west china medical publishers
Keyword
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Keyword "升主动脉瘤" 9 results
  • Bentall手术后早期并发症的发生原因及处理

    目的总结Bentall手术后并发症发生的原因及早期处理经验。方法48例马方综合征(Marfan syndrome)或升主动脉瘤合并主动脉瓣关闭不全患者均行Bentall手术治疗。主动脉瓣置换采用连续缝合5例,其余患者采用间断缝合。冠状动脉开口直接吻合于人工血管上42例,游离成纽扣状后吻合6例,对动脉夹层采用三明治法缝闭。结果全组死亡3例,分别死于严重低心排血量不能脱离体外循环机、脑出血和心室颤动。存活的45例中,术后24h胸腔引流量280-1180ml,发生低心排血量12例,严重心律失常9例,肺功能不全11例,左侧胸腔积血7例等,均经强心、止血、扩张血管、呼吸机辅助呼吸等对症处理治愈。术后住院9~23d。出院时心功能Ⅰ级29例,Ⅱ级15例,无明显改善1例。结论改进手术方法和缝合技术,可减少心肌缺血和体外循环时间,有利于减少Bentall手术后并发症的发生。

    Release date:2016-08-30 06:22 Export PDF Favorites Scan
  • Surgical Treatment of Ascending Aortic Aneurysm in 114 Patients

    ObjectiveTo summarize experience of surgical treatment of ascending aortic aneurysm and analyse related problems.MethodsOne hundred and fourteen (containing 62 cases had aortic dissection) consecutive cases underwent replacement of diseased ascending aorta alone (9 cases) or Bentall operation.ResultsThere were seven operative death (6.14%). The cardiac function, in six of them, was in class Ⅳ(NYHA) preoperatively. Follow up was completed in 107 patients, with a duration of 40±30 months. Eight patients succumbed due to intracranial hemorrhage (3 cases), rupture of abdominal aortic lesion (3 cases), cardiac failure after coronary artery bypass grafting (1 case), and sudden death of unknown cause (1 case),respectively. All 99 long term survivors (86.8%) were in NYHA class Ⅰor Ⅱ.ConclusionThe results indicate that Bentall operation for treating ascending aortic aneurysms and aortic insufficiency, or aortic replacement alone for treating ascending aortic aneurysm gives good functional recovery and an active life for the vast majority of survivors.

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • 胸主动脉瘤的外科治疗

    目的 总结 19例胸主动脉瘤患者的外科治疗经验。 方法  19例胸主动脉瘤患者 ,其中升主动脉瘤 9例 (马方综合征 8例 ) ,7例行 Bentall手术 ,2例行 Cabrol手术 ;降主动脉瘤 10例 ,均行降主动脉置换术。 结果 除 1例患者术中死亡外 ,其余患者经超声心动图检查均示主动脉瓣关闭良好 ,移植的冠状动脉、降主动脉通畅 ,无扭曲 ,无脊髓损伤和神经系统并发症。随访 18例 ,随访时间 0 .3~ 5 .4年 ,心功能恢复至 级 3例 , 级 15例 ,效果满意。 结论 手术治疗胸主动脉瘤安全有效。

    Release date:2016-08-30 06:28 Export PDF Favorites Scan
  • 升主动脉和弓部动脉瘤的外科治疗

    目的 总结升主动脉和弓部动脉瘤手术治疗经验,以期进一步提高手术疗效. 方法 自2000年7月至2002年5月应用深低温停循环(DHCA)和上腔静脉逆行脑灌注(RCP)技术手术治疗升主动脉和弓部动脉瘤20例,其中急症手术5例.施行全弓置换术2例,全弓置换和象鼻手术3例,半弓置换术15例.同期行Bentall手术8例,升主动脉置换术或同时行主动脉瓣置换术12例,冠状动脉旁路移植术1例. 结果 术后早期死亡1例,短时间浅昏迷1例,呼吸功能不全2例,肾功能不全2例,无晚期死亡. 结论 DHCA和RCP技术是手术治疗升主动脉和弓部瘤的安全、有效方法,急性A型夹层动脉瘤的手术方式取决于内膜破裂口的位置;正确掌握DHCA和RCP技术、手术方式和手术技术、围术期处理是提高手术疗效的关键因素.

    Release date:2016-08-30 06:30 Export PDF Favorites Scan
  • 主动脉瓣置换术后升主动脉瘤形成的外科治疗

    目的总结主动脉瓣置换术后升主动脉瘤形成的外科治疗经验。 方法2008年10月至2013年4月郑州大学第一附属医院收治6例主动脉瓣置换术后升主动脉瘤形成患者,其中男2例,女4例;年龄45~63(56.5±3.2)岁。主动脉瓣置换术后44~82(59.5±24.3)个月,均为单纯人工机械主动脉瓣置换术后。5例行单纯升主动脉置换术,1例行David手术。 结果体外循环时间140~270(185.2±90.1)min,升主动脉阻断时间60~220(121.9±78.6)min。6例患者均康复出院。术后将血压控制于120/90 mm Hg以下,应用华法林,维持国际标准化比值(INR)1.5~2.5。术后均给予琥珀酸美托洛尔25 mg,每天2次。出院前复查彩色超声心动图(UCG)示:升主动脉内经28~30 mm。术后对6例患者随访3~12个月,门诊复查UCG示:人工血管内径较出院时无明显改变。 结论主动脉瓣置换术后患者应定期复查UCG,对主动脉内经呈进行性增宽或主动脉瘤形成患者应及早行外科手术治疗。

    Release date: Export PDF Favorites Scan
  • Early to Mid-term Results of Modified Aortoplasty with External Wrap for Aneurysmal Dilatation of the Ascending Aorta

    ObjectiveTo summarize clinical experience and early to mid-term results of modified aortoplasty with external wrap for aneurysmal dilatation of the ascending aorta with or without heart valve disease. MethodsClinical data of 27 patients with aneurysmal dilatation of the ascending aorta who underwent modified aortoplasty with external wrap in Department of Cardiovascular Surgery, Fujian Provincial Hospital from January to October 2003 were retrospectively analyzed. There were 19 male and 8 female patients with their age of 35-71 (57±9)years and body weight of 42-90 (59±11)kg.There were 23 patients with aortic valve disease including 3 patients with bicuspid aortic valve. There were 4 patients in New York Heart Association function class Ⅰ, 9 patients in class Ⅱ, 12 patients in class Ⅲ, and 2 patients in class Ⅳ. Preoperative ascending aortic diameter (AAOD)was 40.0-59.1 (46.4±4.8)mm, left ventricular end-diastolic diameter was 42.5-70.7 (56.9±8.3)mm, and left ventricular ejection fraction (LVEF)was 57.7%±8.0%. Patients were followed up with echocardiography to examine changes of AAOD and left ventricle. ResultsCardiopulmonary bypass (CPB)time was 121.2±52.6 minutes, and aortic cross-clamping time was 70.6±29.7 minutes. Two patients received modified aortoplasty without CPB. There was no in-hospital death.Among the 25 patients who received modified aortoplasty under CPB, 1 patient had cerebral infarction and another patient had hypotension and arrhythmia postoperatively.Postoperative AAOD (36.3±3.4 mm)was significantly smaller than preoperative AAOD (46.4±4.8 mm, t=1.675, P < 0.05). Twenty-four patients were followed up from 1.0 to 120.5 months (average, 35.5 months). During follow-up, no cardiac-related death or reoperation was found. Two patients died of pneumonia, and another 2 patients died of cerebral hemorrhage. One patient had upper gastrointestinal bleeding. Aneurysmal dilatation of the ascending aorta recurred in 1 patient 3 years after discharge with AAOD of 49.9 mm. AAOD at 1 year (40.3±4.3 mm)and 3 years (40.3±5.6 mm)after discharge were significantly smaller than preoperative and postoperative AAOD (P < 0.05). ConclusionModified aortoplasty with external wrap is a good surgical procedure for aneurysmal dilatation of the ascending aorta with or without valve disease, and early to mid-term results are satisfactory.

    Release date: Export PDF Favorites Scan
  • “半兜状”自体心包片吻合技术治疗左冠状动脉开口较低且合并主动脉瓣病变的升主动脉瘤

    目的 探讨在冠状动脉移植时应用“半兜状”自体心包片吻合技术治疗左冠状动脉开口较低且合并主动脉瓣病变的升主动脉瘤的临床效果。 方法 回顾性分析我院心外二科 2012 年 11 月至 2016 年 1 月应用“半兜状”自体心包片吻合技术治疗 7 例左冠状动脉开口较低行 Bentall 术患者的临床资料,其中男 5 例、女 2 例,年龄(45.2±3.1)岁,术前主动脉 CT 血管造影(CTA)提示升主动脉瘤样扩张,直径(6.8±0.8) cm,合并主动脉瓣重度狭窄 2 例,余 5 例主动脉瓣中-重度关闭不全。手术在常规 Bentall 术式的基础上对左冠状动脉移植进行改良。应用自体心包片修剪成梭形,使之呈“半兜状” 兜住左冠状动脉开口下缘,将左冠状动脉开口上缘与人工血管打孔处上缘直接缝合,完成左冠状动脉移植。 结果 全组无死亡病例,体外循环时间(168.0±38.2)min,其中主动脉阻断时间(98.0±28.1) min。术后 24 h 引流量(575.0±65.0)ml。出院前复查心电图及心肌酶学指标(血清肌钙蛋白I、肌酸激酶同工酶、肌酸激酶)均正常。出院随访左室舒张期末内径与术前差异有统计学意义[(5.4±0.5)cm vs.(7.0±0.6)cm,P<0.001]。 结论 本技术手术操作相对简单、吻合方便、吻合口张力较小、出血风险小、止血方便。冠状动脉吻合口无扭曲及牵拉,不影响冠状动脉血流。术后患者心功能恢复良好,取得了良好的早、中期效果。

    Release date:2018-05-02 02:38 Export PDF Favorites Scan
  • Remodeling+Ring (modified Yacoub) technique for the treatment of bicuspid aortic valve regurgitation with ascending aortic aneurysm: A case report

    Patients with bicuspid aortic valve are often complicated with aortic dilatation. If the aortic valve is of good quality, aortic root replacement with aortic valve preservation is feasible. A 35-year-old male patient with bicuspid aortic regurgitation complicated with ascending aortic aneurysm underwent Remodeling+Ring (modified Yacoub) operation. Echocardiography showed that there was no aortic regurgitation on the 3rd day after operation, and the patient was discharged satisfactorily on the 6th day after operation. Remodeling+Ring surgery ensures the physiological movement of the aortic valve, solves the enlarged annulus, avoids the problems caused by valve replacement, and significantly improves the quality of life of patients, which is worth popularizing.

    Release date: Export PDF Favorites Scan
  • The efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch

    Objective To summarize the efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch. Methods The clinical data of patients with ascending aortic aneurysm involving the proximal aortic arch who underwent surgical treatment with aortic arch 1 zone clamping technique in our hospital from 2017 to 2019 were retrospectively analyzed. ResultsA total of 35 patients were enrolled, including 21 males and 14 females, with an average age of 63.9±10.8 years. According to different lesions, the proximal aorta underwent Bentall/Carbrol procedure in 8 patients, Wheat in 4 patients, David in 3 patients, and ascending aorta replacement in 20 patients. Distal lesions were completely resected under aortic arch 1 zone clamping technique, and anastomotic reconstruction was performed under hypothermic cardiopulmonary bypass. Distal anastomosis was performed with interrupted suture in 7 patients, and continuous suture with intermittent reinforcement of the posterior wall in 28 patients. All patients successfully completed the procedure. The average cardiopulmonary bypass time was 121.5±28.2 min, the aortic clamping time was 78.1±21.3 min, and the distal anastomosis time was 15.2±3.6 min. One patient underwent a second thoracotomy for hemostasis, and the remaining patients were drained 330.6±108.1 mL on the first day following the procedure. The postoperative mechanical ventilation time of 2 patients exceeded 24 hours, and the main complications were pulmonary infection in 1 patient and acute renal injury in 2 patients. Transient delirium occurred in 2 patients and no transient or permanent neurological dysfunction occurred. The average follow-up time was 2.6±1.1 years. The maximum diameter of the ascending aorta after operation was 30.4±0.9 mm, the diameter of zone 1 aortic arch was 39.8±3.1 mm, and the diameter of the distal aortic arch was 32.3±4.3 mm. There was no lesion in the artificial blood vessels of all patients, and no aneurysms occurred at the proximal or distal anastomosis. No reoperation or intervention was needed for the aorta. ConclusionThe aortic arch 1 zone clamping technique can simplify the procedure of ascending aortic aneurysm involving the proximal aortic arch, reduce or avoid the use of deep hypothermic circulatory arrest, reduce the surgical trauma, and has good short-term and medium-term efficacy.

    Release date: Export PDF Favorites Scan
1 pages Previous 1 Next

Format

Content