半部分与室间隔缺损之间采用dacron补片连续缝合关闭；肺动脉与右心室切口直接连接。结果2例手术均取得成功。出院时超声检查各吻合口通畅，无残余分流．无主动脉瓣反流。术后随访12个月和6个月，生长发育良好，心胸比率0．75。超声示左心功能良好，前例示主动脉瓣轻度反流．后例左、右心室流出道无残余梗阻．结论采用自体主动脉瓣移植纠治完全性大血管错位伴肺动脉瓣和瓣下狭窄，从解剖上得到彻底纠治．效果良好。由于病例少，随访时间短．还需进一步观察。     

自体心包片加高法治疗主动脉瓣脱垂

目的总结用自体心包加高方法矫正主动脉瓣脱垂的临床经验。方法2000年5月至2007年7月,阜外心血管病医院共对17例主动脉瓣脱垂患者施行自体心包片加高手术,其中主动脉右冠瓣脱垂15例,左冠瓣脱垂1例,无冠瓣脱垂1例;主动脉瓣中度反流10例,重度反流7例。取自体心包,用5-0或6-0 Prolene线连续缝合加高脱垂的主动脉瓣。术中经食管超声心动图（TEE）检查提示：主动脉瓣微量至少量反流;对术前、术后超声心动图检查结果进行比较。结果术前、术后超声心动图检查结果比较：术后左心室舒张期末内径较术前明显缩小（38．3±9．6mm vs．47．2±10．3mm,P=0．013）;主动脉瓣收缩期压差（9．8±5．6mmHg vs．10．3±5．3mmHg,P=0．792）,主动脉瓣舒张期压差均较术前有明显缩小（45．7±13．6mmHg vs．78．4±19．9mmHg,P=0．000）。出院前超声心动图检查提示：无明显主动脉瓣反流4例,轻度反流9例,轻至中度反流4例。平均随访32个月（4～74个月）,1例术后4个月因主动脉瓣大量反流行主动脉瓣置换术,其余患者均不需要进行二次手术。结论主动脉瓣瓣叶自体心包加高成形其手术方法简便,对儿童或小主动脉瓣患者是一种良好的手术方式。     

Ross 手术治疗先天性主动脉瓣膜疾病

目的　总结 Ross手术治疗先天性主动脉瓣膜疾病的临床经验和手术结果。　方法　自 1998年 3月至2 0 0 2年 7月 ,16例主动脉瓣膜疾病患者 (平均年龄 14 .0± 9.9岁 )接受 Ross手术 ,即自体肺动脉瓣移植术。诊断为主动脉瓣二瓣化畸形 ,主动脉瓣狭窄 9例 ,主动脉瓣发育不良呈穹隆状狭窄 2例 ;主动脉瓣脱垂 5例 ,其中合并室间隔缺损和动脉导管未闭各 1例。　结果　无手术死亡 ,全部患者治愈出院。随访 1～ 4 8个月 ,平均 30± 13个月 ,无远期死亡 ,无瓣膜相关并发症。所有患者心功能 级。超声心动图提示主动脉瓣及同种肺动脉瓣功能良好 ,仅 1例患者主动脉瓣有极少量反流 ;所有患者主动脉瓣跨瓣压差 2 .1± 0 .8mm Hg(1k Pa=7.5 mm Hg) ,左心室流出道及主动脉瓣环随着年龄的生长而增长 ,平均瓣环直径较术后增加 4 .0± 2 .1mm。　结论　 Ross手术治疗主动脉瓣膜疾病安全 ,效果好 ,随机体发育而生长 ,可适于某些主动脉瓣瓣膜疾病 ,尤其适于小儿及年轻患者。     

一种新的大鼠同种主动脉瓣异位移植模型

目的 探讨建立一种主动脉瓣异位移植动物模型，用于研究同种心脏瓣膜的保存。方法 受体供体均采用雌性Wistar大鼠，各40只。整块切取受体心脏。保留完整的t动脉瓣、少量心室肌和部分二尖瓣前叶，构建移植物。将移植物与受体腹主动脉端一侧吻合。结果 术后28d，80％受体存活，无下肢瘫痪，移植物搏动良好，切开移植物肉眼观未见血栓，主动脉瓣位于正常位置且活动良好。受体死亡原因有血栓栓塞（12．5％）、术中出血（5．0％）和麻醉意外（2．5％）。结论 此模型可广泛应用于同种心脏瓣膜保存方法等研究，是较理想的模型。     

主动脉瓣置换术后患者再次主动脉外科干预47例

目的 回顾性分析47例主动脉瓣术后再次主动脉外科治疗病例,提高对主动脉瓣术后主动脉疾病再治疗的认识.方法 2003年1月至2012年6月,47例患者因主动脉瓣术后接受再次主动脉手术治疗.男38例,女9例,再次手术间隔时间(6.0±3.8)年.行主动脉根部替换14例,升主动脉替换10例,主动脉根部/升主动脉+全弓替换+象鼻支架置入术21例,全胸腹主动脉替换2例.所有出院患者均行门诊复查和电话随访.结果 47例患者中主动脉夹层25例(53％),升主动脉瘤12例(26％),主动脉根部瘤10例(21％).风湿性心脏病患者升主动脉直径年增长值高于马方综合征患者(P＜0.05).47例均接受外科手术治疗,术中死亡1例;余患者均出院并随访,随访时间(53.49±33.79)个月,3年生存率83％.结论 对马方综合征、风湿性心脏病等主动脉瓣疾病合并主动脉病变要积极干预、严格随访,减少术后主动脉不良事件.     

A difficult case of retrieval of an aortic valve and balloon during a transcatheter aortic valve implantation

INTRODUCTIONTranscatheter aortic valve implantation (TAVI) represents an emerging therapy for valve replacement in patients not suitable for traditional open repair. As awareness of the procedure grows, case numbers are increasing worldwide. Though this procedure represents a less invasive approach to aortic valve replacement, it is not without complications.PRESENTATION OF CASEThis case presentation describes a serious, previously unreported, complication incurred in an 83-year-old male in whom TAVI was attempted. During deployment of the valve at the aortic annulus, both the valve and accompanying balloon embolised into the thoracic aorta and this was further complicated by migration of the balloon into the abdominal aorta and an aortic dissection. The false lumen of the dissection at the level of the infrarenal aorta was tacked to the aortic adventitial wall using interrupted sutures through a laparotomy. A completion angiogram demonstrated that a flow limited dissection did extend up to both common iliac arteries. This was managed with balloon-expandable covered stents deployed in both common iliac arteries with satisfactory outcome.DISCUSSIONThis case occurred as a combination of multiple factors that include lack of burst pacing and poor timing of the balloon inflation. The aortic balloon and the valve had to be removed urgently to avoid ventricular embolization of these structures that can result in a fatal situation.CONCLUSIONThis case presentation describes the management of these complications using a combined open and endovascular approach in a well-equipped hybrid operating theatre, resulting in the patient survival.     

Our experience with aortic root replacement using hand-sewn composite valve graft

Background The purpose of this study is to examine our experience with aortic root replacement using composite valve grafts in patients with proximal aortic disease. Methods and Results Since 1986, 16 patients underwent aortic root replacement using composite valve grafts for various indications which were Marfan's syndrome with annuloaortic ectasia (n=2), aortic regurgitation with ascending aortic aneurysm (n=3), aortic stenosis with regurgitation with poststenotic dilatation (n=9) and progressive aortic dilatation following AVR (n=2). There were 12 males and 4 females. The age range varied between 19 years and 52 years. The choice of conduit was a custom made valved graft using a monoleaflet tilting disc valve (Medtronic Hall valve=11, St Vincent's valve=3, TTK Chitra=1 and Bjork Shiley Valve=1) placed in a Dacron graft (Hemashield=13, Verisoft Cooley=3) prepared using a 4-0 polypropylene suture. The average time taken to construct a valved graft was 20 min±8 min. The coronary implantation was by isolated button technique. There was no size mismatch encountered in any patients. Postoperative bleeding necessitated a delayed sternal closure in 3 patients and re-exploration in another 2. The immediate operative mortality was 2, the cause being ventricular arrhythmia in one and cerebrovascular accident in other. Follow-up period ranged from 2 months to 16 years with a median follow-up of 12 months. One patient had an asymptomatic perigraft collection and no intervention was needed. There was no valve related complications in any of these patients. There was one late death of unknown cause. Conclusions Aortic root replacement using a custom made composite graft offers excellent long-term results, with negligible mortality rate and prosthesis related complications. Custom made grafts make this conduit easily affordable in our country and their performance is comparable to other available composite grafts.     

经导管植入国产自膨式主动脉瓣膜治疗老年性主动脉瓣狭窄(附3例报告)

正75岁以上的老年人退行性心脏瓣膜病发病率高达4.6%~([1])。老年性主动脉瓣狭窄(aortic valve stenosis,AS)发病率越来越高。目前外科主动脉瓣膜置换术(surgery aortic valve replacement,SAVR)仍是治疗重度AS的首选方法,但30%~50%的患者因存在严重合并症、无法承受外科手术而出现心力衰竭和心源性猝死。2002年Cribier等~([2])采用经导管主动     

Pulmonary trunk perforation during transapical minimal invasive aortic valve replacement

In this case report we illustrate our experience with a perforation of the pulmonary trunk during a transapical aortic valve implantation in a single case. The patient suffered from an aortic valve stenosis and was accepted for a minimally invasive procedure because of multiple comorbidities. After unproblematic transapical placement of the aortic valve, a venous bleeding from the anterolateral wound was observed. Median sternotomy showed a bleeding out of the pulmonary trunk that could be stopped with purse-string sutures. The further course of the patient was uneventful.