主动脉窦瘤破裂的改良分型

发布时间：2018-11-01 19:15

【摘要】：目的对主动脉窦瘤破裂(ruptured sinus of Valsalva aneurysm,RSVA)的Sakakibara分型进行改良,探讨其改良分型法对手术修补的指导意义。方法回顾性分析2006年2月至2012年1月期间159例在阜外心血管病医院接受RSVA修补术患者的临床资料,男105例,女54例;年龄2～71(33.4±10.7)岁。所有患者按改良Sakakibara分型归入5类,Ⅰ型:窦瘤破入肺动脉瓣下(n=66),其中84.8%合并室间隔缺损(VSD),53.8%合并主动脉瓣关闭不全(AI);Ⅱ型:窦瘤破入右心室室上嵴或嵴下(n=17),88.2%合并VSD,23.5%合并AI;Ⅲ型:窦瘤在靠近三尖瓣环处破入右心室(Ⅲv型,n=6)或右心房(Ⅲa型,n=21),18.5%合并VSD,25.9%合并AI;Ⅳ型:窦瘤破入右心房(n=46),23.9%合并AI,无VSD;Ⅴ型:其他罕见情况,如窦瘤破入左心房、左心室、肺动脉或其他部位(n=3),全部合并AI,33.3%合并VSD。大部分窦瘤起自主动脉右冠窦(n=122),另有35例起自无冠窦,仅2例起自左冠窦。结果 100%的Ⅴ型和50%的Ⅲv型RSVA患者单纯经主动脉切口入路进行修补。大多数Ⅰ型、Ⅱ型和Ⅳ型患者单纯从窦瘤破入的心腔侧进行修补(所占比率分别为71.2%、64.7%和69.6%),76.2%的Ⅲa型患者同时使用上述2个径路完成修补。其中Ⅳ型患者体外循环时间[(92.4±37.8)min]和主动脉阻断时间[(61.2±30.7)min]最短。全组无手术死亡,2例(Ⅰ型、Ⅱ型各1例)在术后早期因右心室流出道再狭窄而二次手术矫治。对绝大多数患者采用补片材料加固窦瘤的修复方法(n=149),仅10例患者(其中Ⅳ型5例、Ⅲa型4例、Ⅱ型1例)采用单纯线性缝合窦瘤的方法。33例患者同期接受主动脉瓣置换术(66.7%为Ⅰ型)。随访147例(92.5%),2例(Ⅰ型、Ⅲa型)术后因心房颤动而接受射频消融治疗,1例(Ⅳ型)因残余分流再次手术,随访期间无远期死亡。结论 RSVA的改良Sakakibara分型法对选择手术修补入路具有临床指导意义,各种类型的RSVA均可以取得良好的手术治疗效果。
[Abstract]:Objective to improve the Sakakibara classification of ruptured aortic sinus aneurysm (ruptured sinus of Valsalva aneurysm,RSVA) and to explore the significance of the modified classification in surgical repair. Methods the clinical data of 159 patients undergoing RSVA repair in Fuwei Cardiovascular Disease Hospital from February 2006 to January 2012 were retrospectively analyzed. 105 males and 54 females, aged 23.4 卤10.7 years, were enrolled in this study. All patients were classified into 5 groups according to modified Sakakibara classification. Type I: sinus aneurysm ruptured into subpulmonary valve (nnm66), of which 84.8% were associated with ventricular septal defect (VSD),) and 53.8% with aortic valve insufficiency (AI);). Type 鈪，

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