主动脉左心室通道的外科治疗  

Surgical treatment of aortico-left ventricular tunnel

作　　者：王巍[1] 孙海宁[1] 杨克明[1] 罗新锦[1] 胡盛寿[1] 

机构地区：[1]中国医学科学院北京协和医学院北京阜外心血管病医院心外科,100037

出　　处：《中华心血管病杂志》2009年第9期823-825,共3页Chinese Journal of Cardiology

摘　　要：目的总结9例主动脉左心室通道的外科诊治经验。方法回顾性分析我院2002年7月至2008年8月收治主动脉左心室通道患者9例，术前心功能（NYHA）：Ⅰ／级7例，Ⅲ级2例。9例患者中8例术前通过经胸超声心动图诊断，全部经术中食道超声确诊。结果9例均于术中确诊并行手术治疗，主动脉侧直接缝合2例，其中1例缝合通道后行主动脉瓣置换术；自体心包片或涤纶片衬心包从主动脉侧修补5例，其中1例修补通道后行主动脉瓣置换术；自体心包从主动脉侧及左室侧修补1例；切开主动脉左心室通道行主动脉瓣置换术1例。1例术后2个月因感染性心内膜炎、急性心力衰竭死亡；随访3个月至6年，随访7例，失访1例，心功能（NYHA标准）I级患者3例，Ⅱ级3例，Ⅲ级1例。超声心动图示主动脉瓣无或微量反流2例，1例少量反流，2例少到中量反流，主动脉瓣功能正常1例，瓣周漏1例，远期无死亡。结论主动脉左心室通道是一类非常罕见的先天性心脏病，超声心动图在本病诊断方面有着明显的优势；手术是治疗的有效方式，单纯修补效果良好。Objective To review 9 aortico-left ventricular tunnel （ALVT） patients in our hospital, describe the clinical features, diagnosis, treatments and follow-up. Methods We identified 9 patients from July 2002 to August 2008. Clinical and surgical details were reviewed. 7 patients were in NYHA class I and 2 in class Ⅲ, 8 of 9 patients were diagnosed by eehocardiography before operation. Results All patients underwent surgery under standard cardiopulmonary bypass. 2 with direct suture, 5 by patch closure of the aortic end and 1 by patch closure of both aortic end and left ventricular end of the AVLT. 1 underwent aortic valve replacement after incision of the ALVT. One patient died 2 month after operation because of endocarditis and acute heart failure . At follow-up （3 month to 6years） ,3 patients were in NYHA class Ⅰ, 3 in Class Ⅱ , 1 in class Ⅲ and missed 1. No aortic regurgitation or trace in 2, little in 1 ,little to moderate in 2 . The aortic mechanical valve is normal in 1 and paravalvular leakage in 1 patient. Conclusion Aorticoleft ventricular tunnel is a rare cardiac malformation with a good post-operative outcome. Surgery is an effective treatment. Long-term follow-up for post-operation is essential.

关 键 词：心脏缺损 先天性 主动脉左心室通道 心血管外科手术 

分 类 号：R686[医药卫生—骨科学]