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.     

两种封堵器治疗主动脉窦瘤破裂的疗效及安全性

目的探讨应用动脉导管未闭(PDA)封堵器和室间隔缺损(VSD)封堵器治疗主动脉窦瘤破裂的疗效和安全性。方法对19例主动脉窦瘤破裂患者,按所用封堵器分为PDA封堵器组和VSD封堵器组,根据升主动脉造影结果,选择比破口直径大2~5mm的PDA封堵器或VSD封堵器进行经导管介入封堵。术后随访观察临床症状、心电图、残余分流、封堵器形态、有无瓣膜反流等情况。结果两组患者年龄、发病时间和术前TTE所示破口直径、主动脉造影示破口直径差异均无统计学意义(P均0.05)。19例均经升主动脉造影确诊为主动脉窦瘤破裂,其中15例右冠状动脉窦瘤破裂入右心室,3例为右冠状动脉窦瘤破裂入右心房,1例无冠状动脉窦瘤破裂入右心室;共使用PDA封堵器10枚,VSD封堵器11枚,成功率分别为60.00%(6/10)和90.91%(10/11)。术后随访6个月~6年,未发生血栓事件,无瓣膜反流,无心律失常、感染性心内膜炎、心力哀竭及死亡。结论经导管介入治疗主动脉窦瘤破裂安全有效;应用VSD封堵器较PDA封堵器有一定优势。     

经导管封堵主动脉窦瘤破裂

目的探讨经导管介入封堵主动脉窦瘤破裂的临床疗效。方法7例主动脉窦瘤破裂患者,5例为主动脉无冠状动脉窦（无冠窦）破裂至右心房,2例为主动脉右冠状动脉窦（右冠窦）破裂至右心室。对5例患者经同侧的右股动、静脉建立轨道,应用PDA单盘蘑菇伞封堵器进行封堵;对2例患者经同侧右桡动脉及右股静脉建立轨道,置入“细腰大边”的室间隔封堵器。结果7例患者均封堵成功,技术成功率100％;仅2例患者出现微量残余分流,术后2天心脏超声证实完全封闭,无相关并发症。术后1、3、6个月超声心动图显示舒张末期左心室内径均较术前明显改善,封堵器形态、位置良好,无残余分流及主动脉瓣反流。结论介入封堵主动脉窦瘤破裂微创、有效,近期疗效尚满意,中远期的疗效有待进一步随访观察。对于合并心力衰竭或心功能控制不满意的患者,经桡动脉建立轨道是有益的尝试。     

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。…     

主动脉窦瘤破裂的外科治疗

目的 总结1973－1999年85例主动脉窦瘤破裂的外科治疗经验。方法 主劝脉窦瘤破裂85例,合并室间隔缺损40例（47．1％）,主动脉瓣关闭不全15例（17．6％）,均以补片行动脉窦瘤修补,其中40例以同一补片修补主动脉窦瘤和室间隔缺损,5例同期行主动脉瓣置换术,3例行主动脉瓣成形术。结果 全组死亡3例,死亡率3．5％,无残余分流等并发症,71例随访2个月－24年,心功能恢复良好。结论 主动脉窦瘤破裂一经确诊,应尽早手术,采用补片修补主动脉窦瘤及用同一乒乓球拍形补片修补窦瘤和室间隔缺损,效果较好,对于严重的主动脉瓣关闭不全,应同期行主动脉瓣置换术,而轻度主动脉瓣关闭不全可不用特殊处理。     

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。     

主动脉窦瘤破裂的外科治疗

主动脉窦瘤破裂的外科治疗景华，高声甫，周采璋，丁永清，张石江，李忠东我们自１９８１年１月至１９９２年８月共行手术治疗主动脉窦瘤破裂（ＲＡＳＶ）１７例，均获满意疗效。现报道如下：临床资料本组病人中，男１０例，女７例。年龄１１～４７岁（平均２２．６岁）。...     

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。     

主动脉窦瘤破裂的外科治疗

目的 总结主动脉窦瘤破裂的外科治疗经验.方法 83例主动脉窦瘤破裂患者均在气管内插管静脉复合麻醉中度低温体外循环下行主动脉窦瘤修复术,同时矫治合并的心内畸形,包括行主动脉瓣置换术20例,主动脉瓣成形术9例,三尖瓣成形术4例,肺动脉瓣重建术2例,室间隔缺损修补术37例,房间隔缺损修补术5例,右心室流出道疏通2例,右室双腔心矫治术1例.结果 本组无手术死亡.术后并发心力衰竭2例,再次开胸止血4例,均经治疗后痊愈.所有患者均得到随访,随访时间1个月～6年,平均随访25.6个月.心功能Ⅰ～Ⅱ级.心脏彩色超声心动图复查未发现主动脉窦瘤复发或残余分流,主动脉瓣轻度反流2例,轻至中度反流2例;术后6年主动脉瓣重度反流1例,再次行主动脉瓣置换术.结论 主动脉窦瘤破裂预后不良,尽早手术是治疗主动脉窦瘤破裂惟一有效的治疗方法.治疗的关键是恰当切除瘤体,可靠闭合窦瘤口,彻底矫治心脏畸形.     

先天性主动脉窦瘤破裂手术治疗体会

1996年6月至2005年3月，本院共收治了主动脉窦瘤破裂（RASV）20例，手术效果满意，总结报道如下。     

主动脉窦瘤破入右心房的外科治疗效果

目的 总结主动脉窦瘤破入右心房的外科治疗经验,比较经右心房切口、右心房联合主动脉切口两种途径修补的结果.方法 2004年1月至2009年12月共对53例主动脉窦瘤破入右心房的患者进行了外科手术,其中男性35例,女性18例;年龄15～63岁,平均(33±9)岁.其中经右心房途径修补40例(Ⅰ组);经右心房联合主动脉切口修补13例(Ⅱ组).比较两组在心肺转流时间、主动脉阻断时间、呼吸机辅助时间、ICU时间、术后住院时间方面的差异.结果 两组在心肺转流时间[(86±29)min比(96±30)min]、主动脉阻断时间[(59±29)min比(71±25)min]、呼吸机辅助时间[(9±4)h比(161±23)h]、ICU时间[(35±23)h比(35±23)h]、术后住院时间[(7.1±0.9)d比(7.8±2.8)d]方面的差异无统计学意义(P＞0.05).随访1～64个月,平均(32±21)个月.术后随访无死亡,1例术前合并感染性心内膜炎的患者,术后6个月出现主动脉瓣大量反流需手术治疗;1例术后44个月查出冠状动脉粥样硬化性心脏病应用药物治疗,其余患者心功能(NYHA分级)Ⅰ～Ⅱ级.结论 外科治疗主动脉窦瘤破入右心房可取得良好的疗效,经右心房切口、右心房联合主动脉切口两种途径修补效果相当.     

A new and simple classification for the non-coronary sinus of Valsalva aneurysm

Objective: We introduce a simple classification of the non-coronary sinus of Valsalva aneurysm, and suggest a different approach for the corresponding type of non-coronary sinus of Valsalva aneurysm. Methods: Between October 1996 and December 2009, 45 patients with non-coronary sinus of Valsalva aneurysm underwent surgical repair. Twenty-three were male and 22 female. The mean age was 32.80 ± 11.77 years (range, 13–67 years). We divided them into two types, type I: rupture or protrusion into right atrium; and type II: rupture or protrusion into right atrium or right ventricle near or at the tricuspid annulus. For type I (n = 32), the right atrium approach was chosen, using direct suture with patch repair. For type II (n = 13), the transaortic approach with right atrium incision was chosen, with patch repair through an aortic incision and direct suture through a right atrium incision. Surgical results between types I and II were compared as regards cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, and intensive care unit time, and postoperative stay time. Results: There was no early death after operation. There were no significant differences in cardiopulmonary bypass time, mechanical ventilation time, intensive care unit time, and postoperative stay time between two types (p > 0.05). There was significant difference in clamp aorta time, with type II being longer than type I (p < 0.05). Forty-three patients (93.33%) were followed up; one case of coronary artery disease using medication occurred, and there was no late death. Conclusions: Approach through the right atrium or right atrium with aortotomy showed the same early surgical results. Our classification of non-coronary SVA is simple and practical for clinical usage.     

Aneurysms of the sinus of Valsalva: Morphology and long term surgical results

Objective One hundred and forty seven patients with aneurysm of sinus of Valsalva (ASV) underwent surgery between January 1977 and June 2000. The morphological features and the surgical outcome in these patients were analyzed. Patients and Methods The age ranged from 5 to 62 years (mean 27.0<11.5 years), and all were congenital in aetiology. The aneurysm originated from the right coronary sinus in 116 (78.9%), from the non-coronary sinus in 25 (17%) from the left coronary sinus in 1 (0.6%) and from more than one sinus in 5 patients. In 14 patients (9.5%) the ASV remained unruptured. It ruptured into the right ventricle in 87, into the right atrium in 40 and into the left ventricle in 3 patients. In 11 instances, the ASV dissected into the interventricular septum. A ventricular septal defect was present in 63 (43%) patients and in the majority (n=56) it was subarterial. Moderate to severe aortic regurgitation was present in 43 patients. Surgical correction was through a bicameral approach (n=111) or through the aorta (n=28) or the chamber of rupture (n=8). Results There were 3 operative deaths and 5 late deaths over a follow up of 2 months to 23 years (mean 100.7<64.7 months). Acturial and event free survival at 23 years were 94.0%<3.0% and 82.0%<6.0% respectively. Presence of moderate or severe aortic regurgitation was significantly associated with reduced event free survival. A comparison of the Indian patients with patients collected from the literature, revealed that the Indian patients represent a separate subset of patients and can be placed in middle of the spectrum between the Oriental and the Western patients. Conclusion Indian patients represent a different set of patients. Adequate surgery yields gratifying early and late results.     

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     

Ruptured sinus of a Valsalva aneurysm associated with autosomal-dominant polycystic kidney disease in an elderly patient: Report of a case

We report herein the case of a 71-year-old woman with autosomal-dominant polycystic kidney disease (ADPKD), who was referred to our hospital for investigation of facial edema. Echocardiography demonstrated a large aneurysm arising from the noncoronary sinus of Valsalva, with a left to right shunt and jets of blood passing from the aneurysm toward the septal leaflet of the tricuspid valve. Surgical treatment was successfully carried out by resecting the aneurysmal wall and performing a patch closure of the orifice. It is well known that ADPKD predisposes patients to cardiovascular disease, and this case report serves to demonstrate that when a patient with ADPKD presents with progressive heart failure, the possibility of a ruptured sinus of a Valsalva aneurysm must be considered. Received: March 1, 1999 / Accepted: March 24, 2000