Ay Yasin, Ay Nuray Kahraman, Aydin Cemalettin, Kara Ibrahim, Zeybek Rahmi
Department of Cardiovascular Surgery, Bezmialem Vakif University, 34093 Fatih, Istanbul, Turkey.
Int J Surg Case Rep. 2013;4(5):483-5. doi: 10.1016/j.ijscr.2013.02.011. Epub 2013 Feb 26.
Pulmonary artery dissection associated with patent ductus arteriosus is usually seen in patients with pulmonary hypertension and Eisenmenger's syndrome. This paper presents a case with pre-Eisenmenger patent ductus arteriosus complicated by pulmonary artery dissection, and explains how she was surgically treated.
The transthoracic echocardiography of a 21-year-old woman complaining of effort dyspnea revealed patent ductus arteriosus. Contrast-enhanced thoracic computed tomography scan showed patent ductus arteriosus and dissection in the main pulmonary artery extending from the edge of the patent ductus arteriosus orifice to the pulmonary valve. The patent ductus arteriosus was divided with pledgeted prolene suture and the dissected aneurysmal portion of the pulmonary artery was resected by surgery. Dacron graft interposition was applied to the main pulmonary artery.
Because rupture causes cardiogenic shock and sudden death, diagnosis is rare in the living subject and pulmonary artery dissection is frequently detected in autopsy. A case with pulmonary artery dissection as a result of patent ductus arteriosus has been reported in the literature, but the patient died in the preoperative period. In our study, the patient was not diagnosed to have Eisenmenger's syndrome, but had pulmonary artery dissection, a complication arising from patent ductus arteriosus. The patient underwent curative surgery that included pulmonary artery dissection repair and closure of the patent ductus arteriosus.
In addition to pulmonary artery aneurysm, pulmonary artery dissection must also be considered as a complication in cases of patent ductus arteriosus with high pulmonary artery pressure diagnosed in adulthood.
与动脉导管未闭相关的肺动脉夹层通常见于患有肺动脉高压和艾森曼格综合征的患者。本文介绍了一例动脉导管未闭合并肺动脉夹层的艾森曼格综合征前期病例，并阐述了其手术治疗过程。
一名21岁主诉劳力性呼吸困难的女性经胸超声心动图检查显示动脉导管未闭。对比增强胸部计算机断层扫描显示动脉导管未闭以及从动脉导管未闭开口边缘延伸至肺动脉瓣的主肺动脉夹层。通过带垫片的普理灵缝线结扎动脉导管未闭，并手术切除肺动脉夹层动脉瘤部分。用涤纶补片置换主肺动脉。
由于破裂会导致心源性休克和猝死，活体诊断罕见，肺动脉夹层常于尸检时发现。文献报道过动脉导管未闭导致肺动脉夹层的病例，但患者在术前死亡。在我们的研究中，患者未被诊断为艾森曼格综合征，但发生了动脉导管未闭引起的并发症肺动脉夹层。患者接受了包括肺动脉夹层修复和动脉导管未闭闭合在内的根治性手术。
除肺动脉瘤外，对于成年期诊断为肺动脉高压的动脉导管未闭病例，还必须将肺动脉夹层视为一种并发症。
