Fujiwara T, Dokoh S, Inada H, Masaki H, Nogami A, Yamane H, Yoshida H, Morita I, Miyake T, Fukuhiro Y
Department of Thoracic and Cardiovascular Surgery, Kawasaki Medical School.
Kyobu Geka. 1991 Jul;44(8 Suppl):702-5.
Between 1981 and 1989, ten patients underwent replacement of the ascending aorta and aortic valve by a composite graft for an aneurysm of the ascending aorta with aortic regurgitation. The first two cases using an SJM aortic valve prosthesis and Teflon felt-pledgeted mattress sutures for the proximal anastomoses required a coronary bypass graft from the tube graft to the anterior descending coronary artery because of difficulty in completing the graft-left coronary ostial anastomoses. In the subsequent seven cases, an SJM mitral valve prosthesis with a large, soft cuff for a valved conduit was sewn in reverse and a thin wall Teflon roll was used for the Teflon felt of the pledgeted mattress suture in the proximal anastomoses. As a result, anastomoses between the tube graft and coronary ostia were performed easily and successfully in eight patients. One case with Marfan syndrome required reoperation nine years after the first operation for recurrence of the aneurysm of the aortic arch. Thus, the need for careful and continued follow-up is important in the Marfan syndrome.
1981年至1989年间，10例患者因升主动脉瘤合并主动脉反流接受了复合移植物置换升主动脉和主动脉瓣手术。前两例使用圣犹达医疗公司（SJM）主动脉瓣膜假体和带特氟龙毡片褥式缝线进行近端吻合，由于在完成移植物与左冠状动脉开口的吻合时遇到困难，需要从人工血管移植到冠状动脉前降支进行冠状动脉搭桥。在随后的7例病例中，将带有大而柔软袖口的圣犹达医疗公司二尖瓣假体反向缝合作为带瓣管道，近端吻合中使用薄壁特氟龙卷作为带毡片褥式缝线的特氟龙毡。结果，8例患者的人工血管与冠状动脉开口之间的吻合操作轻松且成功。1例马凡综合征患者在首次手术后9年因主动脉弓动脉瘤复发需要再次手术。因此，对马凡综合征患者进行仔细且持续的随访很重要。
