Barbie R M, Girardet R E, Lansing A M, Norman J C
Section of Cardiovascular Surgery, Humana Heart Institute International, Humana Hospital-Audubon, Louisville, KY 40217.
J Ky Med Assoc. 1991 May;89(5):213-7.
Acute mycotic aneurysms of the ascending aorta following aortocoronary bypass are exceedingly rare. To our knowledge, there have been few reports of successful management. The central location of this lesion places it apart from acute or chronic mycotic aneurysms in general and enhances its lethality. The availability of ascending and arch aortography, computerized chest tomography and the techniques of peripheral cardiopulmonary bypass, deep hypothermia and reversible circulatory arrest for prolonged periods of time permit successful management. The purpose of this report is to (1) illustrate such a problem; (2) describe its successful management; (3) review the etiology of mycotic aneurysms, historically and contemporarily; and (4) to differentiate early, acute mycotic aneurysms of the ascending aorta following aortocoronary bypass (usually lethal) from similar late chronic processes (readily reparable).
主动脉冠状动脉旁路移植术后升主动脉急性霉菌性动脉瘤极为罕见。据我们所知，成功治疗的报道很少。该病变的中心位置使其有别于一般的急性或慢性霉菌性动脉瘤，并增加了其致死率。升主动脉和主动脉弓造影、计算机胸部断层扫描以及外周体外循环、深度低温和长时间可逆性循环停止技术的应用使得成功治疗成为可能。本报告的目的是：（1）阐述这样一个问题；（2）描述其成功治疗方法；（3）回顾霉菌性动脉瘤的病因，包括历史和当代的；（4）区分主动脉冠状动脉旁路移植术后升主动脉早期急性霉菌性动脉瘤（通常致命）与类似的晚期慢性病变（易于修复）。
