外科治疗主动脉瓣下狭窄的疗效分析.doc

外科治疗主动脉瓣下狭窄的疗效分析 王 咏，肖颖彬，王学锋，陈 林，刘 梅( 400037重庆，第三军医大学附属新桥医院心内科，国家重点学科全军心血管外科中心) [摘要] 目的 探讨手术治疗主动脉瓣下狭窄的临床疗效。方法 1996年12月至2009年10月在我中心接受手术治疗的58例主动脉瓣下狭窄的患者，其中男35 例，女23 例；年龄1～49 （15.9±5.7）岁。局限型主动脉瓣下狭窄56 例(纤维隔膜型33 例、纤维肌隔型21 例)，隧道型主动脉瓣下狭窄2 例。局限型行狭窄隔膜切除术56 例，加左室肌肉切除术12 例；隧道型行左室流出道疏通术2 例。合并畸形56 例，同期行矫正手术。结果 围手术期死亡3例（5.17%）。术后45 例左室主动脉收缩压力差3.5～28.2（7.0±4.6）mm Hg。术后1、3、5、8年各随访 54、48、31、22例。症状均消失，无再狭窄需手术者。结论 主动脉瓣下狭窄一旦确诊，手术指征明确，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。 [关键词] 主动脉瓣下狭窄；心脏外科手术 [中图法分类号] R654.1; R654.2 [文献标志码]A Surgical treatment of subaortic stenosis Wang Yong，Xiao Yingbin，Wang Xue-feng，Chen Lin liu Mei( Department of Cardiovascular Surgery， Xinqiao Hospital， Chongqing， 400037， China ) [Abstract] Objective To summarize the experience of surgical treatment of subaortic stenosis. Methods 58 patients with subaortic stenosis were treated surgically in our cardiovascular center from December，1996 to October，2009. There were 35 males and 23 females. The mean age at operation was 15.9±5.7 years (range 1 to 49 years) . 56 patients had discrete stenosis and 4 had tunnel stenosis. For the discrete stenosis cases，simply resection of stenosis membrane was donen 56 cases and myoctomy in 12 cases. For tunnel stenosis cases， left ventricular muscle was resected to relieve obstrucion. In 56 patients combined cardiovascular malformation were corrected at the same time. Results There were 3 perioperative deaths. The mean systolic gradient of left ventricle to aorta was 6.9±4.8 mmHg with a range of 3.5-28.2 mmHg in 42 cases after operation. The 1st， 3rd， 5th ，8thyear follow-up rate was 98 %， 87 %， 56 %， 40%， 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 p