Yoshikai Masaru, Ohnishi Hiroyuki, Kamohara Keiji, Minematsu Noritoshi, Fumoto Hideyuki, Itoh Manabu
Department of Cardiovascular Surgery, Shin-Koga Hospital, Kurume, Fukuoka, Japan.
Jpn J Thorac Cardiovasc Surg. 2006 Mar;54(3):120-3. doi: 10.1007/BF02744875.
We experienced 3 cases of an aortic dissection occurring late after an aortic valve replacement, and successfully treated by an aortic root replacement. An aortic dissection involving the ascending aorta can develop late after an aortic valve replacement, and such an occurrence is associated with a high mortality and morbidity. The development of effective surgical strategies at the initial aortic valve surgery, strict control of blood pressure after aortic valve replacement, serial evaluations of aortic size, and the prophylactic replacement of the ascending aorta for patients with aortic dilatation after aortic valve replacement, all play clinically important roles in preventing an aortic dissection after aortic valve replacement. When an aortic dissection occurs in patients with a previous aortic valve replacement, an aortic root replacement should be performed in order to avoid leaving the fragile diseased aortic wall including the sinus of Valsalva.
我们遇到了3例主动脉瓣置换术后晚期发生主动脉夹层的病例，并通过主动脉根部置换成功治疗。累及升主动脉的主动脉夹层可在主动脉瓣置换术后晚期发生，这种情况与高死亡率和高发病率相关。在初次主动脉瓣手术时制定有效的手术策略、主动脉瓣置换术后严格控制血压、对主动脉大小进行系列评估以及对主动脉瓣置换术后主动脉扩张的患者预防性置换升主动脉，在预防主动脉瓣置换术后主动脉夹层方面均发挥着重要的临床作用。对于既往有主动脉瓣置换术的患者发生主动脉夹层时，应进行主动脉根部置换，以避免保留包括主动脉窦在内的脆弱病变主动脉壁。
