Aneurysm of the membranous septum in adult patients with perimembranous ventricular septal defect
Aneurysm of the membranous septum in adult patients with perimembranous ventricular septal defect
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DOI：
10.1016/s1010-7940(96)01058-5
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发表时间：
1997-02-01
影响因子：
3.4
通讯作者：
Ozturk, OY
中科院分区：
文献类型：
--
作者：
Yilmaz, AT;Ozal, E;Ozturk, OY
目的：膜隔动脉瘤（AMS）一直被认为是良性的。我们分析了与AMS相关的成人患者的并发症。方法：回顾性分析254例成人膜周部室间隔缺损（VSD）中发生AMS的51例（20%）。AMS的诊断是基于血管造影标准。51例AMS患者中有39例（76.5%）年龄在20 - 29岁之间。除1例AMS患者外，所有患者的肺-体血流（Q（p）/Q（s））均小于2.3（范围1-2.1，平均1.4）。1例动脉瘤破裂患者的Q（p）/Q（s）为2.7。AMS和/或VSD有6种主要并发症：24例患者（47%）发生主动脉瓣脱垂，15例患者（29.4%）发生主动脉瓣返流，9例患者（17.6%）发生三尖瓣关闭不全，2例患者（4%）发生右心室流出道梗阻，1例患者（2%）发生动脉瘤破裂。7例患者（13.7%）既往有细菌性心内膜炎。所有患者均接受手术治疗。动脉瘤和室间隔缺损直接缝合9例，补片缝合42例。13例轻中度返流患者行主动脉瓣修复术，2例重度返流患者行主动脉瓣置换术。结果：无早期或晚期死亡。在2例VSD通过直接缝合闭合的患者中，在术后3年和7年观察到残余沟通和动脉瘤复发。结论：根据目前的数据，动脉瘤形成在功能上减小了VSD的尺寸，但它具有促进三尖瓣关闭不全、主动脉瓣脱垂、右心室流出道梗阻、破裂和细菌性心内膜炎的潜在后果。因此，我们建议AMS应完全切除，并使用补片关闭产生的缺损，以防止进一步扩大和随之而来的并发症，即使没有心脏症状。(C)1997年Elsevier Science B.V.
Objective: The aneurysm of the membranous septum (AMS) has often been considered as benign in the minds of many previous investigators. We have analyzed the complications associated with AMS in adult patients. Methods: Fifty-one cases (20%) of AMS in 254 adult patients with perimembranous ventricular septal defect (VSD) are described. The diagnosis of AMS was based on angiographic criteria. Thirty-nine (76.5%) of the 51 patients with AMS were aged between 20 and 29 years. All patients but one with AMS had a pulmonary-to-systemic flow (Q(p)/Q(s)) of less than 2.3 (range 1-2.1, mean 1.4). In a patient who had a ruptured aneurysm, the Q(p)/Q(s) was 2.7. There were six main complications affected by AMS and/or VSD; aortic valve prolapse in 24 patients (47%), aortic regurgitation in 15 (29.4%), tricuspid insufficiency in nine (17.6%), right ventricular outflow tract obstruction in two (4%), and rupture of the aneurysm in one patient (2%). Seven patients (13.7%) had prior bacterial endocarditis. All patients underwent surgery. Aneurysm and VSD were closed by direct suture in nine and with a patch in 42 patients. Aortic valve repair was performed in 13 patients in whom regurgitation was mild to moderate, and replacement was required in two patients with severe aortic regurgitation. Results: There were no early or late deaths. Residual communication and recurrence of the aneurysm was noted three and seven years postoperatively in two patients where VSD had been closed by direct suture. Conclusions: According to present data, aneurysm formation functionally reduces the VSD size, but it has the potential consequence of promoting tricuspid insufficiency, aortic valve prolapse, right ventricular outflow tract obstruction, rupture and bacterial endocarditis. Therefore, we recommend that AMS should be resected completely and the defect produced closed with a patch in order to prevent further enlargement and consequent complications even if there are no cardiac symptoms. (C) 1997 Elsevier Science B.V.