Fernández González A L, Martín Trenor A, Herreros J, Llorens R, Gil O, Calabuig J, de Alava E
Servicio de Cirugía Cardiovascular, Facultad de Medicina, Universidad de Navarra, Pamplona.
Rev Esp Cardiol. 1993 Aug;46(8):492-6.
The purpose of this study is to show our experience in the treatment of aneurysms of the ascending aorta in patients with previous aortic valve surgery.
We studied retrospectively the clinical characteristics and operative methods of 9 patients who underwent surgery for aneurysm of the ascending aorta after previous aortic valve replacement.
Time interval between the first and subsequent reoperation was 8.4 +/- 3.5 years (range 4-15 years). During the first operation there were 5 cases who presented with aortic regurgitation and dilatation of the ascending aorta. Isolated valvular aortic replacement was performed in these patients. Two patients underwent valvular replacement and implantation of supracoronary aortic graft. In two other cases valvular replacement was done with wedge resection of the aortic sinuses. Reoperation was performed because to the following reasons: valvular prosthesis disfunction and aneurysm of the ascending aorta (3), valvular prosthesis disfunction and aneurysm of the aortic remnant located between the prosthesis and the supracoronary aortic graft (2), thrombosis of the prosthesis (1), dissection of the ascending aorta (2) and superior vena cava syndrome (1). There was one hospital death. Another patient died after 26 months because of graft infection. The other 7 patients are in functional class I.
We conclude that an aggressive surgical approach should be adopted in patients with degenerative aortic regurgitation and moderate dilatation of the ascending aorta because of the rapid progression of the aortic disease. We advise complete replacement of the aortic root.
本研究的目的是展示我们在治疗曾接受主动脉瓣手术患者的升主动脉瘤方面的经验。
我们回顾性研究了9例曾接受主动脉瓣置换术后行升主动脉瘤手术患者的临床特征及手术方法。
首次手术与后续再次手术的时间间隔为8.4±3.5年（范围4 - 15年）。首次手术时，有5例患者表现为主动脉瓣反流及升主动脉扩张，这些患者接受了单纯主动脉瓣置换术。2例患者接受了瓣膜置换及冠状动脉上主动脉移植物植入术。另外2例患者在进行瓣膜置换时同时行主动脉窦楔形切除术。再次手术的原因如下：人工瓣膜功能障碍及升主动脉瘤（3例）、人工瓣膜功能障碍及位于人工瓣膜与冠状动脉上主动脉移植物之间的主动脉残端动脉瘤（2例）、人工瓣膜血栓形成（1例）、升主动脉夹层（2例）及上腔静脉综合征（1例）。有1例患者在医院死亡。另1例患者在26个月后因移植物感染死亡。其余7例患者心功能为I级。
我们得出结论，对于因主动脉疾病进展迅速而患有退行性主动脉瓣反流及升主动脉中度扩张的患者，应采取积极的手术方法。我们建议对主动脉根部进行完全置换。
