Duveau D, Baron O, Michaud J L, Lefèvre M, Laboux L, Dupon H
Clinique chirurgicale thoracique, cardiaque et vasculaire, Hôpital Guillaume et René-Laënnec, Nantes.
Arch Mal Coeur Vaiss. 1989 May;82(5):785-9.
Aortico-left ventricular tunnel is a rare entity resulting in a communication between the ascending aorta and the left ventricle, with clinical signs of aortic incompetence. On the basis of two personal cases and a review of the literature including 57 patients, the operative mortality and long-term follow-up of these patients are analysed. 51 patients were operated upon with a mortality rate of 21.5% (11 cases). In this mortality group, 64% of the casualties were less than 2 years' old (7/11). Mortality was unrelated to the surgical technique. Aortic incompetence was the crucial factor of post-operative morbidity. 60% of the patients who were operated upon had significant post-operative aortic incompetence. Among the 21 patients with long-term follow-up (1.5 to 14 years), 17 have aortic incompetence (81%), 8 were reoperated and 7 underwent aortic valve replacement. Surgical repair of this malformation should be considered early in life, and the technique used should aim at consolidating the aortic annulus without deformation and at closing the aortico-ventricular window.
主动脉 - 左心室隧道是一种罕见的病变，可导致升主动脉与左心室之间出现交通，并伴有主动脉瓣关闭不全的临床体征。基于两例个人病例并回顾包括57例患者的文献，对这些患者的手术死亡率和长期随访情况进行了分析。51例患者接受了手术，死亡率为21.5%（11例）。在这个死亡组中，64%的死亡患者年龄小于2岁（7/11）。死亡率与手术技术无关。主动脉瓣关闭不全是术后发病的关键因素。60%接受手术的患者术后存在明显的主动脉瓣关闭不全。在21例接受长期随访（1.5至14年）的患者中，17例存在主动脉瓣关闭不全（81%），8例再次手术，7例接受了主动脉瓣置换术。这种畸形的手术修复应在患者生命早期进行考虑，所采用的技术应旨在加固主动脉瓣环而不使其变形，并关闭主动脉 - 心室窗。
