How does aneurysm of aortic sinus do operation?

summary

The rupture of aortic sinus aneurysm should be operated as soon as possible regardless of the size of the rupture and the shunt. There was no small unruptured aortic sinus aneurysm with cardiac malformation and no operation was necessary. Sufficient cardiotonic, diuretic and vasodilator drugs should be given before operation. Repair of aneurysm of sinus of Valsalva, usually through the incision into the heart cavity. Aortic root incision should be used to check and repair aortic insufficiency. So how does aneurysm of aortic sinus do an operation?

How does aneurysm of aortic sinus do operation?

First of all, preoperative preparation: for patients complicated with obvious cardiac insufficiency, sufficient cardiotonic, diuretic and vasodilator drugs, bed rest, low salt diet and intermittent oxygen inhalation should be given before operation to improve cardiac function and general condition.

Second, the operation method: repair of aortic sinus aneurysm, usually through the incision into the heart cavity; In case of aortic regurgitation, aortic root incision should be used for examination and repair. The repair of aortic sinus aneurysm was performed through cardiac cavity. A median incision was made in the chest, along the sternum. Cardiac incision, there are three kinds: right ventricular incision: sinus tumor broken into the right ventricle, especially the right ventricular outflow tract, can do outflow tract incision. Right atrium incision: if sinus tumor breaks into right atrium, it can be done through right atrium incision parallel to atrioventricular sulcus. Left atrial incision: if the sinus tumor breaks into the left atrium, the left atrial incision of atrial sulcus can be made. After exposing the cyst, the wall of the cyst was cut longitudinally from its tip. Then, the wall of the aneurysm was cut off and only the 2 mm edge was reserved for reinforcement and suture. Through the ostium of sinus aneurysm, we examined the aortic valve leaflet for meta lesions and carefully examined whether there was ventricular septal defect. For small aneurysm of the sinus of Valsalva, intermittent mattress suture can be used from the side of the aortic valve ring at the lower margin of the aneurysm with 4-10 double-end needle with gasket, through the aortic valve ring and the normal aortic wall at the upper margin. Generally, 3-5 needles are needed. After ligation, the second layer is sutured continuously. When the tumor is large, patch repair can be used, intermittent mattress suture or continuous suture can be used. The cardiac incision was sutured to remove gas from the heart and aorta. The aortic sinus aneurysm was repaired through the aortic root. The ascending aorta was cut transversely or obliquely 1.5-2.0 cm away from the aortic valve ring. Two traction sutures were placed at the lower edge and one at the upper edge of the ascending aorta, and then the aortic incision was opened with an eye hook to expose the aortic sinus. The aortic valve was examined for malformation, disease and insufficiency. The internal orifice of the sinus aneurysm was found above the aortic valve ring. The lame sac was pulled into the aorta from the cardiac cavity. The wall of the sac was cut off and the residual edge was left for 2 mm. When the sinus aneurysm is small, it can be sutured with 4-0 dacron thread parallel to aortic valve ring in intermittent mattress style. When the sinus aneurysm is large, it can be repaired with patch, and it can be sutured continuously with 4-0 suture. It should be sutured on the aortic annulus and normal aortic wall. When the prolapse of valve leaflet is called obvious incompetence, it can be repaired by folding and suspending the valve leaflet. If the valve is severely calcified, thickened, rolled and unable to be formed, aortic valve replacement should be performed immediately. Suture the aortic incision. Aortic sinus aneurysm with ventricular septal defect repair, aortic sinus aneurysm with ventricular septal defect, often close to the sinus aneurysm below. Right ventricular outflow tract incision is often used in the operation. If the right muscle bundles of the two were separated, they were repaired respectively. If they are adjacent to each other, interrupted mattress suture must be used to sew the lower edge of the aortic valve ring and the upper edge of the normal aortic wall, and avoid distortion of the valve ring. Then the ventricular septal defect was repaired by mattress suture, and the sinus tumor was reinforced and sutured. The larger ostium was repaired with patch and septal defect.

The final postoperative treatment is the same as that of general congenital heart disease. In addition to arterial pressure and central venous pressure, left atrial pressure and cardiac output should be monitored if possible. According to the results of arterial blood gas analysis, timely adjust the parameters of mechanical ventilation, strengthen diuretic and cardiotonic treatment, use positive inotropic drugs and vasodilators as appropriate, and pay attention to the prevention and treatment of arrhythmia. We should also pay attention to the observation and treatment of complications.

matters needing attention

The key to prevention is to master the correct repair technique. When the internal opening of sinus tumor is closed, it should not be on the tumor wall, because there is no brush fiber layer, which is easy to tear, or expand and rupture due to the impact of blood flow in the future. The suture should not be too thick. The suture must pass through the aortic valve ring below the internal orifice of the aneurysm and the normal aortic wall above it. The patients with small and asymptomatic recurrent fistula can be followed up; If the shunt is large and there are clinical symptoms, it should be repaired again.