伴室间隔缺损的主动脉窦瘤破裂患者主动脉瓣反流外科技术探讨  

Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of valsalva aneurysm associated with ventricular septal defect

作　　者：刘爱军[1,2,3] 李志强[1,2,3] 李刚[1,2,3] 李斌[1,2,3] 朱耀斌[1,2,3] 李晓锋[1,2,3] 刘迎龙[1,2,3] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所 [3]北京市儿童心血管病中心小儿心脏中心,北京100029

出　　处：《心肺血管病杂志》2014年第2期194-197,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都市民健康项目培育(项目编号:Z111100074911001)

摘　　要：目的:回顾性总结伴室间隔缺损的主动脉窦瘤破裂(RSVA)的手术治疗,对术前主动脉瓣反流(AR)及术后中期随访AR加重的危险因素进行分析。方法:全组94例患者,RSVA起源于右冠窦瘤91例,破入右心室流出道85例。所有患者均限期内行根治手术,术中行主动脉瓣置换(AVR)24例,补片修补破口基底部63例,直接缝合破口7例。结果:手术无死亡,术后晚期死亡1例系AVR患者。术前61例合并AR,经Logistic回归分析,主动脉瓣继发性改变和室缺直径为术前并发AR的危险因素。术后中期随访56例患者,9例AR加重,单因素分析显示术后合并AR者中期随访AR加重的比率显著高于未合并AR者。结论:早发现、早手术是避免术前AR的有效方法;RSVA术后合并有AR患者应密切随访。Objective：We reviewed the experience of ruptured sinus of Valsalva aneurysms （RSVA） associated with ventricular septal defect （VSD） to determine risk factors for preoperative aortic regurgitation （AR） and postoperative progression of AR.Methods：A total 94 patients underwent a surgical repair of RSVA and VSD.Aneurysms originated from right sinus in 91 patients,and protruded into right ventricle outlet tract in 85 patients.Surgery was performed in a short time once RSVA was diagnosed.Aortic valve replacement （AVR） was performed in 24 patients and aortic valvuloplasty in 6 patients （1 received AVR eventually for aortic valvuloplasty failure）.The methods of RSVA repair included the following：closing the base of the fistula with patch in 63 patients,closing the break with direct sutures （simple/buttressed） in 7 patients.Results：All patients survived the operation.Late death occurred in 1 patient after AVR.AR presented in 61 patients before operation.By Logistic regression analysis,patients with secondary changes of aortic valve and diameter of VSD were risk factors related with preoperative AR.In 56 late follow-up patients without AVR,AR worsened in 9 patients.By univariable analysis,AR at discharge was identified as a risk factor correlative with late postoperative worsening of AR.But by Cox regression analysis,AR at discharge showed no significant contribution to late follow-up AR aggravation.Conclusion：RSVA associated with VSD can be repaired with a low mortality and excellent long-term result.An early diagnosis,an aggressive treatment should be recommended for treatment.Patients with AR at discharge should be followed up closely.

关 键 词：主动脉窦瘤破裂 室间隔缺损 主动脉瓣反流 主动脉瓣置换 危险因素 

分 类 号：R54[医药卫生—心血管疾病]