外科治疗主动脉根部疾病-我们选择什么术式.pptVIP

主动脉根部置换 技术简单容易掌握 需终身抗凝治疗，影响生活质量 Reimplantation 技术 Remodeling 技术 Remodeling (three patch technique) 主动脉瓣保留技术 无需抗凝治疗 生活质量高 技术复杂 1 退行性变 2 Marfan sydrome 3 Marfan 合并主动脉根部瘤 根部置换 严重的主动脉瓣关闭不全 主动脉瓣叶严重撕裂 主动脉瓣环、窦部重度扩张 主动脉瓣保留 主动脉瓣叶正常 3 主动脉夹层 (升主动脉置换) 窦管交界近端正常 无主动脉瓣关闭不全 4 夹层 (主动脉瓣保留或窦成形) 窦部直径小于35mm 夹层累及冠状动脉 夹层累及一个或两个交界导致主动脉瓣关闭不全 5 主动脉夹层 (根部置换) 窦部直径50mm 窦部直径介于 35~50mm,但窦管交接严重破坏，导致重度主动脉瓣关闭不全 6 二瓣化畸形 升主动脉置换+AVR：窦部不扩张，瓣叶严重受损 根部置换：窦部明显扩张，瓣叶严重受损 Remodeling: 窦部扩张，瓣叶关闭好 临床资料 Fuwai Hospital (1996. 10—2008 .12) 三片法手术 有利于主动脉瓣和瓣环处理 操作方便 显露完全 成形充分 个性化重建窦部 选择性重建部分窦部 可防止窦管交界扩张 根部置换还是根部保留？ 根部置换还是保留？ 保留的瓣膜是否能耐久十年或更长 医生是否在这方面很有经验 患者是否理解并能接受将来二次手术 英文版 Root replacement Simple and safe Long life anticoagulation Anticoagulation-related complication Remodeling (three patch technique) Aortic valve sparing No anticoagulation Good life quality Complicated technique 1 Degenerative 2 Marfan sydrome 3 Marfan with Root Aneurysm Root replacement Severe AI Aortic leaflet is abnormal Seriously dilated annulus or sinus Aortic valve sparing Aortic leaflet is normal 3 Dissection (Aortic Replacement) Normal proximal sinotubular junction No AI 4 Dissection (aortic valve sparing or sinus plastic) Sinus diameter 35mm Coronary artery is involved AI because one or two commissures are involved 5 Dissection (Root Replacement) Sinus diameter 50mm Sinus diameter35~50mm,but severe AI because of destroyed sinotubular junction 6 Bicuspid Aortic replacement +AVR：normal sinus, seriously damaged leaflet Root replacement：significantly dilated sinus, serious damaged leaflet Remodeling: dilated sinus ,no AI Clinical data Fuwai Hospital (1996. 10—2008 .12) Aortic valve sparing procedure 1998.11-2008.12 Aortic valve sparing procedure :52 Male : 38 Female:14 Age:37±15years （10-64 years） Three patch technique Convenient and clear explosure Sinus construction individually Root replacement or AVS？ Root replacement or AVS