主动脉窦瘤破裂合并室间隔缺损的心脏解剖学特点及临床分析  

Cardiac anatomy and clinical analysis in patients with combined rupture sinus Valsalva aneurysm and ventricular septal defect

作　　者：金岩[1] 王辉山[1] 方敏华[1] 于岩[1] 王镇龙[1] 

机构地区：[1]沈阳军区总医院心外科,110840

出　　处：《中国心血管杂志》2015年第5期351-354,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的通过分析主动脉窦瘤破裂(RSVA)合并室间隔缺损(VSD)患者的临床资料,探讨其心脏解剖学特点,以提供术前精确诊断及术式良好预判。方法回顾性分析2003年9月至2014年4月我院经手术证实为RSVA患者80例,按是否合并VSD分为两组,比较两组患者心内畸形情况。结果 80例患者分为VSD组38例(47.5%)和无VSD组42例(52.5%),VSD组合并其他心内畸形的比例明显高于无VSD组[7例(18.4%)比1例(2.4%),P=0.043];无VSD组患者病史时间明显短于VSD组[(0.6±1.3)年比(5.9±11.3)年,P=0.002],且心功能NYHA分级明显差于VSD组(3.12±0.52比2.37±0.58,P=0.041)。VSD组合并主动脉瓣病变患者比例高于无VSD组[18例(47.4%)比3例(7.1%),P<0.001]。VSD组38例均起源于右冠窦,其中33例(86.8%)破入有心室流出道,而无VSD组42例起源部位绝大多数仍为右冠窦[38例(90.5%)],但破口部位较为分散。VSD组与无VSD组的破裂部位构成比截然不同(x^2=55.98,P<0.001)。结论 RSVA的部位与是否合并VSD可能存在明显相关性;合并VSD的RSVA患者更容易合并主动脉瓣病变。Objective About 50% of the rupture of sinus Valsalva aneurysm （RSVA） coexists with ventricular septal defect （VSD）. The aim of this study was to provide accurate preoperative diagnosis and operation method anticipation by analyzing the clinical data of RSVA with/without VSD and exploring the heart anatomic features. Methods The clinical data of 80 patients with RSVA were retrospectively analyzed from September 2003 to April 2014. The patients were divided into two groups on the basis of the presence or absence of VSD. Results 80 patients were divided into 38 cases of VSD group （47.5%） and 42 cases of non-VSD group （52. 5% ）. Patients in VSD group were more likely to suffer from other co-existing cardiac abnormalities than non-VSD group [ 7 （ 18.4% ） vs.. 1 （ 2. 4% ）, P = 0. 043 3, and the duration of the symptoms shown by the patients of non-VSD group was significantly shorter than that of VSD group [ （0. 6 ± 1.3 ） years vs.. （ 5.9 ± 11.3 ） years, P = 0. 002 ]. Patients＇ heart function in non-VSD group was significantly worse than that of the VSD group patients （ 3. 12 ± 0. 52 vs.. 2. 37 ± 0. 58, P = 0. 041 ）. 18 patients （47. 4% ） in VSD group and 3 patients （7. 1% ） in non-VSD group accompanied with aortic valve disease （P 〈0. 001）. In the VSD group, all the ruptured aneurysms of 38 patients originated in the fight coronary sinus （RCS）. In the non-VSD group, more than 90. 5% （38/42） of all the ruptured aneurysms also originated in RCS, but the ruptured positions in sinus of Valsalva aneurysm were dispersed. Through an analysis of the constituent ratio of the ruptured position in sinus of Valsalva aneurysm （x^2 = 55.98, P 〈0. 001）, there was a significant difference between the two groups. Conclusions There is an obvious correlation between the RSVA site and with/without VSD. The patients in VSD group are more likely to complicate with aortic valve disease than those in non-VSD group.

关 键 词：主动脉窦瘤破裂 室间隔缺损 解剖学特点 

分 类 号：R654.2[医药卫生—外科学] R322.1[医药卫生—临床医学]