升主动脉瘤合并重度主动脉瓣关闭不全的外科治疗1例报告

临床资料 :患者男性 ,2 7岁 ,表现为心悸气急伴左胸隐痛 4个月。体检 :身体瘦长 ,蜘蛛指(趾 ) ,胸廓扁平 ,心脏浊音界增大 ,主动脉瓣区中度舒张期杂音 ,血压 2 1 /1 6ｋＰａ ,可闻主动脉枪击音。心脏超声示主动脉内径 74ｍｍ ,左心室舒张末期内径 80ｍｍ ,升主动脉瘤样扩张 ,重度主动脉瓣关闭不全。ＭＲＩ示主动脉根部高度扩张呈蒜头样改变。心电图 :左心室肥厚劳损。诊断 :升主动脉瘤伴主动脉瓣关闭不全 (Ｍａｒｆａｎ’ｓＳｙｎｄｒｏｍ) ,心功能Ⅲ级。术前给予卡托普利口服并静滴心肌极化液等处理。手术采用胸正中切口 ,术中见升主动脉高…     

二叶式主动脉瓣合并升主动脉扩张的生物信息学分析

目的 通过生物信息学方法探究二叶式主动脉瓣（bicuspid aortic valve,BAV）合并升主动脉扩张的关键基因及相关富集通路,寻找扩张升主动脉组织中浸润的关键免疫细胞。方法 从基因表达综合数据库下载表达谱数据GSE83675（截至2022年5月12日）,使用R语言筛选差异表达基因、进行基因集富集分析（gene set enrichment analysis,GSEA）,应用STRING数据库及Cytoscape软件构建蛋白互作网络并筛选Hub基因,通过CIBERSORT反卷积算法计算主动脉组织中免疫细胞浸润比例。结果 筛选获得19个上调基因和180个下调基因,GSEA表明主要的富集通路有细胞因子-细胞因子受体相互作用、癌症相关通路、肌动蛋白细胞骨架调节、趋化因子信号通路、丝裂原活化蛋白激酶信号通路等。基于蛋白互作网络筛选出EGFR、RIMS3、DLGAP2、RAPH1、CCNB3、CD3E、PIK3R5、TP73、PAK3、AGAP2这10个Hub基因。CIBERSORT分析表明活化自然杀伤细胞在BAV合并升主动脉扩张患者的主动脉组织中浸润较多。结论 筛选出的关键基因及信号...     

超声心动图评价二叶主动脉瓣畸形与升主动脉扩张的关系

目的　使用超声心动图评价二叶主动脉瓣畸形 (BAV)与升主动脉扩张的关系。方法　使用二维超声在四个部位检测 42例主动脉瓣功能正常的BAV患者 (病例组 1)、3 7例主动脉瓣狭窄的BAV患者 (病例组 2 )和 40例年龄、体表面积、血压等匹配的健康人 (对照组 )的升主动脉内径 :瓣环、瓦氏窦、主动脉上嵴及升主动脉近端。结果　病例组 2升主动脉瓦氏窦、主动脉上嵴及近端内径最大 ,其次为病例组 1(P <0 .0 5～P <0 .0 0 1)。但病例组 1中有一部分BAV患者的升主动脉内径与对照组无显著差异。结论　BAV常合并升主动脉扩张 ,提示两者可能为同一发育异常 ,即先天性主动脉壁发育缺陷的不同表现形式。     

超声诊断主动脉瓣四瓣叶畸形合并升主动脉囊状扩张1例

1 病历摘要 患者，男，17岁，因胸闷、气短伴咳嗽，不能平卧20天入院。查体：心界扩大，主动脉瓣第1、2听诊区可闻及双期杂音。心电图示左心室肥厚。X线胸片示靴型心，心胸比例为0.58。     

主动脉根部病变的外科治疗

主动脉根部瘤样扩张和夹层撕裂是最常见的近端主动脉病变 ,二者常引起主动脉瓣关闭不全。而瘤体破裂和急性夹层撕裂是患者猝死的主要原因。由于病变涉及升主动脉、冠状动脉及主动脉瓣 ,给外科治疗造成了很大困难。本文拟对主动脉根部病变的外科治疗进展 ,综述如下。1　历史回顾主动脉根部瘤和夹层撕裂的处理一直是心血管外科的难点。195 2年 Cooley等 [1 ]采用动脉瘤部分切除术治疗囊袋形升主动脉极部瘤 ,开创了近端主动脉手术的先河。 195 6年他们 [2 ]又成功报道了体外循环支持下 ,近端升主动脉瘤切除、人工血管置换术 ,极大地推动了现代…     

主动脉瓣关闭不全的诊断与治疗

1 引言 主动脉瓣关闭不全可由主动脉瓣病变及主动脉根部扩张而引起.临床上有典型的心脏杂音,伴有周围血管征,随着病情发展可出现心力衰竭,需积极进行治疗.     

瓣环不完整的重症主动脉窦瘤破裂合并主动脉瓣关闭不全的外科治疗

目的:探讨重症主动脉窦瘤破裂及合并主动脉瓣关闭不全的外科治疗方法。方法:回顾性分析2例罕见瓣环不完整的重症主动脉窦瘤破裂合并主动脉瓣关闭不全患者的临床表现、手术方法及疗效。结果:无手术及远期死亡,心功能明显改善,瓣膜开启灵活,无瓣周漏、窦瘤复发及残余分流,手术效果满意。结论:应用Dacron补片行室间隔缺损、窦瘤修补和主动脉瓣环重建,并同期置换主动脉瓣的手术方法,安全可靠,临床疗效满意。     

Semont方法治疗后半规管发作性位置性眩晕的配合及护理

时间护理是探讨“择时护理”的学说。根据时间护理理论，护理人员可结合患者的生物周期和疾病的节律变化特点来展开护理。这是维持和恢复人体正常生理节律，有效促进疾病早期康复的重要手段，也是以人为本护理理念的体现。由于人体生物节律的作用，脑梗死疾病的发生发展具有一定的时间节律性，但根据该节律性对脑梗死患者进行相应时间护理的研究却鲜有报道。本研究从时间护理的角度．提出脑梗死患者的护理措施，以提高护理质量，现报道如下。     

升主动脉瘤切除与同期主动脉瓣置换术的配合及护理

目的探讨升主动脉瘤切除同期主动脉瓣置换术的手术配合及护理要点。方法总结16例在体外循环下行升主动脉瘤切除同期主动脉瓣置换术患者的术中护理配合方法和措施。结果本组病例均顺利完成手术,术中器械护士及巡回护士配合达到预期效果,术后患者恢复良好,顺利出院。结论手术室护士术前充分了解病情及手术操作过程,完备物品准备和心理准备,术中积极主动与手术医师、麻醉医师、灌注医师默契配合,是手术顺利进行、成功的关键。     

Perceval sutureless aortic valve replacement after ascending aortic replacement

In patients with a narrow sinotubular junction, small sinus of Valsalva, or extensibility loss in the aortic root, aortic valve replacement (AVR) with a standard valve is challenging due to limited surgical field. Detailed preoperative measurements of the aortic root render performing AVR using the Perceval valve easy.     

Ascending aortic dilatation rate after transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis: A multidetector computed tomography follow-up study

BACKGROUND: Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). This study aims to assess the ascending aortic dilatation rate (mm/year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography (MDCT) follow-up and to determine the predictors of ascending aortic dilatation rate.METHODS: Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identified using baseline MDCT. Baseline and follow-up MDCT images were analyzed, and the diameters of ascending aorta were measured. Study end point is ascending aortic dilatation rate (mm/year). Furthermore, factors predicting ascending aortic dilatation rate were also investigated.RESULTS: Two hundred and eight patients were included, comprised of 86 BAV and 122 TAV patients. Five, 4, 3, 2, and 1-year MDCT follow-ups were achieved in 7, 9, 30, 46, and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group (43.7±4.4 mm vs. 44.0±4.5 mm; P<0.001) and TAV group (39.1±4.8 mm vs. 39.7±5.1 mm; P<0.001). However, no difference of ascending aortic dilatation rate was found between BAV and TAV groups (0.2±0.8 mm/year vs. 0.3±0.8 mm/year, P=0.592). Multivariate linear regression revealed paravalvular leakage (PVL) grade was independently associated with ascending aortic dilatation rate in the whole population and BAV group, but not TAV group. No aortic events occurred during follow-ups.CONCLUSION: Ascending aortic size continues to grow after TAVR in BAV patients, but the dilatation rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic dilatation rate in BAV patients post-TAVR.     

Painless limited dissection of the ascending aorta presenting with aortic valve regurgitation

Aortic dissection is a medical emergency carrying high morbidity and mortality. Prompt diagnosis is sometimes difficult because of its varying presentations, but it is critical to the achievement of good clinical outcomes. This report describes 2 cases of painless aortic dissection that presented with aortic valve regurgitation. In both, the dissection was limited to the ascending aorta just distal to the aortic valve. These dissections were diagnosed by transthoracic and transesophageal echocardiography.     

1期手术治疗主动脉缩窄合并心内畸形

目的探讨主动脉缩窄合并心内畸形的外科治疗方法。方法 2008年4月~2011年4月共手术治疗CoA合并其他心内畸形12例,其中合并VSD 2例,ASD 3例,VSD＋PDA 7例,合并主动脉弓发育不良2例。全组均行一期矫治,1例采用胸骨正中切口加左后外侧切口进行矫治,11例行胸骨正中单一切口。其中8例患者动脉缩窄段切除端端或端侧吻合,3例患者补片扩大成形,1例行人工血管植入。结果全组无手术死亡,均顺利出院。随访3~40月,术后恢复良好。超声复查无吻合口狭窄,无吻合处动脉瘤形成和主动脉瓣反流等并发症。结论主动脉缩窄合并心内畸形的外科手术策略主要根据心内畸形和缩窄病变特点决定,应视病变长短、并发症而采取不同的手术方法,并通过各种手段尽量避免复发及动脉瘤等并发症的发生。     

Three-dimensional cross-sectional velocity distribution in the ascending aorta in cardiac patients

Summary. Knowledge of the distribution of velocities across the ascending aorta is important for measurements of cardiac output; for understanding the function of normal and diseased valves and for the evaluation of prosthetic valves. The aim of this study was to investigate, in detail, the spatial distribution of axial velocities in the human ascending aorta, covering a nearly complete cross-section of the lumen in a time continuous modus. During open-heart surgery, blood velocities in the ascending aorta were mapped in 10 patients. All patients had aortic valves with no significant clinical evidence of disease. Pulsed Doppler ultrasound technique was used to measure blood velocity using an intraluminal probe with a 1 mm, 10 MHz crystal connected to a position-sensitive device. The distribution of blood velocity in the aorta 6–8 cm above the valve was characterized by a skewed and irregular peak systolic flow, with maximum velocity posteriorly. There was a positive correlation (n=0.854, P < 0.002) between the maximum skewness slope and the stroke volume. Significant retrograde flow was recorded in all patients in the left posterior part of aorta in late systole and early diastole. The rotation of the point of maximal velocity was anticlockwise in six patients, clockwise in three and alternating in one. The present study shows that there is a considerable individual variation in the velocity distribution in the ascending aorta, with no plane symmetric features, and that large sampling volumes are required for reliable estimates of mean velocity.     

超声心动图评价二瓣化主动脉瓣瓣膜功能

目的 探讨超声心动图在二瓣化主动脉瓣病理生理进展评价中的应用,分析二瓣化主动脉瓣各年龄瓣膜病变的程度.方法 回顾性分析135例二瓣化主动脉瓣患者超声资料及病例资料,结合临床资料分析患者病程进展中瓣膜功能的变化.结果 二瓣化主动脉瓣关闭不全最常见,本组资料中为68例(50%),单纯狭窄仅19例(14%).狭窄并关闭不全者29例(22%),瓣膜功能正常者19例(14%).各年龄组内主动脉瓣病变均以关闭不全多见.病程晚期的手术患者各年龄组内主动脉病变亦均以关闭不全为主.结论 超声心动图能对主动脉瓣的病变作出早期诊断.二瓣化主动脉瓣最常见的瓣膜病变是主动脉瓣关闭不全.     

Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation

Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care.