Salomon N W, Stinson E B, Oyer P, Copeland J G, Shumway N E
Ann Thorac Surg. 1978 Nov;26(5):452-60. doi: 10.1016/s0003-4975(10)62925-6.
The operative treatment of 131 patients with congenital aortic stenosis is reviewed. Of the 131 patients, 77% had left ventricular outflow tract (LVOT) obstruction at a single level and 23%, major obstruction at more than one level. There were 3 operative deaths (2.3%) and 10 late deaths (7.8%). Twenty of the 128 discharged patients have undergone a second procedure and 6 a third procedure for recurrent or residual LVOT obstruction. The 26 reoperations included 7 aortic valve replacements, 4 left ventricular apical-abdominal aortic (LV-AA) valved conduits, and 15 extensive aortic valvotomies with or without supravalvular aortoplasty. Five of the 20 patients undergoing reoperation died; 4 of these deaths occurred in patients who had valve replacement at reoperation. The 4 who received LV-AA conduits have sustained excellent hemodynamic and clinical results with no complications. Highly satisfactory clinical results can be obtained with minimal operative risk, regardless of the level of LVOT obstruction. Reoperation for recurrent or residual LVOT obstruction, however, is comparatively more hazardous, and alternative surgical approaches (LV-AA conduits) should be considered.
回顾了131例先天性主动脉瓣狭窄患者的手术治疗情况。在这131例患者中，77%存在单一水平的左心室流出道（LVOT）梗阻，23%存在多个水平的严重梗阻。有3例手术死亡（2.3%）和10例晚期死亡（7.8%）。128例出院患者中有20例因复发性或残留性LVOT梗阻接受了二次手术，6例接受了三次手术。26例再次手术包括7例主动脉瓣置换术、4例左心室心尖-腹主动脉（LV-AA）带瓣管道植入术以及15例广泛的主动脉瓣切开术，其中部分患者还进行了或未进行瓣上主动脉成形术。20例再次手术患者中有5例死亡；其中4例死亡发生在再次手术时进行瓣膜置换的患者中。接受LV-AA管道植入术的4例患者血流动力学和临床效果良好，无并发症。无论LVOT梗阻的水平如何，均可在最小手术风险下获得高度满意的临床效果。然而，因复发性或残留性LVOT梗阻进行再次手术相对更具危险性，应考虑采用替代手术方法（LV-AA管道植入术）。
