Miyatake T, Matsui Y, Suto Y, Imamura M, Shiiya N, Murashita T, Yasuda K
Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
J Cardiovasc Surg (Torino). 2001 Dec;42(6):809-11.
Severe atherosclerotic disease of the ascending aorta is one of the risk factors of dissection of the ascending aorta and cerebral embolism during cardiac operations with cardiopulmonary bypass. Aortic dissection is rare, but once it happens, the mortality rate is high. For the patient with severely atherosclerotic or strongly calcified aorta, we should avoid cannulation into the aorta or clamping of it. In this case, we experienced aortic dissection although we chose the arterial cannulations into the axillary arteries because of the strong calcification of the ascending aorta and the abdominal aorta. The dissection was caused by the cannulation into the axillary artery. Transesophageal echocardiography (TEE) showed the dissection during the operation and the ascending aorta was replaced soon. Early diagnosis and treatment saved the patient. This case showed the following points: 1) cannulation into an axillary artery is not always safe; 2) TEE is very useful to detect the complicated dissection during operation; 3) replacement of the ascending aorta alone can be one of the choices for the treatment of aortic dissection caused by cannulation into an axillary artery.
升主动脉严重动脉粥样硬化疾病是体外循环心脏手术期间升主动脉夹层和脑栓塞的危险因素之一。主动脉夹层很少见，但一旦发生，死亡率很高。对于主动脉严重动脉粥样硬化或钙化严重的患者，应避免在主动脉插管或夹闭。在这种情况下，尽管由于升主动脉和腹主动脉钙化严重我们选择了经腋动脉进行动脉插管，但仍发生了主动脉夹层。夹层是由腋动脉插管引起的。术中经食管超声心动图（TEE）显示了夹层情况，随后很快对升主动脉进行了置换。早期诊断和治疗挽救了患者。该病例表明了以下几点：1）经腋动脉插管并不总是安全的；2）TEE对于术中检测复杂夹层非常有用；3）单纯升主动脉置换可以是治疗经腋动脉插管引起的主动脉夹层的选择之一。
