Williams W G, Mathieu J, Culham G, Trusler G A, Olley P M
Ann Thorac Surg. 1979 Apr;27(4):335-9. doi: 10.1016/s0003-4975(10)63310-3.
Severe supravalvular aortic stenosis was discovered at reoperation in 3 children with recurrent stenosis of the left ventricular outflow tract. The lesion consisted of gross thickening of the sinus ridge, most marked at the site of the previous aortotomy. The thickening had shortened the free edge of one or more leaflets and had distorted adjacent commissures. Preoperative angiography had indicated valve stenosis, but little commissural fusion was found at operation and the outflow tract obstruction was relieved by inserting a prosthetic patch in the ascending aorta. Recognition of this iatrogenic pathology is important to avoid supravalvular stenosis after aortic valvotomy and unnecessary valve replacement in children requiring reoperation for recurrent left ventricular outflow tract obstruction.
在3例左心室流出道复发性狭窄的患儿再次手术时发现了严重的瓣上主动脉狭窄。病变表现为窦嵴明显增厚，以前主动脉切开部位最为显著。增厚使一个或多个瓣叶的游离缘缩短，并使相邻的瓣交界变形。术前血管造影显示瓣膜狭窄，但手术中发现瓣交界融合很少，通过在升主动脉插入人工补片解除了流出道梗阻。认识到这种医源性病变对于避免主动脉瓣切开术后的瓣上狭窄以及避免对需要再次手术治疗复发性左心室流出道梗阻的儿童进行不必要的瓣膜置换很重要。
