48例主动脉瓣下狭窄的外科治疗  

SURGICAL TREATMENT OF SUBVALVULAR AORTIC STENOSIS

作　　者：胡盛寿[1] 朱晓东[1] 萧明第[1] 潘世伟[1] 张国平 

机构地区：[1]中国医学科学院,中国协和医科大学,中国人民解放军第二五二医院

出　　处：《中国循环杂志》1995年第7期404-406,共3页Chinese Circulation Journal

摘　　要：本文报告４８例（分散性）主动脉瓣下狭窄（ＤＳＡＳ）。其中隔膜型狭窄８例（１６．７％），肌纤维型狭窄３９例（８１．８％），隧道型狭窄１例（２％）。单纯ＤＳＡＳ组（１５例）术后无死亡，合并其它心内畸形组（３３例）术后早期死亡２例。作者认为，ＤＳＡＳ手术早期效果良好，并就影响远期疗效的因素进行了讨论。From April 1977 to August 1990, 48 patients (27 males and 21 females) were operated for discrete subvalvular aortic stenosis (DSAS). Group A (n=15 ) with isolated DSAS aged 9 to 26 years (14.9±6.4 years), Group B (n=33) with coexisting other cardiac anomalies (14 patients of PDA, 12 of VSD, 4 of VSD and PDA, 2 of aortic valve stenosis and 1 of aortic valve stenosis and incompetence) aged 3 to 33 years ( 11.3±7.4 years). Membrane stenosis was found in 8 patients (16.7% ) , fibromuscular stenosis in 38 (81.3%), and 'tunnel' stenosis in 1 (2.1%). Isolated resection of the membrane or fibromuscular tissue was performed on 40 patients; resection of the membrane or fibromusclar tissue with left ventricular myotomy on 6, with ventricular septal myotomy-myectomy on 1, and with aortic valve replacement on 1 with no operative deaths in group A, but with 2 early postoperative deaths in group B. 30 patients (78.9%) had improvement or became asymptomatic, while 8 (21.1%) still had moderate or severe symptoms, among the 38 patients followed up for 5 months to 18 years and 2 months (mean, 2 years and 6 months). Systolic heart murmur can be heard in 17 patients (44.7%). It is concluded that fibromuscular stenosis is the most common type of DASA and is always associated with hypertrophied outlet tract of the left ventricle. The operation is usually safe, but with a higher recurrence rate which may be related to (1) failure of complete resection of the stennsis tissue or regrowth of the fibrous tissue, (2) improper operative approach, (3) aortic valve lesion may progress after a satisfactory operation.

关 键 词：先天性心脏病 主动脉瓣下狭窄 外科手术 

分 类 号：R654.2[医药卫生—外科学]