Morgan S, Maturana G, Urzua J, Franck R, Dubernet J
Thorax. 1979 Aug;34(4):459-63. doi: 10.1136/thx.34.4.459.
Controversy exists regarding the timing and technique of total correction of traumatic intracardiac lesions. Five patients with penetrating wounds of the heart received emergency treatment aimed at securing normal haemodynamics. No attempt was made to identify intracardiac lesions at this stage. Cineangiography two months to seven years later showed aorto-right ventricular fistulae in all patients, associated in two with aortic cusp laceration and in one with an aorto-left atrial fistula. The surgical approach for aorto-right ventricular fistula was through the right ventricle or aorta. Valvar injuries were treated by plastic reconstruction. All patients showed good clinical results when seen four to 11 years later. Traumatic intracardiac lesions in patients with stable haemodynamics after initial treatment should be operated on electively. The aortic approach is preferable for aorto-right ventricular fistulae. Conservative plastic repair of valvar injuries achieves long-term competence thus avoiding prosthetic replacement.
关于创伤性心内病变的完全矫正时机和技术存在争议。五名心脏穿透伤患者接受了旨在确保正常血流动力学的紧急治疗。在此阶段未尝试识别心内病变。两月至七年后的心血管造影显示，所有患者均存在主动脉-右心室瘘，其中两例合并主动脉瓣叶撕裂，一例合并主动脉-左心房瘘。主动脉-右心室瘘的手术入路为经右心室或主动脉。瓣膜损伤采用整形修复治疗。四至十一年后复诊时，所有患者临床效果良好。初始治疗后血流动力学稳定的患者，创伤性心内病变应择期手术。主动脉入路更适合主动脉-右心室瘘。瓣膜损伤的保守整形修复可实现长期功能正常，从而避免人工瓣膜置换。
