Zhonghua wai ke za zhi [Chinese journal of surgery] · 1999
[Surgical treatment of dissecting aneurysm of the interventricular septum].
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Wu Q, Xu J, Shen X
Аннотация
OBJECTIVE: To report a kind of extremely rare disease, dissecting aneurysm of the interventricular septum.
METHODS: Between May 1992 and January 1998, 4 patients underwent surgical treatment of dissecting aneurysm of the interventricular septum in Fuwai Hospital, Beijing. The cause of the disease was different in these four patients. Two patients may be attributable to the aneurysm of coronary sinus of valsava, 1 to the result of trauma, and the other to big perforation (diameter: 2 cm) in the bottom of the right coronary sinus of valsava, through which the blood rushed into the cavity of dissecting aneurysm of the interventricular septum. The aneurysm was resected or repaired in these patients. Three of them were subjected to aortic valve replacement and one received repair of the perforation of the right vaslava sinus.
RESULTS: Two patients had successful reoperation and the other 2 suceeded in the first operation. All of them were uneventfully recovered.
CONCLUSIONS: The development of dissecting aneurysm of the interventricular septum is rapid. Its prognosis is poor. Early diagnosis and operation are necessary. The pathogenic mechanism of dissecting aneurysm of the interventricular septum is unknown, but echocardiogram, electrocardiogram and nuclear magnetic resonance (NMR) are valuable for diagnosis. Surgical operation should involve the treatment of aortic valve disease. The wall of the aneurysm should be resected and the interventricular septum should be reconstructed. Good exposure can be obtained from the incision of the ascending aorta and right ventricular outflow tract. The A-V block should be treated simultaneously.
METHODS: Between May 1992 and January 1998, 4 patients underwent surgical treatment of dissecting aneurysm of the interventricular septum in Fuwai Hospital, Beijing. The cause of the disease was different in these four patients. Two patients may be attributable to the aneurysm of coronary sinus of valsava, 1 to the result of trauma, and the other to big perforation (diameter: 2 cm) in the bottom of the right coronary sinus of valsava, through which the blood rushed into the cavity of dissecting aneurysm of the interventricular septum. The aneurysm was resected or repaired in these patients. Three of them were subjected to aortic valve replacement and one received repair of the perforation of the right vaslava sinus.
RESULTS: Two patients had successful reoperation and the other 2 suceeded in the first operation. All of them were uneventfully recovered.
CONCLUSIONS: The development of dissecting aneurysm of the interventricular septum is rapid. Its prognosis is poor. Early diagnosis and operation are necessary. The pathogenic mechanism of dissecting aneurysm of the interventricular septum is unknown, but echocardiogram, electrocardiogram and nuclear magnetic resonance (NMR) are valuable for diagnosis. Surgical operation should involve the treatment of aortic valve disease. The wall of the aneurysm should be resected and the interventricular septum should be reconstructed. Good exposure can be obtained from the incision of the ascending aorta and right ventricular outflow tract. The A-V block should be treated simultaneously.