支架“象鼻子”技术和主动脉瓣成形治疗DeBakey Ⅰ型夹层主动脉瘤合并主动脉瓣关闭不全  

Stented elephant trunk procedure and aortic valvuloplasty for De Bakey Ⅰ aortic dissection with aortic valve insufficiency

作　　者：姚建民[1] 赵向东[1] 肖志斌[1] 王明岩[1] 陆龙[1] 庞中一[1] 王东文[1] 刘静[1] 

机构地区：[1]北京军区总医院心血管病中心外科,100700

出　　处：《中国急救医学》2008年第6期489-491,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的介绍支架"象鼻子"技术和主动脉瓣成形治疗DeBakeyⅠ型夹层主动脉瘤合并主动脉瓣关闭不全的体会。方法自2006-12～2007-12我们采用支架"象鼻子"技术、主动脉瓣成形、升主动脉和全主动脉弓置换治疗DeBakeyⅠ型夹层主动脉瘤合并主动脉瓣关闭不全7例,手术采用胸部正中切口,右腋动脉插管,深低温停循环,选择性顺行脑灌注。通过交界悬吊和(或)部分窦切除进行主动脉瓣成形,用覆膜自膨胀支架血管置入左半弓和降主动脉近端形成"象鼻子"。结果无术中和术后大出血,选择性脑灌注时间和停循环时间20～30min。术后恢复顺利,无住院死亡。随访2～14个月,无明显主动脉瓣膜关闭不全,覆膜支架膨胀良好,支架远段降主动脉真腔扩大,假腔缩小或消失,心功能Ⅰ级。结论支架"象鼻子"技术、主动脉瓣成形、升主动脉和全主动脉弓置换是治疗DeBakeyⅠ型夹层主动脉瘤合并主动脉瓣关闭不全安全、有效的方法。Objective To summarize the experience of stented elephant trunk procedure and aortic valvuloplasty for De Bakey Ⅰaortic dissection with aortic valve insufficiency.Methods From December 2006 to December 2007,7 patients with De Bakey I aortic dissection and aortic valve insufficiency underwent ascending aorta and total aortic arch replacement combined with stented elephant trunk procedure and aortic valvuloplasty.Operations were performed by median sternotomy with deep hypothermic circulatory arrest and right axillary artery cannulation for selective antegrade cerebral perfusion.A self-expandable stent grafting was implanted into the left half arch and proximal descending aorta through the aortic arch to make the elephant trunk.The aortic sinotubular junction was remodelled and the aortic valve was repaired through aortic commissure-suspending and/or partial David procedure.Results Deep hypothermic circulatory arrest and selective cerebral perfusion time was 20～30 min.The postoperative course was uneventful.There was no mortality and massive haemorrhage perioperatively.During a follow-up of 2～14 months,there was no aortic valve insufficiency,false lumen of the descending aorta disappeared or reduced significantly with NYHA classⅠ of cardiac function.Conclusion The stented elephant trunk procedure and aortic valvuloplasty seem to be effective and safe for De Bakey Ⅰ aortic dissection with aortic valve insufficiency.

关 键 词：夹层主动脉瘤 主动脉瓣关闭不全 主动脉支架 

分 类 号：R654.2[医药卫生—外科学]