主动脉根部和瓣膜置换术瓣膜导管的应用

主动脉根部和瓣膜置换术： 瓣膜导管的应用 福建省心血管病研究所 福建省立医院心外科 韩涛 n在主动脉瓣膜病变的病例中，病变常累 及主动脉瓣环、主动脉窦、升主动脉等 ，需要对不同的病变部位、病变形式采 用不同的手术方法进行治疗。 n2000年以来我科有866例病人行主动脉 瓣置换手术，其中涉及主动脉根部升主 动脉病变的患者251例。 一、主动脉根部扩大、主动脉瓣关闭不全 、马凡综合征等采用Bentall手术（147 例）。 n手术特点： n a、连续缝合主动脉瓣，自制主动脉带 瓣导管。 n b、左冠状动脉直接与人造血管缝合， 不做纽扣式缝合。 n c、用主动脉壁将人造血管带瓣导管包 裹。 二、主动脉根部无扩大，主动脉瓣关闭不 全，升主动脉壁撕裂。采用Cabrol（36 例）。 n手术特点： na、将左右冠状动脉或左冠状动脉用 8mm人造血管缝合。 n b、主动脉带瓣导管间断缝合。 n c、用主动脉壁包裹缝合带瓣血管，如 不够则加用心包片。 三、主动脉根部狭窄的主动脉瓣关闭不全 ，升主动脉扩张。（25例） n手术特点： na、扩大主动脉根部。从左冠窦与无冠 窦之间切开二尖瓣环用心包加宽。 nb、间断加连续缝合主动脉瓣。 nc、用人造血管外包主动脉扩张处。 四、主动脉瓣狭窄伴关闭不全，升主动脉 扩张。老年性主动脉瓣钙化（40例）。 n手术特点： na、主动脉瓣置换，间断缝合。 nb、升主动脉外用人造血管包裹。 五、主动脉窦部扩大，主动脉瓣正常。应 用David手术（3例）。 n手术特点： na、常规 David 手术 nb、升主动脉包裹人造血管 体 会： n手术简化，时间缩短 n手术后胸腔引流量减少。 n手术后疗效提高。 谢 谢！ Aortic root and valve surgery: on aortic valve conduit application Department of Cardiovascular Surgery Fujian Provincial Cardiovascular Disease Research Institute Fujian Provincial Hospital Han Tao Prof. nThe cases that suffered from aortic valve disease usually associated with the problems of aortic ring or aortic sinus or ascending aorta, the special surgical treatment should be applied according to different problems of aorta n 866 cases received aortic valve replacement, and among them 251 cases accompanied with aortic root and ascending aorta disorders. Aortic dilatation , aortic regurgitation ,Marfans syndrome etc. Using Bentall procedure. (147 cases) nMethod: na:using running suture in aortic valve replacement and own made valve conduit. nb: left coronary artery anastomosed directly to the synthetic vessel, without using “button suture”. nc: the prosthesis valve conduit wrapped with the remained wall of aorta Not aotic dilatation, aortic regurgitation, dissecting ascending aorta. Using Cabrol procedure. (36 cases) nMethod: n a: left and right coronary arteries anastomosed to a 8mm synthetic vessel. n b: using interrupt suture in aortic valve replacement n c: the prothesis valve conduit wrapped with the remained wall of aorta. The aortic valve regurgitation both with aortic root stenosis and ascending aortic dilatation.(25 cases) nMethod: na: to extend aortic root. to make incision between the left coronary sinus and non- coronary sinus, and then the mitral ring is broaden with pericardium. nb: interrupt and running suture were combined. nc: the dilated aorta restrained and wrapped with a prosthesis blood vessel. The aortic valve stenosis associated both with regurgitation and ascending aorta dilatation. The geratic aortic valve calcification.(40 cases) nMethod: n a: using interrupt suture in aortic valve replacement. n b: the aorta wrapped with a prosthesis vessel. The aortic sinus dilatation with normal aortic valve. Using David procedure. (3 cases) n Method: na: routine David procedure nb: the prosthesis blood vessel wrapped with the remained of aortic wall . Conclusion n1. Shorten and simplified the surg