主动脉根部和瓣膜置换术：瓣膜导管的应用.ppt

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,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。2000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）。,手术特点：a、连续缝合主动脉瓣，自制主动脉带瓣导管。b、左冠状动脉直接与人造血管缝合，不做纽扣式缝合。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）。,手术特点：a、将左右冠状动脉或左冠状动脉用8mm人造血管缝合。b、主动脉带瓣导管间断缝合。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）,手术特点：a、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。b、间断加连续缝合主动脉瓣。c、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）。,手术特点：a、主动脉瓣置换，间断缝合。b、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）。,手术特点：a、常规David手术b、升主动脉包裹人造血管,体会：,手术简化，时间缩短手术后胸腔引流量减少。手术后疗效提高。,谢谢！,Aorticrootandvalvesurgery:onaorticvalveconduitapplicationDepartmentofCardiovascularSurgery,FujianProvincialCardiovascularDiseaseResearchInstituteFujianProvincialHospitalHanTaoProf.,Thecasesthatsufferedfromaorticvalvediseaseusuallyassociatedwiththeproblemsofaorticringoraorticsinusorascendingaorta,thespecialsurgicaltreatmentshouldbeappliedaccordingtodifferentproblemsofaorta866casesreceivedaorticvalvereplacement,andamongthem251casesaccompaniedwithaorticrootandascendingaortadisorders.,Aorticdilatation,aorticregurgitation,Marfanssyndromeetc.UsingBentallprocedure.(147cases),Method:a:usingrunningsutureinaorticvalvereplacementandownmadevalveconduit.b:leftcoronaryarteryanastomoseddirectlytothesyntheticvessel,withoutusing“buttonsuture”.c:theprosthesisvalveconduitwrappedwiththeremainedwallofaorta,Notaoticdilatation,aorticregurgitation,dissectingascendingaorta.UsingCabrolprocedure.(36cases),Method:a:leftandrightcoronaryarteriesanastomosedtoa8mmsyntheticvessel.b:usinginterruptsutureinaorticvalvereplacementc:theprothesisvalveconduitwrappedwiththeremainedwallofaorta.,Theaorticvalveregurgitationbothwithaorticrootstenosisandascendingaorticdilatation.(25cases),Method:a:toextendaorticroot.tomakeincisionbetweentheleftcoronarysinusandnon-coronarysinus,andthenthemitralringisbroadenwithpericardium.b:interruptandrunningsuturewerecombined.c:thedilatedaortarestrainedandwrappedwithaprosthesisbloodvessel.,Theaorticvalvestenosisassociatedbothwithregurgitationandascendingaortadilatation.Thegeraticaorticvalvecalcification.(40cases),Method:a:usinginterruptsutureinaorticvalvereplacement.b:theaortawrappedwithaprosthesisvessel.,Theaorticsinusdilatationwithnormalaorticvalve.UsingDavidprocedure.(3cases),Method:a:routineDavidprocedureb:theprosthesisbloodvesselwrappedwiththeremainedofaorticwall.,Conclusion,1.Shortenandsimplifiedthesu