【摘要】 目的　探讨主动脉窦瘤破裂的临床特点、诊断、治疗和预后。方法　回顾性分析我院1986～ 1998年收治的 6 8例主动脉窦瘤破裂患者的临床资料。结果　男 44例 ,女 2 4例 ,平均年龄(2 9 5± 10 7)岁。主动脉右窦瘤和无窦瘤破裂分别占 79 4%、2 0 6 %。破入右室占 6 7 6 % ,破入右房占 32 3%。室间隔缺损和主动脉瓣关闭不全的发生率分别为 48 5 %、2 0 6 % ,且前者仅见于右窦瘤破入右室的患者。临床突发症状与主动脉窦瘤破入右房明显相关 ,与破入右室相比差异有显著性 (P <0 0 0 1)。心脏超声诊断主动脉窦瘤破裂的敏感性为 97 1% ,特异性 10 0 % ,但高位室间隔缺损的漏诊率达 2 4 2 %。 6 7例手术 ,术后 6周因肺梗塞死亡 1例。随访 36例 ,平均随访时间 6 5年。心功能Ⅰ级 16例 ,Ⅱ级 17例 ,Ⅲ级 3例。再手术 2例。结论　超声心动图联合主动脉造影是主动脉窦瘤破裂的确诊手段 ,及时手术后绝大多数患者预后良好更多还原

【Abstract】 Objective To evaluate the clinical characteristics, diagnosis, treatment and prognosis of ruptured aneurysm of the sinus of Valsalva (ASV). Methods Sixty eight cases of ruptured ASVtreated in our hospital from 1986 to 1998 were retrospectively analyzed. Results The ratio of male to female was 1.8:1 in 68 patients (44 males, 24 females). The mean age was (29.5±10.7) years (8～60 years). The proportion of ruptured aneurysms originating from the right coronary and noncoronary sinus was 79. 4% and 20. 6% respectively. Sixty seven point six percent of ASV ruptured into right ventricle and 32. 3% into right atrium. The incidence of ventricular septal defect and aortic valve insufficiency was 48. 5% and 20. 6% respectively. The former only existed in those patients whose ASV originating from the right coronary sinus and rupturing into right ventricles. There was a significant correlation between sudden onset of symptoms and fistulating of ASV into right atrium and a significant difference as compared with those fistulating into right ventricle ( P <0. 001 ). Diagnostic sensitivity and specificity of echocardiography in ruptured ASV was 97. 1% and 100% respectively, but the rate of missing subarterial ventricular septal defect was 24. 2%. Sixty seven patients received operation, one died of pulmonary embolism six weeks after operation. Thirty six patients were followed up, the mean follow up period was 6.5 years (range 1 to16 years). Two patients were reoperated for leak of ventricular septal defect and aortic regurgitation. The cardiac function of sixteen patients were found to be of NYHA classⅠ, seventeen of classⅡ and three of class Ⅲ. Conclusion Echocardiography in combination with aortography is an accurate diagnostic method for ruptured ASV and the prognosis in majority of the patients operated in time is good.更多还原