瓦氏窦瘤破裂：主动脉瓣的早期复发及转归

Ruptured sinus of valsalva aneurysm: early recurrence and fate of the aortic valve.

作者信息

Azakie A, David T E, Peniston C M, Rao V, Williams W G

机构信息

Division of Cardiovascular Surgery, The Toronto General Hospital, University of Toronto, Ontario, Canada.

出版信息

Ann Thorac Surg. 2000 Nov;70(5):1466-70; discussion 1470-1. doi: 10.1016/s0003-4975(00)01734-3.

DOI:10.1016/s0003-4975(00)01734-3

PMID:11093471

Abstract

BACKGROUND

We reviewed our experience with congenital ruptured sinus of Valsalva aneurysms (RSVA) to determine patterns of early recurrence and the fate of the aortic valve (AV).

METHODS

Over a 28-year period, RSVA was identified in 34 patients, (mean age 31.6 years). Primary closure of the RSVA was performed in 10 patients, and a patch employed in 24. Aortic insufficiency was present in 24 patients. AV replacement (AVR) was performed in 5 patients; AV repair in 6.

RESULTS

Follow-up of 9.2 +/- 8.3 years (6 months to 24 years) was complete in all but 2 patients. Five early fistula recurrences (in 4 patients) correlated with primary rather than patch closure (p < 0.03). Kaplan-Meier survival at 10 years is 90 +/- 7%. Freedom from reoperative AVR at 10 years is 83 +/- 9%. Late AVR was performed in 6 patients for progressive aortic insufficiency due to bicuspid valve (n = 3), cusp disease of affected sinus (n = 2), or aortic root dilatation (n = 2).

CONCLUSIONS

Patch closure of the RSVA should be routinely employed. A bicuspid valve may be associated with the late need for AVR.

摘要

背景

我们回顾了我们处理先天性瓦氏窦瘤破裂（RSVA）的经验，以确定早期复发模式及主动脉瓣（AV）的转归。

方法

在28年期间，共确诊34例RSVA患者（平均年龄31.6岁）。10例患者行RSVA一期闭合术，24例使用补片。24例患者存在主动脉瓣关闭不全。5例行主动脉瓣置换术（AVR）；6例行主动脉瓣修复术。

结果

除2例患者外，其余所有患者均完成了平均9.2±8.3年（6个月至24年）的随访。5例（4名患者）早期瘘管复发与一期闭合而非补片闭合相关（p<0.03）。10年的Kaplan-Meier生存率为90±7%。10年无再次手术AVR的概率为83±9%。6例患者因以下原因后期行AVR：二尖瓣病变（n=3）、患侧窦瓣叶病变（n=2）或主动脉根部扩张（n=2）导致的进行性主动脉瓣关闭不全。