Matos Jesus M, de la Cruz Kim I, Ouzounian Maral, Preventza Ourania, LeMaire Scott A, Coselli Joseph S
Divisions of Vascular Surgery (Dr. Matos) and Cardiothoracic Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery (Drs. Coselli, de la Cruz, LeMaire, Ouzounian, and Preventza), Texas Heart Institute; Houston, Texas 77030.
Tex Heart Inst J. 2014 Apr 1;41(2):198-202. doi: 10.14503/THIJ-12-2901. eCollection 2014 Apr.
Endovascular and open surgical repair have been used in patients with descending thoracic aortic dissection; however, the appropriate treatment is debated. We describe the case of a 60-year-old woman who had a symptomatic, chronic, residual, descending thoracic aortic dissection that was complicated by an aortobronchial fistula. She underwent emergent thoracic endovascular stent-grafting but remained symptomatic. Computed tomographic angiograms showed a contained rupture into the lower lobe of the left lung. The patient underwent definitive surgery to remove the stents, reconstruct the aorta, and resect the nonviable lung tissue. The remainder of her postoperative course was uneventful, and she was discharged from the hospital 13 days after the 2nd operation. Results of genetic testing confirmed an earlier presumptive diagnosis of Marfan syndrome. In an emergency, the best initial option for patients with a complicated descending thoracic aortic dissection might be thoracic endovascular aortic repair, which could serve as a bridge to definitive open repair.
血管内修复术和开放手术修复术已应用于降主动脉夹层患者；然而，合适的治疗方法仍存在争议。我们描述了一名60岁女性患者的病例，该患者患有有症状的慢性残留降主动脉夹层，并伴有主动脉支气管瘘。她接受了急诊胸主动脉血管内支架植入术，但仍有症状。计算机断层血管造影显示左肺下叶有局限性破裂。患者接受了确定性手术，取出支架，重建主动脉，并切除无活力的肺组织。她术后的其余过程平稳，在第二次手术后13天出院。基因检测结果证实了先前对马凡综合征的初步诊断。在紧急情况下，对于合并降主动脉夹层的患者，最佳的初始选择可能是胸主动脉血管内修复术，它可以作为确定性开放修复术的桥梁。
