David手术在主动脉根部瘤合并主动脉瓣二叶畸形治疗中的应用  

David procedure in aortic root aneurysm patients complicated with bicuspid aortic valve

作　　者：徐贞俊[1] 徐灿[1] 宋之昭 李坤生 王东进[1] 潘俊[1] Xu Zhenjun;Xu Can;Song Zhizhao;Li Kunsheng;Wang Dongjin;Pan Jun(Department of Thoracic and Cardiovascular Surgery,Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,南京210009

出　　处：《中华解剖与临床杂志》2021年第5期560-564,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨David手术在治疗主动脉根部瘤合并主动脉瓣二叶畸形中应用的临床效果。方法回顾性研究。纳入南京大学医学院附属鼓楼医院心胸外科2016年1月—2019年1月行David手术治疗主动脉根部瘤合并主动脉瓣二叶畸形的11例患者临床资料。其中男8例、女3例,年龄18~60(35±13)岁;主动脉瓣轻度反流7例、轻中度反流4例,心功能Ⅱ级5例、Ⅲ级5例、Ⅳ级1例。观察患者围术期指标;术后定期复查心脏超声,观察人工血管通畅情况及主动脉瓣反流情况,包括左室射血分数、主动脉瓣反流程度、平均跨瓣压差、峰值跨瓣压差及最大血流速度。结果11例患者均成功实施手术。围术期观察指标:体外循环时间(246.1±27.2)min,主动脉阻断时间(207.5±21.5)min,术后机械通气时间4.5(3.25,9.25)h,重症监护时间(2.8±1.5)d,术后24 h引流量(418.2±299.0)mL。所有患者术后随访18~30个月,平均22.5个月,未见死亡及二次手术病例。随访期间心脏超声显示患者人工血管血流均通畅,主动脉瓣轻微反流8例、轻度反流3例,平均跨瓣压差均<10 mmHg(1 mmHg=0.133 kPa),末次随访时,患者心功能Ⅰ级8例、Ⅱ级3例,较术前明显改善。结论采用David手术结合主动脉瓣修复技术治疗主动脉根部瘤合并中度以下反流的主动脉瓣二叶畸形,其临床疗效满意。Objective This article aims to summarize the experience and outcomes of the David operation in aortic root aneurysm patients complicated with bicuspid aortic valve.Methods Between January 2016 and January 2019,11 aortic root aneurysm patients with bicuspid aortic valve complication underwent the David procedure in the Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital.Characteristics and outcomes were summarized.The age range was from 18 years old to 60 years old,with a mean age of(35±13)years old.Eight of these patients were male.Aortic valve regurgitation was mild for seven patients and mild to moderate for four patients.The New York Heart Association classification gradeⅡwas found in five cases,gradeⅢin five cases,and gradeⅣin one case.The patient's perioperative characteristics were summarized,and regular follow-up with echocardiography was performed to observe the patency of the artificial blood vessel and the aortic valve regurgitation,including left ventricular ejection fraction,degree of aortic valve regurgitation,average and peak transvalvular pressure,and maximum blood flow velocity.Results The operation was successful on all patients,and no redo operations and in-hospital death were recorded.The perioperative observation indicators were as follows:cardiopulmonary bypass time(246.1±27.2)min;aortic cross-clamp time(207.5±21.5)min;postoperative mechanical ventilation time 4.5(3.25,9.25)h;intensive care unit time(2.8±1.5)d;and drainage volume,which was(418.2±299.0)mL after 24 h of operation.All patients were followed up for 18-30 months,with an average of 22.5 months,and no deaths or redo operations were recorded.The blood flow of the artificial blood vessels was unobstructed in the patients at follow-up.During follow-up,eight patients had trivial aortic valve regurgitation,and three patients had mild aortic valve regurgitation.The average transvalvular pressure was<10 mmHg(1 mmHg=0.133 kPa).The New York Heart Association classification gradeⅠwas found in eight cases,wher

关 键 词：主动脉瘤 胸 心血管畸形 David手术 主动脉根部瘤 主动脉瓣二叶畸形 

分 类 号：R654.2[医药卫生—外科学]