Hand William R, Ikonomidis John S, Bratton Charles F, Burch Thomas M, McEvoy Matthew D
Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Case Rep Transplant. 2011;2011:263561. doi: 10.1155/2011/263561. Epub 2012 Jan 11.
A 48-year-old patient with hypertensive end-stage renal disease presented for cadaveric renal transplantation. On physical exam, a previously undocumented diastolic murmur was heard loudest at the left lower sternal border. The patient had a history of pericardial effusions and reported "a feeling of chest fullness" when lying flat. As such, a transesophageal echocardiogram (TEE) was performed after induction of anesthesia to evaluate the pericardial space and possibly determine the etiology and severity of the new murmur. The TEE revealed a Stanford Type A aortic dissection. The renal transplant was cancelled (organ reassigned within region), and the patient underwent an urgent ascending and proximal hemiarch aortic replacement. This case demonstrates the importance of a thorough physical exam and highlights the utility of TEE for noncardiac surgical cases.
一名患有高血压终末期肾病的48岁患者前来接受尸体肾移植。体格检查时，在左胸骨下缘听到了一个之前未记录的舒张期杂音，声音最为响亮。该患者有心包积液病史，平躺时自述有“胸部胀满感”。因此，在麻醉诱导后进行了经食管超声心动图（TEE）检查，以评估心包腔情况，并可能确定新出现杂音的病因和严重程度。TEE显示为斯坦福A型主动脉夹层。肾移植手术取消（器官在该区域内重新分配），患者接受了紧急升主动脉和近端半弓主动脉置换术。该病例证明了全面体格检查的重要性，并突出了TEE在非心脏外科手术病例中的实用性。
