Takahashi Ai, Uchida Tetsuro, Kim Cholsu, Maekawa Yoshiyuki, Miyazaki Ryota, Mizumoto Masahiro, Hirooka Shuto, Yasumoto Takumi, Yoshimura Yoshihiro, Sadahiro Mitsuaki
Second Department of Surgery, Yamagata University, Yamagata, Japan.
Kyobu Geka. 2013 Jul;66(7):532-6.
A 74-year-old female was admitted to our hospital due to hyperkinetic congestive heart failure. Noninvasive positive pressure ventilation, continuous hemodialysis and inotropic support were needed preoperatively. Computed tomography revealed saccular aortic arch aneurysm with aortopulmonary fistula toward the left pulmonary artery. Cardiac catheterization revealed severe left to right shunt with the pulmonary flow/systemic flow (Qp/Qs) ratio of 6.2.Emergency operation was performed under hypothermic circulatory arrest followed by selective cerebral perfusion and lower body perfusion. The aortopulmonary fistula was directly closed, reinforced with the aneurysmal wall, and total arch replacement was performed. Although the patient temporarily recovered by endoscopic suction of the blood from the lungs and continuous hemodialysis filtration, she died because of multiple organ failure due to mesenteric ischemia on postoperative day 34.
一名74岁女性因高动力性充血性心力衰竭入住我院。术前需要无创正压通气、持续血液透析和强心支持。计算机断层扫描显示囊状主动脉弓动脉瘤并伴有向左肺动脉的主肺动脉瘘。心导管检查显示严重的左向右分流，肺血流量/体循环血流量（Qp/Qs）比值为6.2。在低温循环停止、选择性脑灌注和下半身灌注后进行了急诊手术。直接封闭主肺动脉瘘，用动脉瘤壁加固，并进行全弓置换。尽管患者通过内镜抽吸肺内血液和持续血液透析滤过暂时恢复，但术后第34天因肠系膜缺血导致多器官衰竭死亡。
