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find Keyword "主动脉窦瘤破裂" 3 results
  • Modified Sakakibara Classification System for Ruptured Sinus of Valsalva Aneurysm

    Objective To introduce a modified Sakakibara classification system for a ruptured sinus of Valsalva aneurysm (RSVA),and suggest different surgical approaches for corresponding types of RSVA. Methods Clinical data of 159 patients undergoing surgical repair for RSVA in Fu Wai Hospital between February 2006 and January 2012 were retrospectively analyzed. There were 105 male and 54 female patients with their age of 2-71 (33.4±10.7) years. All these patients were divided into 5 types as a modified Sakakibara classification system. Type I: rupture into the right ventricle just beneath the pulmonary valve (n=66),including 84.8% patients with ventricular septal defect (VSD) and 53.8% patients with aortic valve insufficiency (AI). TypeⅡ:rupture into or just beneath the crista supraventricularis of the right ventricle (n=17),including 88.2% patients with VSD and 23.5% patients with AI. Type Ⅲ:rupture into the right atrium (typeⅢ a,n=21) or the right ventricle (typeⅢv,n=6) near or at the tricuspid annulus,including 18.5% patients with VSD and 25.9% patients with AI. TypeⅣ:rupture into the right atrium (n=46),including 23.9% patients with AI but no patient with VSD. TypeⅤ:other rare conditions,such as rupture into the left atrium,left ventricle or pulmonary artery (n=3),including 100% patients with AI and 33.3% patients with VSD. Most RSVA originated in the right coronary sinus (n=122),and others originated in the noncoronary sinus (n=35) or left coronary sinus (n=2). Results All the type V patients (100%) and 50% patients with typeⅢv received RSVA repair through aortotomy. In most patients of typeⅠ,II andⅣ,repair was achieved through the cardiac chamber of the fistula exit (71.2%,64.7% and 69.6% respectively). Both routes of repair were used in 76.2% patients with typeⅢ a. The cardiopulmonary bypass time (92.4±37.8 minutes) and aortic cross-clamp time (61.2±30.7 minutes) was the shortest to repair typeⅣRSVA. There was no in-hospital death in this group. Two patients (type I andⅡrespectively) underwent reoperation during the early postoperative period because of restenosis of the right ventricular outflow tract. Most patients received reinforcement patch for RSVA repair (n=149),and only 10 patients received simple suture repair (including 5 patients with typeⅣ,4 patients with typeⅢ a and 1 patient with typeⅡ). Aortic valve replacement was performed for 33 patients (66.7% of those with typeⅠ). A total of 147 patients (92.5%) were followed up after discharge. Two patients (type I andⅢ a respectively) developed atrial fibrillation and received radiofrequency ablation treatment,1 patient (typeⅣ) underwent reoperation for residual shunt,and there was no late death during follow-up. Conclusion Modified Sakakibara classification system for RVSA provides a guidance to choose an appropriate surgical approach,and satisfactory clinical outcomes can be achieved for all types of RSVA.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 主动脉窦瘤破裂的外科治疗

    目的 总结主动脉窦瘤破裂的外科治疗经验。 方法 83例主动脉窦瘤破裂患者均在气管内插管静脉复合麻醉中度低温体外循环下行主动脉窦瘤修复术,同时矫治合并的心内畸形,包括行主动脉瓣置换术20例,主动脉瓣成形术9例,三尖瓣成形术4例,肺动脉瓣重建术2例,室间隔缺损修补术37例,房间隔缺损修补术5例,右心室流出道疏通2例,右室双腔心矫治术1例。 结果 本组无手术死亡。术后并发心力衰竭2例,再次开胸止血4例,均经治疗后痊愈。所有患者均得到随访,随访时间1个月~6年, 平均随访25.6个月。心功能Ⅰ~Ⅱ级。心脏彩色超声心动图复查:未发现主动脉窦瘤复发或残余分流,主动脉瓣轻度反流2例,轻至中度反流2例;术后6年主动脉瓣重度反流1例,再次行主动脉瓣置换术。 结论 主动脉窦瘤破裂预后不良,尽早手术是治疗主动脉窦瘤破裂惟一有效的治疗方法。治疗的关键是恰当切除瘤体,可靠闭合窦瘤口,彻底矫治心脏畸形。

    Release date:2016-08-30 06:15 Export PDF Favorites Scan
  • Surgical Treatment for Ruptured Sinus of Valsalva Aneurysm

    【摘要】 目的 探讨主动脉窦瘤破裂(RSVA)的临床特点、诊断及外科治疗方法。 方法 2004年1月-2009年12月对28例RSVA患者在体外循环下行RSVA修补术,同期行室间隔缺损修补术18例,房间隔缺损修补术4例,主动脉瓣成形术2例,主动脉瓣置换术4例。术后随访3个月~6年,平均32.4个月。 结果 28例患者均无手术死亡和残余分流。失访4例。心功能Ⅰ级20例,Ⅱ级4例;复查心脏彩色超声心动图无主动脉窦瘤复发或残余分流,主动脉瓣轻-中度反流2例。 结论 外科手术是RSVA的最有效治疗方法,窦瘤破口直径gt;0.5 cm者宜用补片修补。伴有中或重度主动脉瓣关闭不全时需根据主动脉瓣病变程度以及手术者经验决定,必要时需放宽换瓣指征。【Abstract】 Objective To evaluate the clinical characteristics, diagnosis, and surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA). Methods Twenty-eight patients with RSVA were treated surgically in extracorporeal circulation. Repair of RSVA with patch were taken in all patients while closure of ventricular septal defect (VSD) in 18 patients, closure of atrial septal defect (ASD) in four patients, aortic angioplasty (AA) in two patiens and replacement of aortic valve in four patients. Results There was no death and no residue leak after operation. The patients were followed-up for 24 patients, ranged from three months to six years, with the average 32.4 months. The cardiac function of 20 patients was found to be of NYHA classⅠand four patients of classⅡ. Review the heart colour echocardiography, there was no residual tumor or sinus and aortic regurgitation light-moderate in two patients. Conclusions Surgery is the most effective treatment for RSVA, the breaches of sinus tumor in diametergt;0.5 cm is used to repair. When the patients with moderate or severe aortic regurgitation, whether it is necessary to relax in disc indications depends on the degree of aortic disease and performer’s experience.

    Release date:2016-09-08 09:50 Export PDF Favorites Scan
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