Hachimaru Tsuyoshi, Kawaguchi S, Watanabe M, Nakahara H
Department of Cardiovascular Surgery, Hiroo Hospital, Tokyo, Japan.
Kyobu Geka. 2008 Mar;61(3):242-5.
A 78-year-old man had previously undergone replacement of ascending aorta using gelatin-resorcin-formalin (GRF) glue for acute aortic dissection. Five years later, a follow-up computed tomography (CT) showed an aortic root pseudoaneurysm. Ultrasound cardiography revealed moderate aortic regurgitation and pseudoaneurysm of aortic root. Aortic root replacement was planned based on a clinical diagnosis of an anastomotic pseudoaneurysm of the aortic root. The patient was discharged without complication 26 days after surgery. In the histopathological examination, the necrotic change of smooth muscle cells in the aortic media was revealed. Previous reports suggests that the use of GRF glue for reconstructing the dissected aorta results in higher rates of postoperative redissection or pseudoaneurysm. Therefore, careful postoperative follow-up is necessary in such cases and further improvements in the quality of glue or alternative methods will be necessary to prevent problems in the first place.
一名78岁男性曾因急性主动脉夹层使用明胶-间苯二酚-甲醛(GRF)胶水进行升主动脉置换术。五年后,随访计算机断层扫描(CT)显示主动脉根部假性动脉瘤。超声心动图显示中度主动脉瓣反流和主动脉根部假性动脉瘤。基于主动脉根部吻合口假性动脉瘤的临床诊断,计划进行主动脉根部置换术。患者术后26天无并发症出院。组织病理学检查显示主动脉中膜平滑肌细胞坏死改变。既往报道提示,使用GRF胶水重建夹层主动脉会导致术后再夹层或假性动脉瘤发生率更高。因此,此类病例术后需仔细随访,并且有必要进一步提高胶水质量或采用替代方法以从根本上预防问题。