Chiba Y, Muraoka R, Ihaya A, Morioka K
Second Department of Surgery, Fukui Medical School, Japan.
Nihon Geka Hokan. 1993 Nov 1;62(6):297-301.
A new approach to the problem of recurrent infection of an aortic valve prosthesis in a patient with an inaccessible coronary arterial system is presented. The coronary arteries were reconstructed by anastomosing a looped ringed-PTFE graft to the left and right coronary ostia within the aorta, and the graft was withdrawn from the aorta just above the ostia. Then the top of the looped graft was anastomosed to the aorta above a translocated aortic prosthesis. This procedure is most likely to be useful in the treatment of recurrent aortic prosthetic valve endocarditis which has dense pericardial adhesion secondary to multiple cardiac operations. Aortic prosthetic valve endocarditis frequently is associated with a paravalvular ring abscess which may destroy the normal annulus. In these cases, translocating the aortic valve to the ascending aorta, and placing saphenous vein bypass grafts to the right and the left anterior descending coronary artery may be required. However, the coronary arteries may not be accessible following multiple operations. The following case illustrates a new solution to the problem how to translocated the aortic valve and reconstruct the coronary arteries in a patient with an infected aortic root and inaccessible coronary arteries.
本文介绍了一种针对冠状动脉系统难以触及的患者主动脉瓣人工瓣膜反复感染问题的新方法。通过将带环的PTFE移植环与主动脉内的左右冠状动脉开口吻合来重建冠状动脉，移植环在开口上方从主动脉中抽出。然后将带环移植环的顶部与移位后的主动脉人工瓣膜上方的主动脉进行吻合。该手术最有可能用于治疗因多次心脏手术导致心包粘连致密的复发性主动脉人工瓣膜心内膜炎。主动脉人工瓣膜心内膜炎常伴有瓣周环脓肿，可能破坏正常瓣环。在这些情况下，可能需要将主动脉瓣移位至升主动脉，并将大隐静脉旁路移植至左右冠状动脉前降支。然而，多次手术后冠状动脉可能难以触及。以下病例说明了如何在感染性主动脉根部且冠状动脉难以触及的患者中移位主动脉瓣并重建冠状动脉这一问题的新解决方案。
