Yamada T, Suzuki M, Tsujita M, Watanabe Y, Takeda J
Department of Anesthesiology, School of Medicine, Keio University, Tokyo 160-8582.
Masui. 2000 Nov;49(11):1254-6.
A 76-year-old woman with thoracic aortic aneurysm involving distal aortic arch was scheduled for graft replacement from ascending to proximal aortic arch with endovascular stent graft to descending aorta. Surgical procedures were performed under median sternotomy with hypothermic systemic circulation arrest and selective cerebral perfusion. The stent graft composed of 30 mm Gianturco Z stent and 27.5 mm woven Dacron graft was introduced into the descending aorta under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. Ascending and proximal aortic arch replacement was then performed with four branched woven Dacron graft. The aortic pathology was confirmed by TEE and the extent of the aneurysmal lesion was defined. TEE was also useful to find the dislodgement of the stent graft after deployment. This surgical technique, being less invasive than conventional thoracotomy, would be indicated for elderly patients with distal aortic arch aneurysm. TEE is the vital imaging technique for placement of the stent graft, as well as for intraoperative cardiac monitoring.
一名76岁女性，患有累及主动脉弓远端的胸主动脉瘤，计划采用血管内支架移植物从升主动脉至主动脉弓近端进行移植置换，并延伸至降主动脉。手术在正中胸骨切开、低温全身循环停止及选择性脑灌注下进行。由30mm的Gianturco Z支架和27.5mm的编织涤纶移植物组成的支架移植物，在经食管超声心动图（TEE）和荧光透视引导下被置入降主动脉。然后用四分支编织涤纶移植物进行升主动脉和主动脉弓近端置换。通过TEE确认主动脉病变，并明确动脉瘤病变范围。TEE对于发现支架移植物释放后是否移位也很有用。这种手术技术比传统开胸手术侵入性小，适用于患有主动脉弓远端动脉瘤的老年患者。TEE是放置支架移植物以及术中心脏监测的重要成像技术。
