Doty D B, Polansky D B, Jenson C B
J Thorac Cardiovasc Surg. 1977 Sep;74(3):362-71.
Enlargement of the aorta with a diamond-shaped patch of the noncoronary sinus of Valsalva may not be sufficient in severe cases of supravalvular aortic stenosis. This traditional reconstruction is asymmetric, and, if the fibrous supravalvular ring is thick and rigid, the aorta may not open wide with patch angioplasty, so that aortic obstruction may remain. Also, because aortic valve function may not be perfect after asymmetric reconstruction, there may be aortic valve incompetence or obstruction of coronary ostia by the valve cusps. A new reconstructive operation was designed and used in eight patients. All survived and are asymptomatic. The aortoplasty was extended so that the supravalvular ring was incised at two points in the noncoronary and in the right coronary sinuses of Valsalva. The area of stenosis was opened wide, and the cusps of the aortic valve were lengthened, which provided better approximation and function. A tubular Dacron prosthesis, tailored to reconstruct the aorta, provided a wide aortic cross-sectional area. This technique of extended aortoplasty for symmetric reconstruction of the aorta should provide more predictable relief of aortic obstruction and improved function of the aortic valve.
对于严重的主动脉瓣上狭窄病例，使用菱形补片扩大主动脉瓣无冠窦可能并不足够。这种传统重建方法是不对称的，而且，如果纤维性主动脉瓣上环增厚且僵硬，补片血管成形术可能无法使主动脉充分张开，从而可能残留主动脉梗阻。此外，由于不对称重建后主动脉瓣功能可能不完善，可能会出现主动脉瓣关闭不全或瓣叶阻塞冠状动脉开口的情况。设计了一种新的重建手术并应用于8例患者。所有患者均存活且无症状。主动脉成形术得到扩展，使得在主动脉瓣无冠窦和右冠窦的两个点处切开主动脉瓣上环。狭窄区域被充分打开，主动脉瓣叶被延长，这提供了更好的贴合度和功能。定制的管状涤纶人工血管用于重建主动脉，提供了宽阔的主动脉横截面积。这种用于主动脉对称重建的扩展主动脉成形术技术应能更可预测地缓解主动脉梗阻并改善主动脉瓣功能。
