Maruyama Y, Oguma F, Kosuge T, Yokosawa T, Eguchi S
Second Department of Surgery, Niigata University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Nov;38(11):2296-9.
We report a successful repair of an acute type-A aortic dissection during pregnancy. A 29-year-old pregnant woman in the 32 weeks of gestation with Marfan Syndrome was admitted to our hospital for the treatment of anterior chest and back pains. An urgent aortogram through pulmonary artery revealed an aortic dissection beginning from the ascending aorta to the aortic bifurcation. On the following day, an emergent Cesarean section was performed and a baby weighing 1944 g was delivered. Thereafter, cardiopulmonary bypass was instituted and the ascending aorta was opened. An intimal tear was found 2 cm above the aortic valve. The dissected space was closed with reinforcement of Teflon felt strip. A Dacron gusset was sutured to restore aortic continuity. During the weaning from the CPB, a retrograde aortic dissection developed and the heart became arrested. Therefore we immediately converted the aortic perfusion cannula from the right external iliac artery to graft of the ascending aorta, and the operation was completed successfully with a good recovery of the heart. The mother and her child have been alive and well for 3 years and 5 months after the operation.
我们报告了一例妊娠期急性A型主动脉夹层成功修复的病例。一名29岁、孕32周、患有马凡综合征的孕妇因前胸和背部疼痛入院治疗。经肺动脉进行的紧急主动脉造影显示主动脉夹层从升主动脉起始直至主动脉分叉处。次日，进行了急诊剖宫产，娩出一名体重1944克的婴儿。此后，建立体外循环并打开升主动脉。在主动脉瓣上方2厘米处发现内膜撕裂。用特氟龙毡条加强封闭剥离腔隙。缝合涤纶补片以恢复主动脉连续性。在脱离体外循环过程中，发生逆行性主动脉夹层，心脏停搏。因此，我们立即将主动脉灌注插管从右髂外动脉转换至升主动脉移植物，手术成功完成，心脏恢复良好。术后3年5个月，母亲和孩子均存活且状况良好。
