Bapat V N, Tendolkar A G, Khandeparkar J, Dalvi B, Agrawal N, Kulkarni H, Magotra R
Department of Cardiovascular and Thoracic Surgery, King Edward VII Memorial Hospital, Parel, Bombay, India.
Eur J Cardiothorac Surg. 1997 Nov;12(5):759-65. doi: 10.1016/s1010-7940(97)00256-x.
To evaluate and discuss etiopathology, clinical manifestations and surgical outcome of a rare subset of unruptured aneurysm of the sinus of Valsalva which erodes into the interventricular septum.
Between 1989 and 1995, seven cases of unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum underwent surgical correction at the King Edward VII Memorial Hospital, Bombay. The origin of all these aneurysms was from the right coronary sinus. The mean age of presentation was 31 years. All patients were male. Calcification of the aneurysm was seen in three. Three patients presented without aortic regurgitation; all had complete heart block. Four patients presented with aortic regurgitation and in addition, two had complete heart block. Preoperative left ventricular function was poor in patients with aortic regurgitation (Ejection fraction range; 30-42%), when compared to those without aortic regurgitation (Ejection fraction range; 48-52%). Of those without aortic regurgitation at initial presentation, one patient developed progressive aortic regurgitation after 3 years requiring surgery. While two other patients were operated at earliest for closure of aneurysm, even in the absence of aortic regurgitation. All those with aortic regurgitation required surgery for aortic valve replacement and closure of aneurysm. Aneurysm was closed by direct suturing of the ostium in two patients and by patch closure in five patients. Permanent pacemaker was implanted in five patients.
There was no operative death. Patients who underwent aortic valve replacement required postoperative ionotropic support. Two patients, who underwent surgery in absence of aortic regurgitation, remain free of aortic regurgitation at the end of 36 and 42 months of follow-up. One of the patients with calcific aneurysmal sac underwent successful re-replacement of the aortic valve for paravalvar leak after a 2 year interval.
Unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum should be operated at the earliest, which makes surgery simple and prevents development of complications such as aortic regurgitation and heart block.
评估并探讨侵蚀至室间隔的罕见类型的瓦氏窦未破裂动脉瘤的病因病理、临床表现及手术结果。
1989年至1995年间，7例侵蚀至室间隔的瓦氏窦未破裂动脉瘤患者在孟买爱德华七世纪念医院接受了手术矫正。所有这些动脉瘤均起源于右冠状动脉窦。就诊时的平均年龄为31岁。所有患者均为男性。3例可见动脉瘤钙化。3例患者就诊时无主动脉瓣反流；均有完全性心脏传导阻滞。4例患者伴有主动脉瓣反流，此外，2例有完全性心脏传导阻滞。与无主动脉瓣反流的患者（射血分数范围为48%-52%）相比，有主动脉瓣反流的患者术前左心室功能较差（射血分数范围为30%-42%）。最初就诊时无主动脉瓣反流的患者中，1例在3年后出现进行性主动脉瓣反流，需要手术治疗。另外2例患者即使在无主动脉瓣反流的情况下也尽早接受了动脉瘤闭合手术。所有伴有主动脉瓣反流的患者均需要进行主动脉瓣置换和动脉瘤闭合手术。2例患者通过直接缝合瘤口闭合动脉瘤，5例患者通过补片闭合。5例患者植入了永久性起搏器。
无手术死亡。接受主动脉瓣置换的患者术后需要使用正性肌力药物支持。2例在无主动脉瓣反流的情况下接受手术的患者，在随访36个月和42个月结束时仍无主动脉瓣反流。1例有钙化动脉瘤囊的患者在2年后因瓣周漏成功再次进行了主动脉瓣置换。
侵蚀至室间隔的瓦氏窦未破裂动脉瘤应尽早手术，这会使手术简单，并防止诸如主动脉瓣反流和心脏传导阻滞等并发症的发生。
