升主动脉瘤合并主动脉瓣关闭不全的外科治疗

目的总结21例升主动脉瘤合并主动脉瓣关闭不全的外科治疗经验。方法19例行Bentall手术，2例行Cabrol手术；5例同时置换二尖瓣。术前心功能IV级15例，III级6例。动脉瘤直径6～11 cm，平均(8.5±2.6) cm；17例主动脉内膜有撕裂，其中5例升主动脉远端仍有夹层。主动脉瓣环直径2.7～5.4 cm，平均(3.2±1.8）cm。超声心动图检查均示主动脉瓣严重关闭不全。结果手术后无早、晚期死亡，术后超声心动图和造影检查示主动脉瓣关闭良好，移植的冠状动脉通畅、无扭曲，效果满意。结论动脉瘤直径大于6 cm时应及时随访和做预防性手术，一旦发现夹层动脉瘤应立即手术，Bentall手术治疗升主动脉瘤效果良好。

Surgical treatment for aneurysms of ascending aorta and aortic insufficiency

Objective: To review the experience of surgical treatment for aneurysms of ascending aorta associated with aortic insufficiency. Methods: Twenty-one patients underwent surgical treatment for aneurysms of ascending aorta and aortic insufficiency. 15 cases were in heart functional class IV and 6 in class III before operation. The diameter of ascending aorta aneurysm was 6 to 11 cm ［mean,(8.5±2.6) cm］. Aortic intima was torn in 17 cases and dissection of distal ascending aorta occured in 5. The diameter of the aortic annulus was 2.7 to 5.4 cm ［mean,(3.2±1.8) cm］. The preoperative echocardiography showed aortic insufficiency in all cases. Bentall procedure was performed in 19 patients and Cabrol procedure in 2. Mitral valve replacement was done in 5 cases. Results: There was no early and late death. The postoperative echocardiography showed competent aortic valve and coronary angiography was normal without deformation. Conclusion: Patient with aortic aneurysm over 6 cm in diameter should be followed up closely and considered for elective surgery. For patients with dissecting aortic aneurysms emergency operation should be considered.