Bentall手术后晚期因巨大假性动脉瘤压迫导致左前降支动脉血栓形成。
Thrombosis of the left anterior descending artery due to compression from giant pseudoaneurysm late after a bentall operation.
作者信息
Zeitani Jacob, Scafuri Antonio, de Peppo Alfonso Penta, Gaspardone Achille, Polisca Patrizio, Di Marzio Emanuele, Sgrò Stefania, De Vico Pasquale, Chiariello Luigi
机构信息
Division of Cardiac Surgery, Tor Vergata University of Rome, Rome, Italy.
出版信息
J Card Surg. 2006 Mar-Apr;21(2):195-7. doi: 10.1111/j.1540-8191.2006.00206.x.
BACKGROUND
A postoperative pseudoaneurysm may develop and gradually expand in the mediastinal space even late following Bentall operation for aortic root replacement, particularly in patients with dissection of the aorta.
METHODS
A very large (148 mm) pseudoaneurysm originating of the right coronary ostium suture line was observed in a patient admitted with unstable angina 6 years after Bentall procedure for type A aortic dissection. Angiograms showed reduced flow in the right coronary and thrombotic subocclusion of the left anterior descending (LAD) coronary artery due to extrinsic compression from the expanding mediastinal mass.
RESULTS
Reoperation was performed during femoro-femoral cardiopulmonary bypass and brief period of circulatory arrest to clamp the tubular graft. After closure of the detected right coronary ostium in the tubular graft double bypass, grafting to the right coronary and LAD arteries was required. Postoperative course was uneventful.
CONCLUSIONS
Close long-term follow-up after a Bentall procedure is required to minimize the risk of developing a large pseudoaneurysmal mass, in particular, after dissection of the aorta.
背景
在主动脉根部置换的Bentall手术后，纵隔内可能会出现术后假性动脉瘤，并逐渐扩大，甚至在术后较晚时间出现，尤其是在主动脉夹层患者中。
方法
一名因A型主动脉夹层接受Bentall手术6年后因不稳定型心绞痛入院的患者，发现一个起源于右冠状动脉开口缝线处的非常大（148毫米）的假性动脉瘤。血管造影显示，由于纵隔肿块扩大导致的外部压迫，右冠状动脉血流减少，左前降支（LAD）冠状动脉出现血栓形成性次全闭塞。
结果
在股-股体外循环和短暂循环停搏期间进行再次手术，以夹住管状移植物。在管状移植物双旁路中封闭检测到的右冠状动脉开口后，需要将移植物移植到右冠状动脉和LAD动脉。术后病程顺利。
结论
Bentall手术后需要进行密切的长期随访，以将形成大型假性动脉瘤肿块的风险降至最低，尤其是在主动脉夹层后。
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