70例主动脉瓣下狭窄的外科治疗

目的：总结70例主动脉瓣下狭窄的手术治疗经验。方法：全组70例中男46例，女24例；年龄3～46岁。平均11．8岁。均经超声心动图、左心导管和造影检查及术中证实为主动脉瓣下狭窄，局限型64例(纤维隔膜型42例、纤维肌隔型22例)，隧道型6例。局限型行狭窄隔膜切除术58例，加左室肌肉切除术6例；隧道型行左室流出道疏通术6例。合并畸形59例，同期行矫正手术。结果：手术死亡2例。仅l例发生二尖瓣损伤。术后38例左室主动脉收缩压力差0～30mmHg(1mmHg=0．133kPa)，平均7．5mmHg。术后经1、3、5、10、20年各随访58、54、48、32、6例，随访率分别为83％、77％、68％、45％、9％。症状均消失。无再狭窄需手术者。结论：本病一旦确诊，应尽快手术；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；手术关键是彻底疏通左室流出道，术中防止二尖瓣、主动脉瓣及传导束损伤。

Surgical treatment of subaortic stenosis (Report of 70 cases)

Objective: To summarize the experience of surgical treatment of subaortic stenosis. Methods: 70 patients with subaortic stenosis were treated surgically. The diagnosis was made by echocardiography, left ventricular catheterization and angiography. There were 46 males and 24 females. The mean age at operation was 11.8 years (range 3 to 46 years). 64 patients had discrete stenosis and 6 had tunnel stenosis. For the discrete stenosis cases, simply resection of stenosis membrane was done in 58 cases and plus myoctomy in 6 cases. For the tunnel stenosis cases, left ventricular muscle was resected to relieve obstruction. In 59 patients combined cardiovascular malformation were corrected at the same time. Results: There were two postoperative deaths. Mitral valve injury occurred in 1 patient. The mean systolic gradient of left ventricle to aorta was 7.5 mmHg with a range of 0-30 mmHg in 38 cases after operation. The 1-, 3-, 5-, 10-, 20-year follow-up rate was 83%, 77%, 68%, 45%, and 9%,respectively. All patients were asymptomatic postoperatively. No reoperation was required. Conclusion: Once subaortic stenosis was diagnosed, operation should be done. Preoperative echocardiography and routine exploration of the root of aorta should be done during operation are in diagnosing. The key point of the operation that left ventricular outflow tract should be thoroughly dredged, no injury should be made to the mitral valve, aortic valve and conduction bundle.