Labrousse Louis, Montaudon Michel, Billes Marc-Alain, Deville Claude
Department of Cardio-Vascular Surgery, Bordeaux Heart University Hospital, Avenue de Magellan, F. 33 604 Bordeaux-Pessac, France.
Eur J Cardiothorac Surg. 2008 Mar;33(3):518-20. doi: 10.1016/j.ejcts.2007.12.029.
Heart-transplanted patients have a known higher incidence of aortic aneurysms. However, there is paucity of information regarding thoracic localisation in this clinical setting and of the endovascular option in such patients with chronically high level of immunosuppressive agents. We describe long-term follow-up of a 72-year-old man who developed an aneurysm of the descending part of the thoracic aorta 10 years after an orthotopic cardiac transplantation. Because of comorbid medical conditions, classical open-chest procedure could not be performed. An alternative treatment by endovascular repair was applied successfully and allowed a perfect exclusion of the aneurysm. Chronically high level of immunosuppressive agents seems not to be a contraindication to the endovascular option. Consequently, extended cardiovascular screening of heart-transplanted patients is desirable to facilitate early detection and elective endovascular repair.
心脏移植患者主动脉瘤的发病率较高，这是已知的。然而，关于这种临床情况下胸段定位以及长期使用高剂量免疫抑制剂的此类患者的血管内治疗选择的信息却很少。我们描述了一名72岁男性患者的长期随访情况，该患者在原位心脏移植10年后发生了胸主动脉降部动脉瘤。由于存在合并症，无法进行传统的开胸手术。成功应用了血管内修复的替代治疗方法，实现了对动脉瘤的完美封堵。长期高剂量免疫抑制剂似乎并非血管内治疗选择的禁忌证。因此，对心脏移植患者进行全面的心血管筛查，有助于早期发现并进行选择性血管内修复。
