Kawahara Yu, Inage Yuichi, Masaki Naoki, Toyama Shuji, Fukasawa Manabu
Department of Cardiovascular Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
Kyobu Geka. 2013 Aug;66(9):849-51.
56-year-old male, who had undergone re-aortic valve replacement (AVR) 33 years ago, received preoperative study for pancreatic surgery. Computed tomography (CT) revealed a giant pseudoaneurysm (7 cm diameter) of the ascending aorta. The ascending aorta was not dilated. A midline skin incision was performed, followed by full sternotomy. A tight pericardial adhesion was carefully dissected. Cardiopulmonary bypass was established by femoral arterial and bicaval venous cannulation. The pseudoaneurysm was incised under the retrograde cardioplegic protection. A communication between ascending aorta and aneurysm was found 1 cm distal to the previous aortic suture line. This communication coincided with the cardioplegic root cannulation site. The aortic prosthetic valve was intact. The ascending aorta was replaced with 26 mm prosthetic graft. Postoperative course was uneventful. In this case, CT was useful to select the approach to the complicated postoperative surgical site.
一名56岁男性，33年前接受了再次主动脉瓣置换术（AVR），现因胰腺手术接受术前检查。计算机断层扫描（CT）显示升主动脉有一个巨大假性动脉瘤（直径7厘米）。升主动脉未扩张。行中线皮肤切口，随后进行全胸骨切开术。仔细分离紧密的心包粘连。通过股动脉和双腔静脉插管建立体外循环。在逆行心脏停搏保护下切开假性动脉瘤。在先前主动脉缝合线远端1厘米处发现升主动脉与动脉瘤之间存在交通。此交通与心脏停搏根部插管部位一致。主动脉人工瓣膜完好无损。用26毫米人工血管替换升主动脉。术后过程顺利。在这种情况下，CT有助于选择处理复杂术后手术部位的方法。
