摘要
目的 总结 70例主动脉瓣下狭窄的手术治疗经验。方法 全组 70例中男 4 6例 ,女 2 4例 ;年龄 3～ 4 6岁 ,平均 11.8岁。均经超声心动图、左心导管和造影检查及术中证实为主动脉瓣下狭窄 ,局限型 6 4例 (纤维隔膜型 4 2例、纤维肌隔型 2 2例 ) ,隧道型 6例。局限型行狭窄隔膜切除术 5 8例 ,加左室肌肉切除术 6例 ;隧道型行左室流出道疏通术 6例。合并畸形 5 9例 ,同期行矫正手术。结果 手术死亡 2例。仅 1例发生二尖瓣损伤。术后 38例左室主动脉收缩压力差 0～ 30mmHg(1mmHg =0 133kPa) ,平均 75mmHg。术后经 1、3、5、10、2 0年各随访 5 8、5 4、4 8、32、6例 ,随访率分别为 83%、77%、6 8%、4 5 %、9% ,症状均消失 ,无再狭窄需手术者。结论 本病一旦确诊 ,应尽快手术 ;术前超声心动图检查及术中常规主动脉根部探查 ,对防止有合并畸形时本病的漏诊尤为重要 ;手术关键是彻底疏通左室流出道 ,术中防止二尖瓣、主动脉瓣及传导束损伤。
Objective: To summarize the experience of surgical treatment of subaortic stenosis. Methods: 70 patients with subaortic stenosis were treated surgically. The diagnosis was made by echocardiography, left ventricular catheterization and angiography. There were 46 males and 24 females. The mean age at operation was 11.8 years (range 3 to 46 years). 64 patients had discrete stenosis and 6 had tunnel stenosis. For the discrete stenosis cases, simply resection of stenosis membrane was done in 58 cases and plus myoctomy in 6 cases. For the tunnel stenosis cases, left ventricular muscle was resected to relieve obstruction. In 59 patients combined cardiovascular malformation were corrected at the same time. Results: There were two postoperative deaths. Mitral valve injury occurred in 1 patient. The mean systolic gradient of left ventricle to aorta was 7.5 mmHg with a range of 0-30 mmHg in 38 cases after operation. The 1-, 3-, 5-, 10-, 20-year follow-up rate was 83%, 77%, 68%, 45%, and 9%,respectively. All patients were asymptomatic postoperatively. No reoperation was required. Conclusion: Once subaortic stenosis was diagnosed, operation should be done. Preoperative echocardiography and routine exploration of the root of aorta should be done during operation are in diagnosing. The key point of the operation that left ventricular outflow tract should be thoroughly dredged, no injury should be made to the mitral valve, aortic valve and conduction bundle.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2003年第5期266-268,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
