Inberg M V, Havia T, Laaksonen V, Möttönen M, Wegelius U, Vänttinen E
Scand J Thorac Cardiovasc Surg. 1977;11(1):25-31. doi: 10.3109/14017437709167809.
The clinical series comprised 14 patients with aneurysms of the ascending aorta. In the autopsy series, there were additionally 19 patients, who had died suddenly as a results of free perforation or dissection of the ascending aorta. In the clinical series, the cause of the aneurysmal formation was cystic medial necrosis in 10 patients, 8 of whom had severe aortic valve insufficiency. Twelve patients were operated on using extracorporeal circulation, Both the ascending aorta and aortic valve were replaced with prosthesis in 6 cases. Three patients underwent emergency surgery due to pericardial tamponade. All three died, despite a technically successful operation. One patient out of 9 electively operated upon died. A follow-up examination was carried out on the 5 surviving cystic medial necrosis patients. Aneurysms of the sinuses of Valsalva developed after supracoronary resection in 2 patients. The results showed that elective operations in the event of aneurysms of the ascending aorta can be carried out with an acceptably low mortality rate. However, after supracoronary resection, in cases of cystic medial necrosis, the risk of developing aneurysms of the proximal aortic remnant seems obvious. Therefore, in patients in whom the whole aortic root is involved, total removal of the ascending aorta and re-implantation of the coronary ostia into the prosthetic tube is preferable.
临床系列包括14例升主动脉瘤患者。尸检系列中，另有19例患者因升主动脉游离穿孔或夹层而猝死。临床系列中，10例患者动脉瘤形成的原因是囊性中层坏死，其中8例有严重主动脉瓣关闭不全。12例患者接受了体外循环手术，6例患者同时置换了升主动脉和主动脉瓣。3例患者因心包填塞接受急诊手术，尽管手术技术成功，但3例均死亡。9例择期手术患者中有1例死亡。对5例存活的囊性中层坏死患者进行了随访检查。2例患者在冠状动脉上切除术后发生了主动脉瓣窦瘤。结果表明，升主动脉瘤患者进行择期手术时，死亡率可以接受地低。然而，在冠状动脉上切除术后，对于囊性中层坏死病例，近端主动脉残端发生动脉瘤的风险似乎很明显。因此，对于整个主动脉根部受累的患者，最好完全切除升主动脉并将冠状动脉开口重新植入人工血管。
