Yu Zaiqiang, Ogasawara Takashi, Daitoku Kazuyuki, Fukuda Ikuo
Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
Interact Cardiovasc Thorac Surg. 2011 Oct;13(4):421-3. doi: 10.1510/icvts.2011.273144. Epub 2011 Jul 7.
We report a case of simultaneous repair of an extensive thoracic aortic aneurysm from the aortic root to the distal aortic arch. A 54-year-old male had annuloaortic ectasia and a transverse aortic and distal arch aneurysm. Aneurysms of the descending aorta and the abdominal aorta were also demonstrated. The patient underwent aortic valve-sparing root reconstruction, replacement of the aortic arch and placement of a frozen elephant trunk stent-graft concomitantly through a median sternotomy incision. Because a complicated procedure was necessary, root reconstruction was performed first and coronary perfusion was resumed. This case suggests that the surgical procedure should be determined on the bases of the situation of thoracic aortic aneurysm and the general condition of the patient. Treatment for extensive diseased aorta from the aortic root to the distal aortic arch is a surgical challenge. Although single-stage repair is one of the options for this condition, it is very invasive. Total arch replacement with the frozen elephant trunk technique is efficacious to exclude distal arch aneurysm or descending aortic aneurysm through median sternotomy. An aortic valve-sparing operation was developed to preserve the native aortic valve function in order to improve the patient's quality of life. We herein report a case of concomitant total arch replacement using a frozen elephant trunk and aortic valve-sparing operation for extensive thoracic aortic aneurysm.
我们报告一例从主动脉根部至主动脉弓远端的广泛性胸主动脉瘤同时修复的病例。一名54岁男性患有主动脉瓣环扩张以及横行主动脉和主动脉弓远端动脉瘤。降主动脉和腹主动脉也发现有动脉瘤。该患者接受了保留主动脉瓣的根部重建、主动脉弓置换，并通过正中胸骨切开术切口同时置入了带膜支架象鼻移植物。由于需要进行复杂的手术，首先进行了根部重建并恢复了冠状动脉灌注。该病例表明，手术方式应根据胸主动脉瘤的情况和患者的一般状况来确定。治疗从主动脉根部至主动脉弓远端的广泛性病变主动脉是一项手术挑战。尽管一期修复是这种情况的选择之一，但它具有很高的侵袭性。采用带膜支架象鼻技术进行全弓置换，通过正中胸骨切开术可有效排除主动脉弓远端动脉瘤或降主动脉瘤。为了提高患者的生活质量，人们开发了保留主动脉瓣的手术以保留天然主动脉瓣功能。我们在此报告一例使用带膜支架象鼻技术和保留主动脉瓣手术同时进行全弓置换治疗广泛性胸主动脉瘤的病例。
