Serino W, Andrade J L, Ross D, de Leval M, Somerville J
Br Heart J. 1983 May;49(5):501-6. doi: 10.1136/hrt.49.5.501.
The long-term follow-up of six patients operated on for aorto-left ventricular communication has been reviewed in detail. All had residual aortic regurgitation after the initial repair of the defect. It was severe in four and required repeated reoperation in three with ultimate aortic valve replacement. The failure of early repair to solve the haemodynamic problem has provoked a reconsideration of the basic anatomy, of the surgical approach, and of the postoperative physiology of this anomaly. The so called "tunnel" is not a tunnel with length but should be considered as a localised breach at the insertion of the right coronary cusp. The localised aortic root dilatation at the site is a weakness that remains after closure of the tunnel leaving a poorly supported aortic valve and a weak root. Thus, the initial repair of the aorto-left ventricular communication must not only close the communication but reinforce, strengthen, and support the right aortic sinus in order to maintain cusp competence.
对6例接受主动脉-左心室连通修复手术患者的长期随访情况进行了详细回顾。所有患者在最初修复缺损后均有残余主动脉瓣反流。其中4例反流严重，3例需要反复再次手术，最终进行了主动脉瓣置换。早期修复未能解决血流动力学问题，促使人们重新审视这种异常情况的基本解剖结构、手术方法和术后生理状况。所谓的“隧道”并非具有一定长度的隧道，而应被视为右冠状动脉瓣叶附着处的局限性缺损。该部位局限性主动脉根部扩张是一种薄弱环节，在隧道闭合后依然存在，导致主动脉瓣支撑不佳且根部薄弱。因此，主动脉-左心室连通的初始修复不仅要闭合连通口，还必须加强、加固并支撑右主动脉窦，以维持瓣叶功能。
