主动脉瓣置换术后升主动脉瘤形成的外科治疗_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

陈茂林 , 舒礼良 , 苏刚 ,  徐敬

郑州大学第一附属医院心外科，郑州 450052;

Corresponding author：

徐敬, Email: xujing00111@sina.com

Keywords：

主动脉瓣置换; 升主动脉瘤; 外科治疗

DOI：

10.7507/1007-4848.20140078

Video：

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目的总结主动脉瓣置换术后升主动脉瘤形成的外科治疗经验。方法 2008年10月至2013年4月郑州大学第一附属医院收治6例主动脉瓣置换术后升主动脉瘤形成患者，其中男2例，女4例；年龄45～63（56.5±3.2）岁。主动脉瓣置换术后44～82（59.5±24.3）个月，均为单纯人工机械主动脉瓣置换术后。5例行单纯升主动脉置换术，1例行David手术。结果体外循环时间140～270（185.2±90.1）min，升主动脉阻断时间60～220（121.9±78.6）min。6例患者均康复出院。术后将血压控制于120/90 mm Hg以下，应用华法林，维持国际标准化比值（INR）1.5～2.5。术后均给予琥珀酸美托洛尔25 mg，每天2次。出院前复查彩色超声心动图（UCG）示：升主动脉内经28～30 mm。术后对6例患者随访3～12个月，门诊复查UCG示：人工血管内径较出院时无明显改变。结论主动脉瓣置换术后患者应定期复查UCG，对主动脉内经呈进行性增宽或主动脉瘤形成患者应及早行外科手术治疗。

Citation： 陈茂林, 舒礼良, 苏刚, 徐敬. 主动脉瓣置换术后升主动脉瘤形成的外科治疗. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 275-276. doi: 10.7507/1007-4848.20140078 Copy

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11.	徐志云,张宝仁,邹良建,等.主动脉二叶瓣畸形伴升主动脉瘤样扩张的外科治疗.中华胸心血管外科杂志,2004,20 (1):47-48.
12.	Mckellar SH,Michelena HI,Li Zhuo,et al.Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves.Am J Cardiol,2010,106 (11):1626-1633.
13.	Nair HC.Transesophageal echocardiaography evaluation of thoracic aorta.Ann Card Anaesth,2010,13 (2):186.
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1. Roubelakis A,Karangelis D,Kaarne M.Giant aortic root after previous aortic valve replacement.Ann Card Anaesth,2013,16 (2):153-154.
2. Bauer M,Pasic M,Schaffarzyk R,et al.Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve.Ann Thorac Surg,2002,73 (3):720-724.
3. 贺继刚,陈智豫,王戈楠,等.胸主动脉真性动脉瘤的外科治疗.中国胸心血管外科临床杂志,2012,19 (4):438-439.
4. 刘延华,王平凡,梁志强,等.Bentall术后升主动脉中远端及弓、降部主动脉瘤一例.中国胸心血管外科临床杂志,2010,17 (5):439.
5. Yoshikai M,Ohnishi H,Kamohara K,et al.Aortic dissection late after aortic valve replacement.Jpn J Thorac Cardiovasc Surg,2006,54 (3):120-123.
6. Martin C,Sun W,Primiano C,et al.Age-dependent ascending aorta mechanics assessed through multiphase CT.Ann Biomed Eng,2013,41 (12):2565-2574.
7. Breithaupt-Grögler K,Belz GG.Epidemiology of the arterial stiffness.Pathol Biol (Paris),1999,47 (6):604-613.
8. 王敏生,王春生,丁文军,等.114例升主动脉瘤的外科治疗.中国胸心血管外科临床杂志,2005,12 (1):1-3.
9. Michelena HI,Desjardins VA,Avierinos JF,et al.Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community.Circulation,2008,117 (21):2776-2784.
10. Fernandes S,Khairy P,Graham DA,et al.Bicuspid aortic valve and associated aortic dilation in the young.Heart,2012,98 (13):1014-1019.
11. 徐志云,张宝仁,邹良建,等.主动脉二叶瓣畸形伴升主动脉瘤样扩张的外科治疗.中华胸心血管外科杂志,2004,20 (1):47-48.
12. Mckellar SH,Michelena HI,Li Zhuo,et al.Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves.Am J Cardiol,2010,106 (11):1626-1633.
13. Nair HC.Transesophageal echocardiaography evaluation of thoracic aorta.Ann Card Anaesth,2010,13 (2):186.
14. Tsutsumi K,Inoue Y,Hashizume K,et al.Risk factor analysis for acute type A aortic dissection after aortic valve replacement.Gen Thorac Cardiovasc Surg,2010,58 (12):601-605.
15. Guntheroth WG.A critical review of the American College of Cardiology/American Heart Association practice guidelines on bicuspid aortic valve with dilated ascending aorta.Am J Cardiol,2008,102 (1):107-110.

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主动脉瓣置换术后升主动脉瘤形成的外科治疗

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