Tuncer Altug, Tuncer Eylem Yayla, Tas Serpil Gezer, Erdem Hasan, Polat Adil
Kartal Kosuyolu Heart and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey.
J Card Surg. 2011 Sep;26(5):501-5. doi: 10.1111/j.1540-8191.2011.01302.x. Epub 2011 Aug 31.
We have presented the results of pulmonary arterial aneurysm repairs performed over eight years.
From 2002 to December 2010, we performed nine operations for pulmonary artery aneurysms in our department. The mean age of the patients was 37.8 ± 17.1 years and four were females. Five patients had pulmonic valve stenosis, three patients had concomitant pathologies on the aortic or mitral valves, and two had isolated pulmonary arterial aneurysm. Aneurysm repairs were performed by plication in eight patients and with Dacron patch repair in one patient.
There were no postoperative deaths. Three patients required inotropic support postoperatively. One patient had pulmonary morbidity. The results of the pathology revealed intimal hyalinization, edema, and elastic fiber degeneration in the media, fibrosis in the adventitia, and increased vascularity. All patients were in New York Heart Association Class I or II except for one patient who had a prolonged intensive care stay. The mean duration of follow-up was 48.6 ± 33.2 months (range, 2 to 107) adding up to a total of 36.4 patient/years. The mean diameter of the pulmonary artery in the recent imaging was 3.6 ± 0.4 cm.
Pulmonary artery aneurysms are rare entities which are usually associated with other congenital defects. While surgery is the preferred treatment for symptomatic aneurysms, controversy exists as to the indications for repair in asymptomatic patients.
我们展示了八年来肺动脉瘤修复手术的结果。
2002年至2010年12月,我们科室对9例肺动脉瘤患者进行了手术。患者的平均年龄为37.8±17.1岁,其中4例为女性。5例患者有肺动脉瓣狭窄,3例患者合并主动脉瓣或二尖瓣病变,2例患者为孤立性肺动脉瘤。8例患者采用折叠术修复动脉瘤,1例患者采用涤纶补片修复。
术后无死亡病例。3例患者术后需要使用血管活性药物支持。1例患者发生肺部并发症。病理结果显示内膜玻璃样变、水肿、中膜弹性纤维变性、外膜纤维化以及血管增多。除1例患者在重症监护病房住院时间延长外,所有患者均为纽约心脏协会心功能Ⅰ级或Ⅱ级。平均随访时间为48.6±33.2个月(范围2至107个月),总计36.4患者/年。近期影像学检查显示肺动脉的平均直径为3.6±0.4 cm。
肺动脉瘤是罕见疾病,通常与其他先天性缺陷相关。虽然手术是有症状动脉瘤的首选治疗方法,但对于无症状患者的修复指征仍存在争议。