Nakayama Y, Sakata R, Umebayashi Y, Ueyama K, Aragaki K, Ura M
Department of Cardiovascular Surgery, Kumamoto Central Hospital, Japan.
Kyobu Geka. 1996 Jun;49(6):452-5.
During the past 4 years, from January 1991 to December 1994, we experienced 12 cases of aortic root reconstruction utilizing Carrel patch method. The cases included annulo-aortic ectasia (AAE), root aneurysm with aortic regurgitation (AR), and aortic dissection with AR. The aortic valve and aortic root were resected, the coronary ostia were dissected free, mobilized, and then implanted to the composite graft. Coronary anastmosis was performed by mattress suture and reinforced by Tefron felt strips. It was necessary in one case to undergo coronary artery bypass grafting for myocardial ischemia due to coronary ostial stenosis. Operative procedure could be performed in 4 cases without blood transfusion. Post operative death was seen in only 1 case at 25 postoperative day, who underwent on emergency operation for cardiac tamponade due to aortic dissection. Pseudoaneurysm formations of coronary ostia or hospital death was not observed in any other cases during follow up period (average 25 months). Late tamponade was shown in one case as a complication, and the majority of cases had uneventful postoperative course. The operative procedure is considered feasible in any anatomic variation of the aortic root disease, even if dislocation of coronary ostia is minimal, and can be expect for prevention of pseudoaneurysm formation, and long term survival.
在过去4年中，即从1991年1月至1994年12月，我们采用卡雷尔补片法进行了12例主动脉根部重建手术。病例包括主动脉瓣环扩张（AAE）、伴有主动脉瓣反流（AR）的根部动脉瘤以及伴有AR的主动脉夹层。切除主动脉瓣和主动脉根部，游离、松解冠状动脉开口，然后将其植入复合移植物。冠状动脉吻合采用褥式缝合，并用特氟龙毡条加强。有1例因冠状动脉开口狭窄导致心肌缺血，需行冠状动脉旁路移植术。4例手术过程中未输血。术后仅1例于术后第25天死亡，该患者因主动脉夹层导致心脏压塞而接受急诊手术。随访期间（平均25个月），其他病例均未观察到冠状动脉开口假性动脉瘤形成或医院死亡。有1例出现晚期心脏压塞并发症，大多数病例术后病程顺利。该手术方法被认为适用于主动脉根部疾病的任何解剖变异，即使冠状动脉开口移位极小，并且有望预防假性动脉瘤形成和实现长期生存。
