【主动脉瓣重植术一期全胸主动脉置换术——一例Marfan合并主动脉环扩张合并DeBakey I型慢性主动脉夹层的再手术】。

N Tabayashi, S Kitamura, S Taniguchi, S Kobayashi, K Niwaya, Y Yoshikawa
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引用次数: 0

摘要

一名23岁的马凡氏综合征患者,患有I型主动脉环扩张和慢性主动脉夹层,成功治疗。他接受了一次全胸主动脉置换术,采用逆行拉穿技术并保留主动脉瓣再植(David手术)。用hemasshield移植物代替降主动脉,移植物逆行通过降主动脉瘤。因此,在不结扎肋间动脉的情况下,移植物被植入降主动脉瘤内。术后MRI显示移植物和动脉瘤之间的空间完全凝固。大卫的手术保留了自己的主动脉瓣,术后不需要抗凝治疗。术后未见主动脉反流及左心室与主动脉间压力梯度。我们的结论是,对于有全胸主动脉动脉瘤和主动脉环扩张的患者,采用逆行拉穿技术和保留主动脉瓣的单期再植术是有用的。
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[One-stage replacement of the entire thoracic aorta with aortic valve reimplantation technique--a reoperation for a Marfan patient with annulo-aortic ectasia and chronic aortic dissection of DeBakey type I].

A 23-year-old man with Marfan syndrome, who had annulo-aortic ectasia and chronic aortic dissection of type I, was successfully treated. He underwent one-stage replacement of the entire thoracic aorta using a retrograde pull-through technique with aortic valve sparing reimplantation (David procedure). The descending aorta was replaced with a Hemashield graft, and then the graft was passed through within the descending aortic aneurysm in the retrograde fashion. Thus, the graft was inserted inside the descending aortic aneurysm without ligation of some of the intercostal arteries. Postoperative MRI showed complete clotting of the space between the graft and the aneurysm. David's reimplantation procedure which spares own aortic valve, requires no anticoagulant therapy in the post operative period. Neither aortic regurgitation nor pressure gradient between the left ventricle and the aorta were observed postoperatively. We conclude that the replacement of the entire thoracic aorta using a retrograde pull-through technique with an aortic valve sparing reimplantation by the single stage is useful for the selected patients with aneurysm of the entire thoracic aorta and annulo-aortic ectasia.

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