Oshima Hideki, Abe Tomonobu, Narita Yuji, Usui Akihiko
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Interact Cardiovasc Thorac Surg. 2016 Oct;23(4):668-70. doi: 10.1093/icvts/ivw195. Epub 2016 Jun 20.
A 72-year old man with an unruptured aneurysm of the right sinus of Valsalva and aortic insufficiency underwent aortic root replacement using a valved composite graft created with a 28-mm woven Dacron graft (Gelweave Valsalva™ graft, Vascutek Terumo, Renfrewshire, Scotland) and a 25-mm stented bioprosthetic aortic valve (Carpentier-Edwards PERIMOUNT pericardial bioprosthesis, Edwards Lifesciences, Irvine, CA, USA). His postoperative course was uneventful. He had undergone a follow-up CT scan once a year. Although no abnormal signs were detected 5 years after surgery, a CT scan performed in the sixth postoperative year revealed an aortic false aneurysm around the Dacron graft. The false aneurysm enlarged over time and he underwent elective surgery. Two small holes were identified in the 'sinus' portion of the Valsalva graft. The holes were located at the site of the vascular prosthesis corresponding to the level sandwiched between the strut of the bioprosthetic aortic valve and the main pulmonary artery. Therefore, the vascular prosthesis could be exposed to persistent pulsatile contact with the strut resulting from pulsation of the pulmonary artery. This contact/friction might result in fraying of the fabric of the vascular prosthesis, finally leading to non-anastomotic rupture of the Valsalva graft.
一名72岁男性，患有未破裂的主动脉瓣窦瘤和主动脉瓣关闭不全，接受了主动脉根部置换术，使用的是一种带瓣复合移植物，该移植物由一个28毫米编织涤纶移植物（Gelweave Valsalva™移植物，Vascutek Terumo，苏格兰伦弗鲁郡）和一个25毫米带支架生物人工主动脉瓣（Carpentier-Edwards PERIMOUNT心包生物人工瓣膜，Edwards Lifesciences，美国加利福尼亚州欧文市）制成。他的术后过程顺利。他每年进行一次随访CT扫描。虽然术后5年未检测到异常迹象，但术后第6年进行的CT扫描显示涤纶移植物周围出现主动脉假性动脉瘤。假性动脉瘤随时间逐渐增大，他接受了择期手术。在Valsalva移植物的“窦”部发现了两个小孔。这些小孔位于血管假体对应于夹在生物人工主动脉瓣支柱和主肺动脉之间水平的部位。因此，血管假体可能会因肺动脉搏动而持续受到与支柱的搏动接触。这种接触/摩擦可能导致血管假体织物磨损，最终导致Valsalva移植物非吻合口破裂。
