Eldien Altarabsheh Salah, Deo Salil, Oluseun Ali O, Rihal Charanjit S, Joyce Lyle
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Heart Surg Forum. 2012 Feb;15(1):E34-6. doi: 10.1532/HSF98.20111099.
Aortic pseudoaneurysm is a rare complication after blunt chest trauma or cardiac surgical procedures and can occur at the site of cannulation or root vent insertion on the ascending aorta. These pseudoaneurysms have the potential to expand, erode, and rupture, and detecting this condition before complications occur is the key to successful management. We had replaced the mitral valve with a 31-mm bioprosthesis in an 82-year-old patient and repaired an ascending aorta aneurysm, but a computed tomography scan on postoperative day 18 revealed a pseudoaneurysm at the site of the previous aortic cannulation. Because of the patient's advanced age and multiple comorbidities, we sealed off the neck of the pseudoaneurysm with a 12-mm Amplatzer Vascular Plug in the interventional cardiology suite instead of subjecting her to a surgical repair involving redo sternotomy and a period of circulatory arrest. Deployment of the Amplatzer plug effectively shut off flow into the pseudoaneurysm, and the patient recovered well. Although the optimal management strategy for aortic pseudoaneurysms is a matter of controversy, endovascular interventions may be a safer alternative to surgery for patients with multiple comorbidities.
主动脉假性动脉瘤是钝性胸部创伤或心脏外科手术后的一种罕见并发症，可发生在升主动脉插管部位或根部排气口插入处。这些假性动脉瘤有可能扩大、侵蚀并破裂，在并发症发生前检测到这种情况是成功治疗的关键。我们为一名82岁患者置换了31毫米的生物瓣膜二尖瓣，并修复了升主动脉瘤，但术后第18天的计算机断层扫描显示，先前主动脉插管部位出现了假性动脉瘤。由于患者年事已高且合并多种疾病，我们在介入心脏病学套房中用一个12毫米的Amplatzer血管封堵器封堵了假性动脉瘤的颈部，而不是让她接受涉及再次开胸和一段时间循环停止的手术修复。Amplatzer封堵器的置入有效地阻断了流入假性动脉瘤的血流，患者恢复良好。尽管主动脉假性动脉瘤的最佳治疗策略存在争议，但对于合并多种疾病的患者，血管内介入治疗可能是比手术更安全的选择。
