成人先天性主动脉瓣狭窄的外科治疗  

Surgery treatment of congenital stenosis of aortic valve in adults

作　　者：郑向阳[1] 梁志强[1] 张力[1] 何发明[1] 朱汝军[1] 徐宏耀[1] 

机构地区：[1]河南省胸科医院心血管外科,郑州450003

出　　处：《医药论坛杂志》2015年第5期35-37,共3页Journal of Medical Forum

摘　　要：目的总结成人先天性主动脉瓣狭窄外科治疗的效果和经验。方法2002年—2009年，共收治先天性主动脉瓣狭窄成人病例106例。85例单纯行主动脉瓣置换术，16例行Wheat手术，5例行Bentall手术。同期行冠脉动脉旁路移植术12例，二尖瓣成形术8例，主动脉窦管交界加宽17例。结果1例在行主动脉瓣置换同期行冠脉动脉旁路移植术后，无法停体外循环，自动出院。1例术后出现Ⅲ。房室传导阻滞，植入永久性起搏器后康复出院。术后早期无死亡病例。术后早期并发低心排综合征12例，恶性心律失常19例。随访6月～5年患者症状明显改善，心功能在Ⅱ级以上。结论成人先天性主动脉瓣狭窄患者主动脉瓣口面积〈0．75cm^2和／或跨瓣压差〉50mmHg，或已出现晕厥、心绞痛、充血性心力衰竭和感染性心内膜炎应该尽早手术。运用Tel指数和其他常用的超声指标，有助于更好地决定主动脉瓣置换术的最佳手术时机。Objective To summarize the clinic effect and experience of congenital stenosis of aortic valve in adults. Methods Totally 106 patients with congenital stenosis of aortic valve received surgical treatment from 2002 to 2009. In all of them, aortic valve replacement was performed in 85 cases; Wheat procedure was performed in 16 cases; Bentall procedure was performed in 5 cases. 12 patients with coronary artery disease underwent CABG; 8 patients underwent mi- tral valve repair and 17 underwent patch enlargement of the sinotubular junction stenosis. Results one who combined AVR and CABG died from low cardiac output syndrome during operation. One was implanted permanent pacemaker because of Ⅲ° atrial ventricular block after 2 weeks in postoperative. None died in the early postoperative period. 12 cases concurrence low cardiac output syndrome; 19 cases appearance malignant arrhythmia. Symptom was obviously improved and all of them were above heart function （NYHA） of grade Ⅱ in followed - up patients from 6 months to 5 years postop- eratively. Conclusions The patients with congenital stenosis of aortic valve in adults need as soon as possible operation if their aortic valve area was less than 0. 75era2 or（ and ） PPG exceed 50mm Hg. Those who have appearaneed apopsychia, angina pectoris, congestive cardiac failure, or infective endocarditis should accept operation early. The application of Tei index combining frequently used index of ultrasound conduce to the best operation opportunity of AVR.

关 键 词：先天性主动脉瓣狭窄 成人 TEI指数 心脏手术 

分 类 号：R654.2[医药卫生—外科学]