Horimi H, Hasegawa T, Kato M, Fukushima K, Misawa Y
Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Tochigi, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Jun;39(6):901-9.
Seventeen patients underwent surgical treatment of the ascending aorta, aortic valve, and coronary artery as well. Diagnosis of 13 patients were annulo-aortic ectasia, 3 had dissecting aneurysm (type I: 2, type II: 1), and one had supra-valvular aortic stenosis. In annulo-aortic ectasia, Bentall's method was carried out in 11 cases, and Cabrol's operation was performed in 3, one of the latter group had received Bentall's procedure 4 years prior to the second operation. One patient died of acute myocardial infarction 3 days following operation, who had severe stenosis of the left anterior descending artery not detected by preoperative angiography. During long-term follow up, 2 patients died of cardiac failure. Three patients had dissection of the ascending aorta and coronary artery (right coronary artery: 2, left coronary artery: 1). The aorta was reconstructed, aortic valve was replaced, and coronary artery was revascularized with saphenous vein graft. They have been alive and well up to post operative 6 years. Right coronary ostioplasty as well as aortic valve replacement and extended aortoplasty were attempted in one patient with Williams' syndrome. This patient had been well until sudden death which occured 11 months after the operation.
17例患者接受了升主动脉、主动脉瓣及冠状动脉的手术治疗。13例诊断为瓣环主动脉扩张,3例为夹层动脉瘤(Ⅰ型:2例,Ⅱ型:1例),1例为主动脉瓣上狭窄。在瓣环主动脉扩张患者中,11例行Bentall手术,3例行Cabrol手术,后者中有1例在第二次手术前4年接受过Bentall手术。1例患者术后3天死于急性心肌梗死,其术前血管造影未发现左前降支严重狭窄。在长期随访中,2例患者死于心力衰竭。3例患者出现升主动脉及冠状动脉夹层(右冠状动脉:2例,左冠状动脉:1例)。对其进行了主动脉重建、主动脉瓣置换,并采用大隐静脉移植行冠状动脉血运重建。他们术后存活至今已6年。对1例患有威廉姆斯综合征的患者尝试了右冠状动脉成形术以及主动脉瓣置换和扩大主动脉成形术。该患者术后情况良好,直至术后11个月突然死亡。