老年性退行性主动脉瓣的外科治疗

目的探索总结老年性退行性主动脉瓣替换术的经验。方法31例老年性退行性主动脉瓣患者，其中主动脉瓣狭窄21例、主动脉关闭不全2例、主动脉瓣合并二尖瓣3例、主动脉瓣合并冠状动脉硬化5例。术中主动脉表面超声扫描，主动脉钙化5例。升主动脉采用球囊阻断、手术方法有单纯瓣膜替换、瓣膜替换加冠状动脉旁路术。结果1例因升主动脉严重钙化，叩之似“水泥管道”，考虑升主动脉切开后难于关闭而放弃手术。其余病例手术顺利，无脑及外周器官栓塞并发症。1例应用双侧乳内动脉行旁路术者，术后12 d发生胸骨裂开，全麻下行Rob iscek胸骨固定术，3周后恢复出院。结论术中升主动脉表面超声扫描是一种可靠简便的判断升主动脉硬化的方法。手术时尽量减少升主动脉操作，升主动脉球囊阻断是一种简单可靠的方法。

The valve replacement on the senile degenerative heart valve diseases

Objective To summarize the experience of the valve replacement for the senile degenerative heart valve diseases.Methods Thirty-one patients had degenerative heart valve diseases including 21 pure aortic stenosises,2 aortic insufficiency,3 aortic mixed bicuspid valve insufficiency and 5 mixed valve diseases and coronary artery diseases.Calcified atheromata of the ascending aorta were found by epiaortic ultrasonography in 5 patients.The aorta was crossclamped by a balloon through femoral artery in patients with calcified atheromata.All patients had aortic valve replacement,and 5 patients had concomitant coronary artery bypass graft(CABG).Results One patient didn't operate on for "porcelain" aorta.All operated patients had no stroke,no mortality.One patient's breast bone was ceasmic after 12 days of CABG by arteriae mammaria interna and Robiscek breast fixation operation were done under pamplegia and recovered after 3 weeks.Conclusion Intra-operative evaluation of the aorta by epiaortic echocardiography is a simple and reliable procedure.Cross-clamping the aorta by a balloon is also a simple method.