双瓣膜置换术中细小主动脉根部的扩大成形(附7例报告)  

Inverse "Y" incision technique of enlargement annulus for double valve replacement in small aortic root: seven cases report

作　　者：姜月平[1] 罗德源[1] 黄淼龙[1] 龙荣尊[1] 万仁平[1] 陈翀[1] 

机构地区：[1]韶关市粤北人民医院心胸外科,广东512025

出　　处：《中华胸心血管外科杂志》2005年第5期263-265,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的报道一种双瓣膜置换术中扩大细小主动脉根部的手术方法和结果.方法 7例双瓣膜置换术中细小主动脉根部(瓣环直径17～20 mm)者,将斜行的主动脉切口经左、无冠窦交界呈倒'Y'形向二尖瓣前叶切开,切除二尖瓣叶时保留3～5 mm宽的前瓣叶组织,补片扩大主动脉瓣瓣环后植入人工瓣膜.结果 7例扩大主动脉瓣环直径4～7 mm,主动脉瓣和二尖瓣分别植入21～23 mm和25～27 mm人工机械瓣.无手术死亡,1例二次开胸止血.随访1～26个月,病人心功能恢复良好.结论对双瓣膜置换术中的细小主动脉根部,Manouguian法不能有效扩大主动脉瓣环时,该术式可作为一种安全有效的替代方法.Objective To report the surgical procedure and its results of enlargement annulus for double valve replacement in aortic root. Methods were 7 patients with small aortic root undergoing double valve replacement. Mean age of 42 years （from 34 to 52 years）. The diameters of aortic annulus ranged from 17 to 20 mm. The aortotomy was extended through the commissuree that separates the left and noncoronary cusps of the aortic valve. The aortic annulus was divided, and the incision was extended into anterior leaflet of the mitml valve as inverse ＂Y＂. The anterior leaflet of the mitml valve was excised 3 - 5 mm to its root. A prosthetic patch was attached to the aortic-mitral valve so the aortic annulus was enlarged. The prosthetic valve was implanted. Moreover, it was attached to the prosthetic patch, at the root of the anterior leaflet of the mitral valve. Results The diameters of aortic annulus after operation were enlarged to 4 - 7 mm. The prosthetic valve （φ21 - 23 mm） was implanted in aortic valve position and the prosthetic valve （φ25 - 27 mm） in mitml valve position. There were no operative and postoperative deaths. One patient was re-operated for bleeding. All patients were followed up from 1 to 26 months and their cardiac function was significantly improved. Conclusion This surgical procedure is safe and effective for replacement, for double valve replacement in small aortic root.

关 键 词：心脏瓣膜疾病/外科学 主动脉瓣 心脏瓣膜 人工 心脏瓣膜假体植入 细小主动脉根部 双瓣膜置换 术中 扩大成形 二尖瓣前叶 二次开胸止血 

分 类 号：R654.3[医药卫生—外科学]