Fukumura Yoshiaki, Osumi Masahiro, Matsueda Takashi, Kurushima Atsushi, Otani Takashi
Department of Cardiovascular Surgery, Tokushima Red Cross Hospital, Komatsushima, Japan.
Kyobu Geka. 2010 Jun;63(6):449-52.
We described a rare complication that occurred during the 2nd stage of a total aortic replacement. The patient was a 72-year-old male who presented with type B acute aortic dissection complicated by distal arch aneurysm. Following the replacement of the total arch aorta with an elephant trunk graft (22 mm Gelweave graft), the descending and abdominal aorta enlarged rapidly. After about 3 months, he was scheduled for the 2nd operation. Through the 8th intercostal space and under partial cardiopulmonary bypass, the descending and the abdominal aorta was replaced with a 20 mm Gelweave-Coselli graft. The 12th intercostal artery, celiac trunk, superior mesenteric artery (SMA), and bilateral renal arteries were reconstructed. During the operation, severe bleeding began from the entire elephant trunk graft. After heparin neutralization and a massive transfusion of blood, fresh frozen plasma, and platelet-rich plasma, the bleeding was controlled. However, paraplegia occurred probably because of severe intraoperative hypotension. Careful attention should be paid during the 2nd stage of an elephant trunk operation.
我们描述了一例在全主动脉置换术第二阶段发生的罕见并发症。患者为一名72岁男性，患有B型急性主动脉夹层并伴有远端主动脉弓动脉瘤。在用象鼻移植物（22毫米Gelweave移植物）置换整个主动脉弓后，降主动脉和腹主动脉迅速扩张。大约3个月后，他被安排进行第二次手术。通过第八肋间间隙并在部分体外循环下，用20毫米Gelweave - Coselli移植物置换降主动脉和腹主动脉。重建了第十二肋间动脉、腹腔干、肠系膜上动脉（SMA）和双侧肾动脉。手术过程中，整个象鼻移植物开始严重出血。在肝素中和并大量输注血液、新鲜冰冻血浆和富含血小板血浆后，出血得到控制。然而，可能由于术中严重低血压导致了截瘫。在象鼻手术的第二阶段应予以密切关注。
