Okamoto Kazuma, Casselman Filip P, De Geest Raphael, Vanermen Hugo
Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
Interact Cardiovasc Thorac Surg. 2008 Dec;7(6):1164-6. doi: 10.1510/icvts.2008.183103. Epub 2008 Jul 23.
We performed surgical repair of a giant left coronary ostial aneurysm after aortic root replacement using composite valve graft (modified Bentall procedure) in a patient with Marfan syndrome. Aneurysmal formation in the left main stem itself is very rare. In order to avoid mobilizing the coronary ostium from severe adhesions after previous surgery and to reduce the tension on the anastomosis, the left main trunk was reconstructed using an interposition Dacron graft. In aortic root surgeries in Marfan patients, the size of the side hole on the composite graft should be kept relatively small to fit the diameter of the native coronary arteries for prevention of coronary buttons from forming aneurysms at the level of the coronary button anastomosis. In addition, close observation to the coronary button anastomosis is indispensable in postoperative check-up.
我们对一名患有马凡综合征的患者，在使用复合瓣膜移植物进行主动脉根部置换（改良Bentall手术）后，对巨大的左冠状动脉开口动脉瘤进行了手术修复。左主干本身形成动脉瘤非常罕见。为避免在先前手术后因严重粘连而移动冠状动脉开口，并降低吻合口的张力，使用涤纶补片移植重建左主干。在马凡综合征患者的主动脉根部手术中，复合移植物上侧孔的尺寸应保持相对较小，以适应原生冠状动脉的直径，防止冠状动脉纽扣在冠状动脉纽扣吻合处形成动脉瘤。此外，术后检查中对冠状动脉纽扣吻合口进行密切观察是必不可少的。
