Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan,
Surg Today. 2014 Jan;44(1):94-9. doi: 10.1007/s00595-013-0510-z. Epub 2013 Feb 11.
Pseudoaneurysms of the thoracic aorta after cardiovascular surgery are rare, but life-threatening complications. We herein describe the clinical outcomes of pseudoaneurysms of the thoracic aorta arising after cardiovascular surgery.
We retrospectively reviewed 14 patients (mean age 64 years) who underwent reoperation for a pseudoaneurysm of the thoracic aorta between January 1997 and December 2010.
Pseudoaneurysms of the thoracic aorta were detected incidentally during routine follow-up in 11 asymptomatic patients, whereas symptoms or signs indicating an aortic pseudoaneurysm were present in three patients. The mean intervals between repeat and previous cardiovascular surgeries and the follow-up were 167 and 62 months, respectively. The aortic pseudoaneurysms were located in the proximal and distal suture lines in six patients, and at aortotomy sites in four. These locations accounted for about 70 % of all aortic pseudoaneurysms. None of the patients died in the hospital. Postoperative complications, such as a need for permanent pacemaker implantation or groin-related issues, occurred in five patients. However, no major postoperative complications, aorta-related events or a need for reoperation developed during the follow-up period.
Regular follow-up, including imaging modalities and physical examinations, is mandatory to detect aortic pseudoaneurysms after cardiovascular surgery.
心血管手术后发生的胸主动脉假性动脉瘤是罕见但危及生命的并发症。本文描述了心血管手术后发生的胸主动脉假性动脉瘤的临床结果。
我们回顾性分析了 1997 年 1 月至 2010 年 12 月期间因胸主动脉假性动脉瘤而行再次手术的 14 例患者(平均年龄 64 岁)。
11 例无症状患者在常规随访中偶然发现胸主动脉假性动脉瘤,而 3 例患者有提示主动脉假性动脉瘤的症状或体征。重复和上次心血管手术之间以及随访的平均间隔时间分别为 167 个月和 62 个月。主动脉假性动脉瘤位于 6 例患者的近端和远端缝线处,4 例位于主动脉切开部位。这些部位占所有主动脉假性动脉瘤的约 70%。无患者在院内死亡。5 例患者发生术后并发症,如需要植入永久性起搏器或腹股沟相关问题。然而,在随访期间,没有发生重大术后并发症、主动脉相关事件或需要再次手术。
心血管手术后,必须定期进行随访,包括影像学检查和体格检查,以发现主动脉假性动脉瘤。