主动脉根部和瓣膜置换术：瓣膜导管的应用

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1、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

2、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、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:onaorticvalveconduitapplicationDepartmentofCardiovascularSurgeryFujianProvincialCardiovascularDiseaseResearchInstituteFujianProvincialHospitalHanTaoProf.Thecasesthatsufferedfromaorticvalvedisea

4、seusuallyassociatedwiththeproblemsofaorticringoraorticsinusorascendingaorta,thespecialsurgicaltreatmentshouldbeappliedaccordingtodifferentproblemsofaorta866casesreceivedaorticvalvereplacement,andamongthem251casesaccompaniedwithaorticrootandascendingaortadisorders.Aorticdilatation,aorticr

5、egurgitation,Marfan’ssyndromeetc.UsingBentallprocedure.(147cases)Method:a:usingrunningsutureinaorticvalvereplacementandownmadevalveconduit.b:leftcoronaryarteryanastomoseddirectlytothesyntheticvessel,withoutusing“buttonsuture”.c:theprosthesisvalveconduitwrappedwiththeremainedwallofaortaNo

6、taoticdilatation,aorticregurgitation,dissectingascendingaorta.UsingCabrolprocedure.(36cases)Method:a:leftandrightcoronaryarteriesanastomosedtoa8mmsyntheticvessel.b:usinginterruptsutureinaorticvalvereplacementc:theprothesisvalveconduitwrappedwiththeremainedwallofaorta.Theaorticvalveregurg

7、itationbothwithaorticrootstenosisandascendingaorticdilatation.(25cases)Method:a:toextendaorticroot.tomakeincisionbetweentheleftcoronarysinusandnon-coronarysinus,andthenthemitralringisbroadenwithpericardium.b:interruptandrunningsuturewerecombined.c:thedilatedaortarestraine