Honjo Osami, Ishino Kozo, Kawada Masaaki, Ohtsuki Shin-ichi, Akagi Teiji, Sano Shunji
Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Circ J. 2006 Jul;70(7):939-41. doi: 10.1253/circj.70.939.
Despite successful surgical repair, patients with congenital aortico-left ventricular tunnel (ALVT) are at risk of developing aortic incompetence in the late postoperative period. Two cases of ALVT were followed for 10 years with special reference to aortic incompetence and geometry of the aortic root. The patients underwent repair of ALVT, one at 4 years of age and the other at 4 months of age. The first patient had a slit-like tunnel (type I) and the aortic orifice was closed with a pericardial patch. The second patient had a large tunnel with an extracardiac aneurysm (type II) and was closed with a pericardial patch at the aortic orifice and a Dacron patch at the left ventricular orifice, thereby completely obliterating the tunnel. The last echocardiographic evaluation showed no residual flow in the tunnel and no aortic incompetence in case 1, but there was mild aortic valvular regurgitation with deformity of the right sinus in case 2. Careful long-term follow-up is necessary because patients with ALVT have some inherent structural abnormalities from the left ventricular outflow tract to the aortic root.
尽管手术修复成功，但先天性主动脉-左心室隧道（ALVT）患者在术后晚期仍有发生主动脉瓣关闭不全的风险。对2例ALVT患者进行了10年的随访，特别关注主动脉瓣关闭不全和主动脉根部的形态。这2例患者均接受了ALVT修复手术，1例在4岁时进行，另1例在4个月时进行。第1例患者有一条缝隙样隧道（I型），主动脉口用心包补片封闭。第2例患者有一个伴有心外动脉瘤的大隧道（II型），主动脉口用心包补片封闭，左心室口用涤纶补片封闭，从而完全闭塞了隧道。最后一次超声心动图评估显示，第1例患者隧道内无残余血流，也无主动脉瓣关闭不全，但第2例患者有轻度主动脉瓣反流，右冠状动脉窦畸形。由于ALVT患者从左心室流出道到主动脉根部存在一些固有的结构异常，因此需要进行仔细的长期随访。
