Ohuchi H, Kyo S, Matsumura M, Tanabe H, Asano H, Imanaka K, Ishikawa M, Muramatsu T, Yokote Y, Omoto R
Department of Surgery, Saitama Medical School, Moroyama, Japan.
Jpn Circ J. 2000 Jul;64(7):533-6. doi: 10.1253/jcj.64.533.
A 36-year-old female was admitted for severe chest pain followed by profound shock. Electrocardiography showed severe ST segment depression (0.5-0.7 mV) in all leads except aVR and aVL. Echocardiography revealed an intimal flap in the ascending aorta and coexisting grade 3 aortic regurgitation. She was immediately intubated and transferred to the intensive care unit. Transesophageal echocardiography (TEE) demonstrated an intimal tear at 2 cm above the sinotubular junction, and the ostium of the left main trunk was oppressed by the intimal flap during diastole. Emergency graft replacement of the ascending aorta and aortic hemiarch concomitant with aortic valve resuspension was performed successfully. The ECG changes reversed to normal immediately after the operation. The patient was extubated 2 days postoperatively and discharged from the hospital 14 days postoperatively. TEE is useful for the rapid evaluation of coronary malperfusion as a complication of acute aortic dissection, especially in patients with hemodynamic instability.
一名36岁女性因严重胸痛继而出现深度休克入院。心电图显示除aVR和aVL导联外，所有导联均有严重的ST段压低（0.5 - 0.7 mV）。超声心动图显示升主动脉有内膜瓣，并存3级主动脉瓣反流。她立即被插管并转入重症监护病房。经食管超声心动图（TEE）显示在窦管交界处上方2 cm处有内膜撕裂，舒张期左主干开口被内膜瓣压迫。成功进行了升主动脉和主动脉半弓的紧急移植置换术并同时进行了主动脉瓣悬吊术。术后心电图变化立即恢复正常。患者术后2天拔管，术后14天出院。TEE对于快速评估作为急性主动脉夹层并发症的冠状动脉灌注不良很有用，尤其是在血流动力学不稳定的患者中。
