先天性二叶主动脉瓣畸形的外科治疗

摘要

目的 探讨先天性二叶主动脉瓣畸形(CBAV)的临床分型、手术指征和方法.方法 选择我院CBAV患者68例,其中伴感染性心内膜炎(IE)16例(22.9％),合并升主动脉瘤样或夹层病变10例(14.7％).所有患者均手术置换人工机械或生物瓣膜,其中16例清除心内赘生物,同期行二尖瓣置换19例,升主动脉人工血管置换7例,升主动脉成形术3例,动脉导管结扎术3例,室间隔缺损修补3例,主动脉窦瘤破裂修补3例,冠状动脉搭桥术4例.结果 术后早期死亡2例,晚期死亡1例,其余患者均恢复了基本的生活自理.结论 我国广大临床医师对CBAV病因、分型及病理等方面的认识仍有待进一步提高,CBAV并发的动脉夹层及动脉瘤病变的处理指征需积极对待,其手术的远期疗效还需进一步的随访.%Objective To explore the clinical classification surgical indications, surgical methods of CBAV. Methods 68 patients with CBAV underwent cardiac valve replacement. Associated cardiac lesions were infective endocarditis in 16 patients, 10 patients had ascending aortic aneurysm or acute aortic dissection. All patients underwent surgical replacement of mechanical or biological valres, of which 16 cases underwent clear cardiac neoplasm. At the same time, 19 cases underwent mitral valre replacement, 7 cases underwent aorta replacement, 3 cases underwent aorta angioplasty, 3 cases underwent ligation of patent ductus arteriosis, 3 cases underwent repair of ventricular septal defect, 3 cases underwent Ruptured sinus of valsalva aneurysm, and another 4 cases underwent coronary artery bypass surgery. Results There were 2 early postoperative deaths 1 late death, the rest of patients were recover basic life. Conclusion The knowledge of clinicians about CBAV is to be further enhanced, atients with ascending aortic aneurysm or acute aortic dissection need more actively surgical interventions. Treatment efficacy of operation should need to further follow up.