主动脉瓣下狭窄的外科治疗

目的：总结42例主动脉瓣下狭窄的手术治疗体会，探讨各种不同病变分型的较好手术方式。方法：本组42例中男27例，女15例；年龄2～38岁，平均13．6岁。均经超声心动图及术中证实为主动脉瓣下狭窄，其中纤维隔膜型28例，纤维肌隔型11例，管状型3例。分别行狭窄隔膜切除、纤维肌隔及部分左室肌肉切除和左室流出道跨瓣扩大成形 主动脉瓣置换治疗。合并畸形29例，同期行矫治手术。结果：本组无手术死亡，经观察疗效满意。结论：主动脉瓣下狭窄临床诊断一旦确立，应尽早手术；术前超声心动图检查及术中常规主动脉根部探查，对防止有合并畸形时本病的漏诊尤为重要；经室间隔缺损手术径路具有操作简便、避免损伤冠状动脉及主动脉瓣的优点；手术要求彻底疏通左室流出道；术中应尽量避免对二尖瓣、主动脉瓣及传导束的损伤。

Surgical treatment of subaortic stenosis

Objective To summarize the experience in surgical treatment of subaortic stenosis, and to explore appropriate surgical procedure for different types of subaortic stenosis. Methods Of 42 patients with subaortic stenosis who were surgically treated, 27 were male and 15 female. The diagnosis was made by echocardiography and confirmed by the operation. The mean age was 13. 6 years (ranged a from 2 to 38 years). Of 39 patients with discrete stenosis,28 underwent simple resection of stenosis membrane,and 11 resection of stenosis mem-brane and myoctomy. The outflow tract of left ventricle was widened and shaped, and aortic valve was replaced in 3 patients with tunnel stenosis. The cardiovascular malformation accomp-anying the stenosis were corrected at the same time in 120 patients. Results There were no postoperative death. The curative effects were satisfactory in all the patients. Conclusions Once subaortic stenosis is diagnosed, operation shall be done. Preop-erative echocardiography and the routine exploration of the root of aorta during the operation should be done to diagnose the subaortic stenosis accompanying the othor Cardio-vascular malformation. The operation for the stenosis through the same approach as the operation for the ventricular septal defect is convenient and can avoid injuring the coronary artery and aortic valve. The key to the operation is that left ventricular outflow tract should be thoroughly dredged.and no injury should be made to the mitral valve.aortic valve and conduction bundle.