Nawata Kan, Morota T
Department of Cardiothoracic Surgery, Tokyo University, Tokyo, Japan.
Kyobu Geka. 2009 Oct;62(11):983-5.
Annuloaortic ectasia is frequently related with Marfan syndrome, and Bentall procedure or aortic root replacement with valved conduit has been the conventional standard operation for this disease. Recently, some institutes have adopted valve-sparing aortic root replacement (VSARR) instead of Bentall procedure. Young female patients with Marfan syndrome who wishes for childbearing seem to be a group of good candidates of this type of operation, because it let them free from morbidities after artificial valve implantation. Valve-sparing operation should be taken into consideration when the size of Valsalva sinus reaches 45 mm for patients with Marfan syndrome and when it reaches 40 mm for patients with past histories or family histories of aortic dissection or aortic rupture. Since pregnancy is one of the most serious risk factors for aortic events, Valsalva sinus of 40 mm or larger could be the new standard for surgical indication if VSARR is applicable.
主动脉环扩张常与马凡综合征相关，而Bentall手术或带瓣管道主动脉根部置换术一直是该病的传统标准手术。最近，一些机构采用了保留瓣膜的主动脉根部置换术（VSARR）而非Bentall手术。希望生育的年轻马凡综合征女性患者似乎是这类手术的理想候选人群，因为该手术可使她们免于人工瓣膜植入后的并发症。对于马凡综合征患者，当主动脉窦大小达到45mm时，以及对于有主动脉夹层或主动脉破裂既往史或家族史的患者，当主动脉窦大小达到40mm时，应考虑保留瓣膜手术。由于妊娠是主动脉事件最严重的危险因素之一，如果VSARR适用，40mm或更大的主动脉窦可能成为手术指征的新标准。
