主动脉窦瘤破裂58例的手术治疗

目的]总结分析58例主动脉窦瘤破裂的临床特点和手术经验.方法]在1991年1月到2011年5月20年间本院手术治疗主动脉窦瘤破裂58例,男性36例,女性22例,年龄7～ 61岁,平均（31.7±11.7）岁,窦瘤来源于右冠窦31例,无冠窦27例;破入右心室18例,破入右房39例,破入左心房1例;合并心脏病变室间隔缺损12例,主动脉瓣关闭不全11例,合并感染性心内膜炎7例,合并三尖瓣关闭不全7例.通过破入心腔修补40例,通过主动脉切口2例,通过双途径修补16例.应用补片55例,直接修补3例.同时室间隔缺损修补12例,主动脉瓣置换8例、成形2例,三尖瓣成形5例,二尖瓣置换1例.结果]早期死亡1例,随访45例（随访率为78.9%,45/57）,随访时间2个月至18年,平均（5.5±5.3）年,晚期死亡1例,窦瘤复发再次手术1例,主动脉瓣关闭不全再次手术行主动脉瓣置换2例.结论]主动脉窦瘤破裂一旦确诊应尽早手术,术中准确闭合缺损的窦瘤壁和彻底矫治合并的心脏畸形是关键,术后注意随访观察主动脉瓣病变情况,手术疗效满意

Surgical Treatment of 58 Patients with Ruptured Sinus of Valsalva Aneurysm

Objective]To summarize the clinical features and surgical experience of 58 patients with ruptured sinus of valsalva aneurysm（RSVA）. Methods]Totally 58 RSVA patients（36 males and 22 females with the mean age of 31.7±11.7 years old ranged 7-61 years old） underwent surgery from January 1991 to May 2011. The RSVA of 31 cases originated from the right sinus and that of 27 cases originated from non-coronary sinus. There were 18 cases of RSVA to right ventricle, 39 cases to right atrium and one case to left atrium. There were 12 cases complicated with cardiovascular lesions ventricular septal defect（VSD）, 11 cases of aortic valve incompetence, 7 cases of infective endocarditis and 7 cases of tricuspid valve incompetence. The repair via the penetration chamber was performed in 40 cases, aortic incision in 2 cases and both above approaches in 16 cases. Patches were used in 55 cases and direct repair was used in 3 cases. VSD repair was underwent in 12 cases, aortic valve replacement in 8 cases, aortic valve repair in 2 cases, tricuspid valve repair in 5 cases and mitral valve replacement in one case. Results]Early death was found in one case. The follow-up of 5.5±5.3 years（2 months to 18 years） was completed in 45 patients. Late death was found in one case. One case underwent reoperation owing to the recurrence of RSVA. Two cases underwent aortic valve replacement again owing to aortic incompetence. Conclusion]When the diagnosis of RSVA was defined, surgical repair should be promptly performed. Precise closure of the wall defect of RSVA and complete correction of complicated cardiac abnormalities during the operation are the critical surgical procedures. Aortic valve lesion should be followed up and observed after operation. The surgical result is satisfactory.