主动脉瓣上狭窄13例的外科治疗  

SURGICAL RESULT OF SUPRAVALVULAR AORTIC STENOSIS IN 13 CASES

作　　者：赖锋华[1] 李韬[1] 陈凯明[1] 陈景伟[1] 刘浪[1] 林世廷[1] 朱伯卫[1] 

机构地区：[1]广东省高州市人民医院心血管病外科,525200

出　　处：《中国煤炭工业医学杂志》2013年第3期362-364,共3页Chinese Journal of Coal Industry Medicine

摘　　要：目的总结先天性主动脉瓣上狭窄(SVAS)术前诊断和外科治疗中的经验。方法 2005年1月—2011年6月收治SVAS患者13例,男8例,女5例,年龄1.9～19.0岁,平均(5.73±6.36)岁,局限性狭窄11例(84.6%),弥漫性狭窄2例(15.4%)。Williams综合征4例(30.7%),9例合并其他心脏畸形,包括主动脉瓣狭窄3例,主动脉瓣关闭不全2例,冠状动脉畸形1例,合并动脉导管未闭1例,2例合并肺动脉狭窄,术前超声心动图检查漏诊1例,并发主动脉瓣狭窄。单片法加宽9例,倒"Y"法2例,三片法2例。结果本组手术早期死亡2例,其余患者痊愈出院。局限型SVAS狭窄解除满意,压差降至0～20mmHg;弥漫型效果不佳,1例术后随访3年仍有轻到中度狭窄,目前仍在随访中。11例术后随访1个月～5年平均随访3.5年,心功能I级10例,II级1例;随访无假性动脉瘤形成。结论局限性主动脉瓣上狭窄的手术治疗效果良好,弥漫型手术治疗效果不佳,应谨慎选择手术治疗。Objective To review the experience of diagnosis and surgical management of supravalvular aortic ste- nosis （SVAS）. Methods From Jan. 2005 to Jun. 2011, 13 cases of SVAS, with an average age of （5.73 ± 6. 36）years （from 1.9 to 19 years）, underwent surgical repair in author＇s hospital. Among them, included 8 males and 5 females, 11 （84. 6 % ）cased were localized type SVAS and 2 （15.4% ）cases were diffused type SVAS. Of the 13 cases, there were 4 cases with Williams syndrome, 9 cases with other cardiac defects including 3 cases of aortic valve stenosis, 2 cases of aortic incompetence, 1 case of coronary artery malformation, 1 case of patent ductus ar- teriosus, 2 cases of pulmonary artery stenosis. There was 1 case with aortic valve stenosis misdiagnosed by echo- cardiography before surgery. Operative technique included single, diamond- shaped patch aortoplasty in 9 cases, inverted bifurcated patch aortoplasty in 2 cases, and three coronary sinuses patch aortoplhsty in 2 cases. Results Except 2 cases died in the early postoperative period, all the localized type SVAS received good surgical outcome with mean pressure gradient reduced to （10± 5）mmHg （0-20mmHg）. Of 11 cases followed up from Ⅰ month to 5 years, there were 10 cases with class Ⅰ heart function and 1 case with class Ⅱ heart function. Of the 11 cases, there was no pseudoaneurysm founded in the follow up. Conclusion Good surgical outcome of SVAS can be a- chieved in localized type. But it is ineffective in diffuse type, so we should be take a caution on surgical treatment of diffused type SVAS.

关 键 词：主动脉瓣上狭窄 先天性心脏病 外科治疗 

分 类 号：R654.2[医药卫生—外科学]