Baille Y, Sigwalt M, Vaillant A, Sicard Desnuelle M P, Varnet B
Arch Mal Coeur Vaiss. 1981 Nov;74(11):1359-64.
The tactical decision in patients with decompensated valvular disease associated with a severe stenosis of the aortic isthmus is always difficult. One stage surgical repair using two separate approaches is a long and high risk procedure. It would seem more logical and safer to treat the lesions in two stages a few weeks apart, the severest lesion being managed first. In the two cases reported. The isthmic stenoses and valvular lesions were of the same severity and made both classical techniques impracticable. Therefore the patients underwent a single stage procedure by a median approach associating valve replacement under cardiopulmonary bypass (mitral and tricuspid in one and aortic in the other case) and an ascending aorta-abdominal aorta dacron conduit. The present postoperative survival periods are 30 and 9 months. The functional result was good (Class 1 and 0) and postoperative angiography has shown the montage to be working satisfactorily. This technique is exceptional but may be useful in borderline cases with decompensated valvular disease and severe isthmic stenosis.
对于伴有主动脉峡部严重狭窄的失代偿性瓣膜病患者，战术决策始终困难。采用两种不同方法进行一期手术修复是一个漫长且高风险的过程。相隔几周分两期治疗病变似乎更合理、更安全，先处理最严重的病变。在报道的两例病例中。峡部狭窄和瓣膜病变严重程度相同，使得两种传统技术均不可行。因此，患者通过正中入路进行一期手术，在体外循环下联合瓣膜置换（一例为二尖瓣和三尖瓣置换，另一例为主动脉瓣置换）以及升主动脉-腹主动脉涤纶血管移植。目前术后生存期分别为30个月和9个月。功能结果良好（1级和0级），术后血管造影显示拼接效果令人满意。这种技术很特殊，但可能对伴有失代偿性瓣膜病和严重峡部狭窄的临界病例有用。
