Kanno M, Ikeda T, Tatebayashi T, Ono M
Division of Cardiovascular Surgery, Southern Tohoku General Hospital, Kooriyama, Japan.
Kyobu Geka. 2000 Jan;53(1):64-7.
A 72-year-old man with a history of hypertension for 20 years was admitted with symptoms of acute aortic dissection. Computed tomography showed a crescentic thickening of the ascending aortic wall, suggesting an intramural hematoma. Sixteen hours after admission, he underwent urgent repair of the ascending aorta because of cardiac tamponade. We inspected the inside of the aorta from the aortic valve to the arch. Subadventitial hematoma due to hemorrhage from the outer media was confirmed. Rupture of the vasa vasorum was thought to be an initiating mechanism. The affected aortic wall was simply resutured and was not replaced with a graft because the intima was intact and the media was not dissected and the aortic wall was considered to be tolerable to normal blood pressure. The patient continues to do well 18 months following operation. An intramural hematoma of the ascending aorta should be regarded as a precursor of imminent rupture or classic dissection.
一名有20年高血压病史的72岁男性因急性主动脉夹层症状入院。计算机断层扫描显示升主动脉壁呈新月形增厚，提示壁内血肿。入院16小时后，因心脏压塞，他接受了升主动脉紧急修复手术。我们检查了从主动脉瓣到主动脉弓的主动脉内部。证实存在因外膜出血导致的外膜下血肿。血管滋养管破裂被认为是起始机制。由于内膜完整、中膜未剥离且主动脉壁被认为能耐受正常血压，因此仅对受影响的主动脉壁进行了简单缝合，未进行人工血管置换。术后18个月，患者情况良好。升主动脉壁内血肿应被视为即将破裂或典型夹层的先兆。
