Dietl C A, Torres A R
Institute of Cardiology and Cardiovascular Surgery (Fundación Favaloro), Hospital Guemes, Buenos Aires, Argentina.
Cardiovasc Surg. 1993 Dec;1(6):638-42.
Between September 1980 and August 1988, 21 patients, of mean age 7.3 (range 1-19) years, with ventricular septal defect and aortic valve prolapse, underwent surgery. Aortic insufficiency was mild in three patients, moderate in 13 and severe in five. Surgical repair was performed using a combined transaortic and transpulmonary approach. The prolapsed leaflets were evaluated through the ventricular septal defect before and after valvuloplasty. Using the Trusler technique, the prolapsed cusps were plicated at the level of the commissures; only one patient required aortic valve replacement. After functional assessment of the valve repair, through the ventricular septal defect, during infusion of cardioplegia in the aortic root, the defects were closed through the pulmonary artery, or through a right atriotomy. Mean follow-up was 51.5 (range 3-108) months. One patient developed bacterial endocarditis and died 3 months after surgery. The other 20 patients remained symptom-free. There are no residual ventricular septal defects, and mild residual aortic insufficiency is present in six patients. The mean(s.d.) cardiothoracic ratio decreased from 0.61(0.07) before to 0.49(0.05) after surgery. In summary, preservation and repair of the prolapsed aortic valve is possible even in the presence of severe aortic insufficiency. The combined approach through both great arteries enables good visualization with minimal traction, and accurate assessment of the aortic valvuloplasty through the ventricular septal defect. In addition, problems associated with a right ventriculotomy are avoided.
1980年9月至1988年8月期间，21例平均年龄7.3岁（范围1 - 19岁）的室间隔缺损合并主动脉瓣脱垂患者接受了手术。3例患者主动脉瓣关闭不全为轻度，13例为中度，5例为重度。采用经主动脉和经肺动脉联合入路进行手术修复。在瓣膜成形术前和术后，通过室间隔缺损对脱垂的瓣叶进行评估。采用特拉斯勒技术，在瓣叶交界处水平对脱垂的瓣叶进行折叠；仅1例患者需要进行主动脉瓣置换。在主动脉根部灌注心脏停搏液期间，通过室间隔缺损对瓣膜修复进行功能评估后，经肺动脉或经右心房切口关闭缺损。平均随访时间为51.5个月（范围3 - 108个月）。1例患者发生细菌性心内膜炎，术后3个月死亡。其他20例患者无症状。无残余室间隔缺损，6例患者存在轻度残余主动脉瓣关闭不全。心胸比率平均值（标准差）从术前的0.61（0.07）降至术后的0.49（0.05）。总之，即使存在严重的主动脉瓣关闭不全，保留和修复脱垂的主动脉瓣也是可行的。通过两条大动脉的联合入路能够在最小牵拉的情况下实现良好的视野，并通过室间隔缺损对主动脉瓣成形术进行准确评估。此外，避免了与右心室切开术相关的问题。
