Yamamoto T, Makuuchi H, Naruse Y, Kobayashi T, Goto M, Nonaka K
Department of Cardiovascular Surgery, Toranomon Hospital, Tokyo, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Jun;46(6):565-9. doi: 10.1007/BF03250601.
We present a surgical case of a 35-year-old man with aortitis. He had been performed the reconstruction of the right common carotid artery with a saphenous vein graft at 23 years old for his ruptured aneurysm by aortitis. The aortic valve replacement and CABG (LITA to LAD, SVG to D1 and SVG to RCA) were performed for aortic regurgitation and aneurysms of coronary arteries two years ago. The diastolic murmur was first heard at 18 months after the operation. The echocardiography on admission showed an abnormal movement of the prosthetic valve with perivalvular leakage. At the second operation, the valve dehiscence was observed. Although the tissues around the dehiscence was friable and edematous, there were no signs of vegetation nor abscess formation. His aortic root was replaced with a cryopreserved aortic allograft conduit. His postoperative course was uneventful and aortography revealed neither aortic regurgitation nor stenosis of the coronary artery or SVGs. We think the softness of the allograft valve ring is favorable in valve detachment cases due to not only infection but also aortitis, to prevent redetachment.
我们报告一例35岁主动脉炎男性患者的外科手术病例。他在23岁时因主动脉炎导致动脉瘤破裂，接受了右颈总动脉用大隐静脉移植的重建手术。两年前，因主动脉瓣反流和冠状动脉瘤进行了主动脉瓣置换术和冠状动脉旁路移植术（左内乳动脉至左前降支、大隐静脉至第一对角支、大隐静脉至右冠状动脉）。术后18个月首次听到舒张期杂音。入院时超声心动图显示人工瓣膜运动异常伴瓣周漏。在第二次手术中，观察到瓣膜裂开。尽管裂开周围的组织脆弱且水肿，但没有赘生物或脓肿形成的迹象。他的主动脉根部用冷冻保存的主动脉同种异体移植管道进行了置换。他的术后过程平稳，主动脉造影显示既无主动脉瓣反流，冠状动脉或大隐静脉移植血管也无狭窄。我们认为，同种异体移植瓣膜环的柔软性不仅在因感染而且在因主动脉炎导致的瓣膜脱离病例中有利于防止再次脱离。
