Yilmaz A T, Ozal E, Arslan M, Tatar H, Oztürk O Y
Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
Eur J Cardiothorac Surg. 1997 Feb;11(2):307-11. doi: 10.1016/s1010-7940(96)01058-5.
The aneurysm of the membranous septum (AMS) has often been considered as benign in the minds of many previous investigators. We have analyzed the complications with AMS in adult patients.
Fifty-one cases (20%) of AMS in 254 adult patients with perimembranous ventricular septal defect (VSD) are described. The diagnosis of AMS was based on angiographic criteria. Thirty-nine (76.5%) of the 51 patients with AMS were aged between 20 and 29 years. All patients but one with AMS had a pulmonary-to-systemic flow (Qp/Qs) of less than 2.3 (range 1-2.1, mean 1.4). In a patient who had a ruptured aneurysm, the Qp/Qs was 2.7. There were six main complications affected by AMS and/or VSD; aortic valve prolapse in 24 patients (47%), aortic regurgitation in 15 (29.4%), tricuspid insufficiency in nine (17.6%), right ventricular outflow tract obstruction in two (4%), and rupture of the aneurysm in one patient (2%). Seven patients (13.7%) had prior bacterial endocarditis. All patients underwent surgery. Aneurysm and VSD were closed by direct suture in nine and with a patch in 42 patients. Aortic valve repair was performed in 13 patients in whom regurgitation was mild to moderate, and replacement was required in two patients with severe aortic regurgitation.
There were no early or late deaths. Residual communication and recurrence of the aneurysm was noted three and seven years postoperatively in two patients where VSD had been closed by direct suture.
According to present data, aneurysm formation functionally reduces the VSD size, but it has the potential consequence of promoting tricuspid insufficiency, aortic valve prolapse, right ventricular outflow tract obstruction, rupture and bacterial endocarditis. Therefore, we recommend that AMS should be resected completely and the defect produced closed with a patch in order to prevent further enlargement and consequent complications even if there are no cardiac symptoms.
在许多既往研究者的认知中，膜周部室间隔瘤（AMS）常被视为良性病变。我们分析了成年患者中AMS的并发症情况。
描述了254例成年膜周部室间隔缺损（VSD）患者中的51例（20%）AMS病例。AMS的诊断基于血管造影标准。51例AMS患者中39例（76.5%）年龄在20至29岁之间。除1例患者外，所有AMS患者的肺循环与体循环血流量之比（Qp/Qs）均小于2.3（范围1 - 2.1，平均1.4）。1例动脉瘤破裂患者的Qp/Qs为2.7。有6种主要并发症受AMS和/或VSD影响；24例患者（47%）出现主动脉瓣脱垂，15例（29.4%）出现主动脉瓣反流，9例（17.6%）出现三尖瓣关闭不全，2例（4%）出现右心室流出道梗阻，1例患者（2%）出现动脉瘤破裂。7例患者（13.7%）曾患细菌性心内膜炎。所有患者均接受了手术。9例患者通过直接缝合关闭动脉瘤和VSD，42例患者使用补片修补。13例轻度至中度反流患者进行了主动脉瓣修复，2例严重主动脉瓣反流患者需要进行瓣膜置换。
无早期或晚期死亡病例。在2例直接缝合关闭VSD的患者中，术后3年和7年分别发现残余分流和动脉瘤复发。
根据目前的数据，动脉瘤形成在功能上减小了VSD的大小，但有可能导致三尖瓣关闭不全、主动脉瓣脱垂、右心室流出道梗阻、破裂和细菌性心内膜炎等后果。因此，我们建议即使没有心脏症状，也应完全切除AMS并使用补片封闭产生的缺损，以防止其进一步扩大及随之而来的并发症。
