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手术治疗升主动脉瘤合并主动脉瓣关闭不全5例。主动脉造影示升主动脉扩张呈梨形,长9~11.7cm,直径6~8cm。4例伴中至重度主动脉瓣关闭不全,1例为主动脉瓣狭窄与关闭不全。心功能Ⅱ级2例,Ⅲ级3例。切除升主动脉瘤,4例做主动脉根置换(Bentall手术),1例分别置换升主动脉和主动脉瓣。术中吻合口出血和术后心包内明显渗血各1例均治愈,全组病例康复出院,随访3~24个月,症状消失、心功能均改善为Ⅰ级。重点讨论了有关手术指征、心肌保护、手术方式和术中注意事项。
Surgical treatment of ascending aortic aneurysm with aortic insufficiency in 5 cases. Aortic imaging showed ascending aorta pear-shaped expansion, length 9 ~ 11.7cm, diameter 6 ~ 8cm. 4 cases with moderate to severe aortic regurgitation, 1 case of aortic stenosis and incomplete closure. Heart function in grade Ⅱ 2 cases, Ⅲ grade in 3 cases. Ascending aortic aneurysm was excised, 4 cases were treated with aortic root replacement (Bentall surgery), and 1 case was replaced by ascending aorta and aortic valve respectively. Intraoperative anastomotic bleeding and postoperative pericardial obvious bleeding in 1 case were cured, all patients were discharged from hospital, followed up for 3 to 24 months, the symptoms disappeared, heart function improved to grade Ⅰ. Focus on the surgical indications, myocardial protection, surgical methods and intraoperative precautions.