Fattori R, Bacchi-Reggiani L, Bertaccini P, Napoli G, Fusco F, Longo M, Pierangeli A, Gavelli G
Institute of Radiology and Cardiac Surgery, University of Bologna, Bologna, Italy.
Am J Cardiol. 2000 Oct 15;86(8):868-72. doi: 10.1016/s0002-9149(00)01108-5.
Patients after aortic dissection repair still have long-term unfavorable prognosis and need careful monitoring. The purpose of this study was to analyze the evolution of aortic dissection after surgical repair in correlation to anatomic changes emerging from systematic magnetic resonance imaging (MRI) follow-up. Between January 1992 and June 1998, 70 patients underwent surgery for type A aortic dissection. Fifty-eight patients were discharged from the hospital (17% operative mortality) and were followed by serial MRI for 12 to 90 months after surgery. In all, 436 postoperative MRI examinations were analyzed. In 13 patients (22.5%) no residual intimal flap was identified, whereas 45 patients (77.5%) presented with distal dissection, with a partial thrombosis of the false lumen in 24. The yearly aortic growth rate was maximum in the descending aortic segment (0.37 +/- 0.43 cm) and was significantly higher in the absence of thrombus in the false lumen (0.56 +/- 0.57 cm) (p <0.05). There were 4 sudden deaths, with documented aortic rupture in 2. Sixteen patients underwent reoperation for expanding aortic diameter. In all but 1 patient, a residual dissection was present (in 13 without any thrombosis of the false lumen). Close MRI follow-up in patients after dissection surgical repair can identify the progression of aortic pathology, providing effective prevention of aortic rupture and timely reoperation. Thrombosis of the false lumen appears to be a protective factor against aortic dilation.
主动脉夹层修复术后的患者仍有长期不良预后，需要密切监测。本研究的目的是分析手术修复后主动脉夹层的演变情况，并与系统磁共振成像（MRI）随访中出现的解剖学变化相关联。1992年1月至1998年6月，70例患者接受了A型主动脉夹层手术。58例患者出院（手术死亡率17%），术后接受了12至90个月的系列MRI随访。总共分析了436次术后MRI检查。13例患者（22.5%）未发现残余内膜瓣，而45例患者（77.5%）出现远端夹层，其中24例假腔部分血栓形成。降主动脉段的年主动脉生长率最高（0.37±0.43 cm），在假腔内无血栓时显著更高（0.56±0.57 cm）（p<0.05）。有4例猝死，其中2例记录为主动脉破裂。16例患者因主动脉直径扩大接受了再次手术。除1例患者外，其余患者均存在残余夹层（13例假腔内无血栓形成）。对夹层手术修复后的患者进行密切的MRI随访可以识别主动脉病变的进展，有效预防主动脉破裂并及时进行再次手术。假腔血栓形成似乎是防止主动脉扩张的保护因素。
