Piwnica A, Bercot M, Menasche P, Kural S, Commin P, Verrières D, Stephan Y
Arch Mal Coeur Vaiss. 1982 Sep;75(9):999-1004.
Aorto-left ventricular discontinuity may result from destruction of the aortic ring in aortic valve endocarditis, making solid implantation of a valvular prosthesis difficult. We believe the best technique to be the insertion of a valved Dacron tube from a noninfected area of the left ventricle to the ascending aorta distal to the coronary ostia, the coronary arteries being reimplanted in the tube. This technique implies a relatively dilated aortic ring and the integrity of the supra-annular aortic wall. When these conditions are not fulfilled, the problem has to be solved by supra coronary implantation of an aortic prosthesis with double aorto-coronary bypass grafts. Valved tubes from the left ventricular apex to the abdominal aorta is complex major surgery, the indications for which should be limited to the most mutilating forms of endocarditis causing such severe annular and periannular lesions that the two preceding techniques are impossible. Despite the advances in surgical technique, operative mortality remains high, a problem that could undoubtedly be reduced by early surgery before the association of hemodynamic and infectious complications lead to severe cardiac failure and widespread local lesions.
主动脉-左心室不连续可能源于主动脉瓣心内膜炎时主动脉环的破坏，使得瓣膜假体的牢固植入变得困难。我们认为最佳技术是从左心室的未感染区域插入带瓣涤纶管至冠状动脉开口远端的升主动脉，冠状动脉重新植入该管。该技术意味着主动脉环相对扩张以及主动脉瓣环上壁的完整性。当这些条件不满足时，问题必须通过带双主动脉-冠状动脉旁路移植的主动脉假体在冠状动脉上方植入来解决。从左心室心尖到腹主动脉的带瓣管是复杂的大手术，其适应证应限于最严重的心内膜炎形式，这种心内膜炎会导致如此严重的瓣环和瓣环周围病变，以至于无法采用前两种技术。尽管手术技术有所进步，但手术死亡率仍然很高，毫无疑问，在血流动力学和感染并发症联合导致严重心力衰竭和广泛局部病变之前进行早期手术，这个问题是可以减少的。
