Aoyagi S, Fukunaga S, Hayashida N, Maruyama H, Akashi H, Kawara T
Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Ann Thorac Cardiovasc Surg. 1999 Aug;5(4):269-72.
A 79-year-old woman, who had had no history of trauma, tuberculosis, or collagen diseases, was referred for examination of general fatigue and shortness of breath on exertion. Physical examination revealed engorged neck veins, hepatomegaly, and ascites with abdominal distention. On chest x-ray the cardiac shadow was slightly enlarged and bilateral pleural effusion was present. An electrocardiogram showed low voltage of the QRS complex. Computed tomographic scans revealed two lumens in the remarkably dilated ascending aorta and the severely thickened pericardium. Cardiac catheterization showed elevated right atrial pressure and elevated right and left ventricular end-diastolic pressures, in addition to a pressure record of early diastolic dip and end-systolic plateau in the right ventricle. Aortography demonstrated aortic dissection localized to the ascending aorta. On the basis of these findings, the diagnosis of chronic ascending aortic dissection complicated with constrictive pericarditis was made. After subtotal pericardiectomy, graft replacement of the ascending aorta and proximal aortic arch was performed with successful results. Her postoperative recovery was uneventful. Histological studies of the pericardium showed fibrosis and marked infiltration of the inflammatory cells. No findings of specific pericarditis such as tuberculosis or collagen diseases were detected.
一位79岁女性，既往无外伤、结核或胶原病病史，因全身乏力和劳力性气短前来就诊。体格检查发现颈静脉怒张、肝肿大及腹胀伴腹水。胸部X线检查显示心脏阴影轻度增大，双侧胸腔积液。心电图显示QRS波群低电压。计算机断层扫描显示升主动脉显著扩张且有两个管腔，心包严重增厚。心导管检查显示右心房压力升高，右心室和左心室舒张末期压力升高，此外右心室还有舒张早期下倾和收缩末期高原样压力记录。主动脉造影显示主动脉夹层局限于升主动脉。基于这些发现，诊断为慢性升主动脉夹层并发缩窄性心包炎。在进行次全心包切除术后，对升主动脉和主动脉弓近端进行了人工血管置换，结果成功。她术后恢复顺利。心包组织学研究显示纤维化及炎性细胞明显浸润。未发现结核或胶原病等特异性心包炎的表现。
