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

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％)破入右心室流出道,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(χ2=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], 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 right 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 ( χ2 = 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.