升主动脉至胸降主动脉人工血管转流在主动脉缩窄外科治疗中的应用

目的：分析总结使用升主动脉至胸降主动脉人工血管转流术治疗成人型主动脉缩窄10例临床病例资料,探讨升主动脉至胸降主动脉人工血管转流术在临床中治疗主动脉缩窄的意义。方法中国医学科学院、北京协和医院心脏外科2006年1月-2015年12月共收治成人主动脉缩窄患者10例,其中男性患者7例,女性患者3例,年龄14~35岁,中位年龄27岁,其中1例合并主动脉瓣二瓣畸形及主动脉根部瘤样扩张,余均为单纯主动脉缩窄。10例患者静息情况下测量上下肢压差均大于20 mmHg (1 mmHg=0.133 kPa),术前评估无明确手术禁忌。10例均在体外循环下行升主动脉至胸降主动脉人工血管转流术,合并主动脉瓣二瓣畸形及主动脉根部扩张的患者,同时行Bentall术。结果无围术期死亡及大出血、脊髓缺血性损害等严重并发症,嘱托患者出院后3~6个月门诊复查,复测上下肢压差均小于20 mmHg,CTA结果提示未见动脉瘤、人工血管血栓形成等表现。结论利用人工血管从升主动脉转流至降主动脉是治疗胸主动脉缩窄的有效方法。

Ascending to descending aorta extraanatomic bypass for coarctation of aorta

Objective To summarize the treatment of 10 aortic coarctation cases ,who receive the surgery from ascending aorta to thoracic descending aorta with the prosthetic graft, discuss the valuable and appliable of this method. Methods Cardiac surgery, Chinese Acdemy of Medical Sciences, Peking Union Medical College Hospital department treated 10 patients who got the aortic coarctation from Jan. 2006 to Dec. 2015 Seven male patients and 3 cases of female patients consist of the sample, aged from 14 to 35 years old, the median age was 27. One cases consolidated aortic valve deformity and aortic root expansion, the others were simple aortic coarctation. Their upper limbs blood pressure was 20 mmHg higher compared with the low limb. Meanwhile, there was no sign of surgery contraindication. Ten cases received this operation under cardiopulmonary bypass situation. And the patient who consolidate aortic valve deformity and aortic root expansion receive the Bentall surgery at the same time. Results There was no death during perioperative time, no spinal cord ischemic and other serious complications. Those patients went back to outpatient department after discharging from hospital 3 to 6 months. The differential pressure between upperlimbs and low limbs were less than 20 mmHg, and the CTA results indicated no aneurysms. Conclusion Using artificial blood vessels to make a graft from the ascending aorta to the descending aorta is an effective method for treatment of thoracic aorta.