主动脉瓣上狭窄的外科治疗

报告１３例主动脉瓣上狭窄（ｓｕｐｒａｖａｌｖｕｌａｒａｏｒｔｉｃｓｔｅｎｏｓｉｓ，ＳＶＡＳ）病例的治疗。其中局限型１１例，弥漫型２例。合并的心血管畸形包括：主动脉瓣狭窄５例，主动脉瓣反流２例，主动脉瓣环发育不全２例，冠状动脉畸形６例，动脉导管未闭１例，多发肺动脉狭窄１例，肺动脉瓣上隔膜１例，头臂动脉畸形５例。１３例病人中，９例行狭窄解除术，１例用同种升主动脉行心尖至胸主动脉架桥术，１例单纯动脉导管结扎术，２例未手术。结果手术早期死亡２例，晚期死亡１例。作者认为ＳＶＡＳ手术治疗的要点为：（１）充分解除主动脉瓣上狭窄；（２）避免一切影响冠状动脉灌注的因素；（２）妥善处理并存的主动脉瓣病变。     

主动脉瓣上狭窄的外科治疗

１９０年４月至１９６年１１月收治７例主动脉瓣上狭窄（ＳＶＡＳ）病人，其中４例为Ｗｉｌｉａｍｓ综合征。术前超声心动图测定跨狭窄段压力阶差为８．０～１９．２ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），平均１１．０９±４．３ｋＰａ。所有病人均行主动脉扩大补片成形术。结果：无围术期死亡，随访２～８０个月，平均２５．７个月，解除狭窄满意，仅１例出现轻度主动脉瓣关闭不全。结论：运用菱形补片直接进行主动脉扩大成形术仍然是矫治沙漏型ＳＶＡＳ的首选方法。Ｗｉｌｉａｍｓ综合征病人应注意是否合并其他畸形。超声心动图对于ＳＶＡＳ的诊断具有独特作用     

主动脉瓣上狭窄的外科治疗

主动脉瓣上狭窄是先天性心脏病中较少见的畸形 ,病理改变可分为 :隔膜型、漏沙型、弥漫型 ;外科临床将其分为 :局限型及弥漫型。我们总结 1998年 2月至 2 0 0 0年 11月收治 4例主动脉瓣上狭窄病例 ,现报道如下。临床资料　本组中男 3例 ,女 1例 ;年龄 11～ 18岁 ,平均14 5岁。其中 2例为Williams综合征。除 1例无症状外 ,其余 3例有心悸、气促症状 ;1例胸痛 ,1例有 3次晕厥史。查体 :3例血压正常 ,1例上、下肢血压相等。于右胸 2、3肋间可闻及 3～ 4 /VI级收缩期杂音 ,1例A2 听诊区闻及舒张期杂音。心电图检查显示左心室肥大伴ST段改变 …     

先天性主动脉瓣上狭窄的外科治疗

目的 为了提高先天性主动脉瓣上狭窄（ＳＶＡＳ）的外科治疗水平，总结其治疗经验。方法 对我院１９８６年５月￣１９９６年１１月收治的９例先天性ＳＶＡＳ患者施行手术治疗。手术均在体外循环下进行，局限型ＳＶＡＳ均采用“泪滴”状补片行升主动脉扩大成形术；弥漫型ＳＶＡＳ采用主动脉延长加宽补片成形术。结果 无围术期死亡。随访２５￣１３０个月，平均随访４５．４个月局限型ＳＶＡＳ狭窄解除满意，压差降至０￣２．６６ｋ     

小儿先天性主动脉瓣上狭窄的外科治疗

目的 回顾和总结先天性主动脉瓣上狭窄(SVAS)的手术治疗经验.方法 2004年1月至2008年12月,收治43例SVAS患者,年龄6个月～15岁(平均4.3岁).局限型35例,广泛型8例.局限型行主动脉瓣窦–升主动脉补片扩大成形术;广泛型行升主动脉–主动脉弓延长补片成形术.21例行肺动脉分支狭窄扩大,2例行二尖瓣整形术.结果 3例局限型SVAS用Gore-Tex片扩大狭窄因吻合口明显渗血,改用心包片后好转;5例合并冠状动脉狭窄者中3例死亡,1例再手术后存活.随访9～60个月,局限型SVAS残余梗阻2例(5.7%);广泛型SVAS主动脉弓三大分支动脉残余梗阻4例(80%),补片远心端残余梗阻3例(37.5%).结论 SVAS早期手术可减轻左右心室的后负荷;改良Gore-Tex补片方法明显减少术后渗血.SVAS合并冠状动脉狭小可能是术后较高死亡率的原因.     

主动脉瓣上狭窄合并主动脉弓及分支发育不良的外科治疗

2003年11月我们成功为1例主动脉瓣上狭窄合并主动脉弓及分子支血管发育不良病儿进行手术治疗，现报道如下。     

分散性主动脉瓣瓣下狭窄的病理解剖及外科治疗

目的 探讨主动脉瓣瓣下狭窄病理解剖及外科治疗价值。方法 分析２１例主动脉瓣瓣下狭窄病例的病理形态及外科治疗结果。根据Ｋｅｌｌｙ分型，纤维隔膜性狭窄１０例，肌纤维性狭窄１１例。行纤维隔膜切除术１２例，室隔肌肉开槽术１例，室隔肌肉切除术８例。同期纠治合并畸形。结果 主动脉瓣瓣下狭窄病理形态复杂、病变范围大、合并畸形多。Ｋｅｌｌｙ分型对手术有一定指导意义。本组无早期死亡。随访１０例病人，远期疗效不确定。     

Ross-Konno手术治疗儿童主动脉瓣及瓣下狭窄的临床疗效

目的评价Ross-Konno手术治疗儿童主动脉瓣及瓣下狭窄的早期临床疗效。方法 2018年12月至2019年12月,共12例患儿因主动脉瓣及瓣下狭窄在我科接受手术治疗,其中男8例、女4例,接受手术时中位年龄4岁(11个月~12岁)。Ross-Konno手术11例,单纯Ross手术1例。主动脉瓣重度狭窄8例,主动脉瓣关闭不全2例,狭窄合并关闭不全2例。合并主动脉二瓣化畸形6例,瓣下流出道显著狭窄4例,合并二尖瓣病变4例,合并弓部病变3例。手术采用自体肺动脉带瓣管道移植于主动脉瓣位,同期采用Konno法扩大左室流出道。采用牛颈静脉或带瓣Gore-tex人工血管重建右室流出道,并同期矫治心内合并畸形。所有患者均经多普勒彩色超声心动图定期进行随访评估。结果全组无手术死亡。术后中位随访时间5.5(1~12)个月,1例患儿残余左室流出道中度狭窄,其余患儿无显著左室流出道残余梗阻或复发梗阻,无新主动脉瓣显著反流。1例患儿肺动脉带瓣管道主干中度狭窄,余重建右室流出道血流通畅,无明显瓣膜反流及赘生物形成。结论对于不适合瓣膜成形或置换术的儿童主动脉瓣膜病变,Ross-Konno手术早期结果满意。     

小儿局限性主动脉瓣上狭窄的手术治疗

小儿局限性主动脉瓣上狭窄的手术治疗严勤苏肇伉丁文祥徐志伟曹鼎方朱铭作者单位：２０００９２上海第二医科大学附属新华医院小儿胸心外科１９９０年１月至１９９５年４月我们共为７例局限性主动脉瓣上狭窄病儿进行手术治疗，现总结临床经验如下：临床资料本组男４例，女...     

Impact of Aortic Valve Replacement for Aortic Stenosis on Coexisting Mitral Stenosis

Purpose: The course of coexisting mitral valve stenosis is not clear after aortic valve replacement (AVR) for aortic stenosis (AS). We investigated the effect of AVR for AS on coexisting mitral stenosis (MS).Methods: Between January 2002 and December 2019, 1338 consecutive patients underwent surgical AVR at Shiga University of Medical Science. Of them, 34 patients with moderate MS (mitral valve area [MVA]: 1.5–2.0 cm²) were included in the present study. We evaluated the postoperative clinical outcomes in these patients.Results: Mean MVA in our cohort significantly increased 1 week after operation compared with preoperative values, and the change was maintained for 5 years after surgery. Follow-up was completed in 94.1% (32/34) patients, and mean follow-up duration was 4.0 ± 3.0 years. No patients underwent mitral surgery for remaining MS after AVR during postoperative follow-up.Conclusion: AVR for AS resulted in increased MVA in patients with MS, and the change was maintained during follow-up.     

球囊血管成形术治疗主动脉狭窄

经皮穿刺球囊导管血管腔内成形术，在国外已广泛应用。１９８９年以来我们用此成形术治疗主动脉狭窄４例，３例成功。随访３～８个月，狭窄无复发，近期疗效比较满意。球囊血管成形术效果好且成功率高，操作简便安全可重复使用，是心血管病非手术治疗的新技术之一。     

Supravalvular aortic stenosis repair: surgical training of 2 repair techniques using 3D-printed models

There are a number of techniques used in the surgical treatment of supravalvular aortic stenosis with excellent results; however, junior surgeons’ experience may be limited due to its rare nature. Simulation with 3D-printed models provides a safe platform for surgeons to rehearse surgical techniques prior to patient application but must replicate all features of surgical anatomy. Here, we describe how software manipulation can be used to accurately reproduce the surgical anatomy in supravalvular aortic stenosis and be used to train surgeons in 2 different techniques.     

主动脉瓣重度狭窄伴左心室收缩功能受损患者的外科疗效分析

目的分析主动脉瓣置换术在治疗主动脉瓣重度狭窄伴左心室收缩功能受损患者中的疗效。方法回顾性分析2000年1月至2011年12月在第二军医大学长海医院接受手术治疗的主动脉瓣重度狭窄伴左心室收缩功能受损[左心室射血分数（LVEF）〈50％]患者的临床资料,排除二尖瓣狭窄患者。共纳入29例患者,男22例、女7例,年龄14～76（56.3±12．9）岁。将患者手术前后临床及心脏超声心动图相关指标进行比较,评价手术效果,并根据患者LVEF恢复情况,分析可能影响患者术后心脏功能恢复的危险因素。结果术后早期死亡1例。其余28例患者术后主动脉瓣跨瓣压差由（97．6±25．1）mmHg降至（25．0±9．7）mmHg,LVEF由41％±6％增加至56％±11％,左心室舒张／收缩期末直径／容积均较术前明显改善（P均〈0．001）。结论主动脉瓣膜置换术是主动脉瓣重度狭窄伴左心室收缩功能受损患者的有效治疗方法,术后左心室超声指标显著改善。术前左心室扩大程度较低可能更利于术后LVEF的恢复。     

Concomitant Mitral Regurgitation in Patients Undergoing Surgical Aortic Valve Replacement for Aortic Stenosis: A Systematic Review

Background: Concomitant mitral regurgitation (MR) is frequently seen in patients undergoing surgical aortic valve replacement (AVR) for severe aortic stenosis (AS). When the severity of MR is moderate or less, the decision to undertake simultaneous mitral valve intervention can be challenging.Methods: A systematic search of Medline, PubMed (NCBI), Embase and Cochrane Library was conducted to qualitatively assess the current evidence for concomitant mitral valve intervention for MR in patients with AS undergoing AVR. The primary outcome for this systematic review was the postoperative change in the severity of MR and other outcomes of interest included factors that predict improvement or persistence of MR and long-term impacts of residual MR.Results: A total of 17 studies were included. The percentage of patients demonstrating improvement in MR severity following AVR ranged from 17.2% to 72%; the studies that exclusively included patients with moderate functional MR and reported longer term echocardiographic follow-up of greater than 12 months demonstrated an improvement in MR severity of 45% to 72%.Conclusion: This systematic review demonstrates that a proportion of patients can exhibit an improvement in MR following isolated surgical AVR, but whether this confers any long-term morbidity and mortality benefit remains unclear.     

升主动脉瘤伴主动脉瓣关闭不全外科治疗25例

报告２５例升主动脉瘤伴主动脉瓣关闭不全的手术经验。方法１１例伴有主动脉夹层分离，其中ＤｅＢａｋｅｙⅠ型６例、Ⅱ型５例。施行Ｂｅｎｔａｌ手术１９例，分别置换主动脉瓣及升主动脉１例，升主动脉置换加主动脉瓣悬吊５例。结果因止血困难采用Ｃａｂｒｏｌ分流止血２例；术后１６小时延迟大出血１例；无早期死亡病例。远期因心内膜炎死亡２例；术后３０月发生胸降主动脉瘤１例；无假性动脉瘤发生。结论应根据升主动脉瘤的病变类型及范围采用不同的手术方式。准确的吻合技术、保留瘤壁的完整性，使升主动脉瘤的手术治疗更为安全。心内膜炎是Ｂｅｎｔａｌ手术后最主要的远期并发症，须引起高度重视     

主动脉瓣环扩大联合环上瓣置换术治疗成人小瓣环主动脉瓣狭窄近中期疗效分析

目的评价主动脉瓣环扩大联合环上瓣置换术治疗成人小瓣环主动脉瓣狭窄的近中期结果。方法对2007年1月至2011年7月北京安贞医院心外科38例成人小瓣环主动脉瓣狭窄患者行主动脉瓣环扩大后植入环上型人工瓣膜,男12例、女26例,年龄16~58（38.6±21.0）岁,体重48~78（58.5±12.0）kg,身高153~176（162.8±12.0）cm,体表面积（1.67±0.32）m2。风湿性主动脉瓣狭窄19例,先天性主动脉瓣二叶瓣畸形合并狭窄11例,主动脉瓣退行性钙化伴狭窄5例,主动脉瓣狭窄合并感染性心内膜炎3例。入院时心功能分级（NYHA）Ⅱ级8例,Ⅲ级29例,Ⅳ级1例。主动脉瓣环内径15~20（17.6±2.8）mm,平均跨瓣压差53~75（62.8±10.5）mm Hg。结果体外循环时间83~145（112±29）min,升主动脉阻断时间58~116（87±28）min,手术中测瓣器测得主动脉瓣环径15~20（17.3±2.6）mm,扩大瓣环后测瓣器测得瓣环径20~25（22.6±2.3）mm,主动脉瓣环周径增加12~17（14.0±2.6）mm,植入瓣膜增加2~3个标号。无围手术期死亡,无出血等严重并发症。住ICU时间12~41（26±14）h,总住院时间9~15（12.5±3.2）d。37例（97.4%）门诊随访2年以上,所有患者心功能分级（NYHA）Ⅰ级,3例主动脉瓣听诊区存在2/6级收缩期杂音。35例心电图显示左心室肥厚心电图表现显著改善或消失,2例表现为左心室轻度肥厚劳损,无明显心肌缺血表现,无室性心律失常及严重房室传导阻滞。结论主动脉瓣环扩大联合环上瓣置换术治疗成人小瓣环主动脉瓣狭窄近中期效果满意,远期结果有待进一步随访。     

Aortic valve replacement with frozen irradiated homografts : An 18-year experience

Between May 1968 and April 1981, 339 patients underwent isolated aortic valve replacement using frozen irradiated homografts. All the operations were carried out by the same surgeon (EJMW) using the same technique. Thirty-two patients were lost to follow-up at various stages and the long-term results of the remaining 307 patients are reported. Two hundred and thirty-four were males and 73 females. Their ages ranged between 10 and 75 years, with a mean age of 53. The dominant lesion was aortic stenosis in 195 cases (63.5%), aortic regurgitation in 68 (22.1%), and mixed aortic valve disease in 44 (14.3%). Early mortality was 8.8% and late mortality during the 5–18 year follow-up period was 49.6%. Re-operations for homograft failure were carried out in 112 patients (40%), with an early mortality of 25%. The results are compared with those of other major series using antibiotic sterilized homograft valves.