主动脉窦瘤破裂21例外科治疗体会.docVIP

主动脉窦瘤破裂21例外科治疗体会【摘要】 目的 总结主动脉窦瘤破裂（RSVA）的外科治疗经验。方法 1992年12月至2007年11月，在中度低温体外循环 (CPB)下行主动脉窦瘤破裂修补术21例。同期行室间隔缺损(VSD)修补术10例，行房间隔缺损(ASD)修补术3例，行主动脉瓣成形术(AVP)2例，行主动脉瓣置换术（AVR）3例。结果 本组无死亡病例，所有患者均痊愈出院，随诊无复发。结论 主动脉窦瘤破裂的患者一经确诊，应尽早手术，术中确切修补窦瘤和加强心肌保护是手术成功的关键。? 【关键词】主动脉窦瘤破裂；外科手术 Surgical treatment of ruptured aneurysm of the sinus of valsalva LI Zhi-yi，LI Gang，CHEN Wei-xin，et al.The Department of condiae surgery Shenzhen Sun Yat-sen Cardiovascular Hospital， Shenzhen 518020,China ? 【Abstract】 Objective To summerize the experience of surgical treatment of rupture of aotic sinusal anerrysm during past 15 years．Methods From December 1992 to November 2007，21 cases ruptured aneurysm of the surgical treatment were performed under moderate hypothermia with cardiopulmonary bypass．Concomitant procedures included VSD repaire in 10 cases，ASD repair in 3 cases，AVP in 2 and AVR in 3.Results No surgical death and late death．All patients were recovered smoothly．No recurrence occurred during follow-up survey．Conclusion Following diagnosis of ruptured aneurysm of sinus of valsalva，surgical repair should be performed as quickly as possible．The essential factors to success in the surgery are that ruptured aneurysm of sinus of valsalva should be repaired precisely and myocardial protection should be enhanced．? 【Key words】Ruptured aneurysm of the sinus of valsalva；Cardiac surgical procedures 主动脉窦瘤破裂(RSVA)是一种很少见的心脏疾患，约占先天性心脏病的0．31%~3．56%。破裂后引起心脏内大量的左向右分流，治疗不及时常会导致心力衰竭，甚至死亡。1992年12月至2007年11月本院共收治主动脉窦瘤破裂患者21例。报告如下。 1 资料与方法 1．1 一般资料 本组21例中男13例，女8例，突然起病l5例，隐匿起病6例。年龄18-50岁，平均（29．4±4．9）岁；体质量（41~65）kg，平均（45．1±18．5）kg。单纯RSVA8例，合并其他畸形13例。NYHA心功能Ⅱ级6例，余均为Ⅲ~Ⅳ级。胸痛5例，胸骨左缘第3~4肋间可闻及连续性杂音21例，周围血管征阳性11例。胸部X线片均示：肺血增多，心脏增大，破入右房病例尤为明显，且心脏增大比肺血增多更显著。心胸比例0．55~0．81。心电图示：左心室肥厚15例，右心室肥厚6例。心脏彩超示：①破口起源:右冠窦16例，无冠窦5例；②窦瘤破入:右心房7例，右心室14例；③合并的心脏畸形：房间隔缺损（ASD）3例，室间隔缺损（VSD）10例，主动脉瓣关闭不全（AI）5例。 1．2 手术方法 所有患者均在全麻、中低温体外循环下行手术，取胸正中切口入路，心外探查进一步明确窦瘤破入部位及合并畸形。常规行升主动脉、上下腔静脉插管，体外循环转流前置左心引流管以利左心室减压。阻断升主动脉后直接切开主动脉根部，经左右冠脉开