Giommi L, Cavallini C, Franceschini E, Marton F, Risica G, Olivari Z, Cuzzato V
Divisione Cardiologica, Ospedale Regionale, Treviso.
G Ital Cardiol. 1991 Jan;21(1):41-8.
To evaluate the reliability of cineangiography in identifying some morphologic characteristics of type A aortic dissection, the angiograms of 36 consecutive patients were retrospectively revised and compared with the surgical of necropsy findings. The following features were examined: site and extension of intimal tear (s); extension of the wall dissection; coronary and brachiocephalic arteries involvement; coexisting anuloaortic ectasia; aortic valve state. The angiographic diagnosis of site and extension of the intimal tear was correct in 97 (35/36) and 100% of cases respectively. In one case the presence of an intimal tear at the level of the aortic arch was missed because of the superimposition of the innominate artery. The extension of the wall dissection was correctly identified in 24 out of 25 patients. In one case the presence of distal false lumen thrombosis made the correct diagnosis impossible. The brachiocephalic arteries involvement was always correctly stated while the coronary involvement was suspected in 6 and confirmed in 5 (1 false positive). Anuloectasia was suspected in 12 and confirmed in 10 (2 false positives). In our experience the most challenging diagnosed were the presence of aortic arch tears and the aortic arch and coronary arteries involvement in the dissection. This study confirms that many morphologic features of type A aortic dissection can be adequately assessed by cineangiography.
为评估电影血管造影术在识别A型主动脉夹层某些形态学特征方面的可靠性，我们回顾性分析了36例连续患者的血管造影片，并与手术或尸检结果进行比较。检查了以下特征：内膜撕裂的部位和范围；壁内夹层的范围；冠状动脉和头臂动脉受累情况；是否并存主动脉环扩张；主动脉瓣状态。内膜撕裂部位和范围的血管造影诊断分别在97%（35/36）和100%的病例中正确。有1例因无名动脉重叠而漏诊主动脉弓水平的内膜撕裂。25例患者中有24例壁内夹层范围被正确识别。有1例因远端假腔血栓形成而无法做出正确诊断。头臂动脉受累情况总是能正确判断，而冠状动脉受累在6例中被怀疑，5例得到证实（1例假阳性）。12例怀疑有主动脉环扩张，10例得到证实（2例假阳性）。根据我们的经验，最具挑战性的诊断是主动脉弓撕裂以及夹层累及主动脉弓和冠状动脉。本研究证实，电影血管造影术可充分评估A型主动脉夹层的许多形态学特征。
