Morisaki Akimasa, Kato Yasuyuki, Motoki Manabu, Takahashi Yosuke, Nishimura Shinsuke, Shibata Toshihiko
Department of Cardiovascular Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
J Cardiothorac Surg. 2014 Jun 19;9:109. doi: 10.1186/1749-8090-9-109.
There are no previous reports of rupture of a heterologous pericardial patch after aortic annulus enlargement. Our patient, a 72-year-old Japanese female, presented with congestive heart failure resulting from heart compression from pseudoaneurysm formation in the aortic root. At 57 years of age the patient had undergone replacement of the ascending aorta for Stanford type A acute aortic dissection. At 66 years of age she had undergone aortic valve replacement with a mechanical valve, accompanied by enlargement of the aortic annulus using an equine pericardial patch, for severe aortic valve stenosis with a narrow aortic annulus. Equine pericardial patch was used in the aortic annulus enlargement to form the aortic root from the ascending aortic vascular prosthesis to the non-coronary cusp of the aortic valve. We performed repeat median sternotomy under cardiopulmonary bypass with moderate hypothermia. The ascending aorta was balloon-occluded because of dense adhesions around the superior vena cava and ascending aorta due to the pseudoaneurysm. A tear in the equine pericardial patch was noted at the aortic root. The patient underwent pseudoaneurysm excision and repair of the aortic root using a double-layered, Hemashield-reinforced bovine pericardial patch. Routine follow-up with computed tomography should be performed for early detection of complications from a heterologous pericardial patch.
此前尚无主动脉瓣环扩大术后异种心包补片破裂的报道。我们的患者是一名72岁的日本女性，因主动脉根部假性动脉瘤形成导致心脏受压而出现充血性心力衰竭。患者57岁时因斯坦福A型急性主动脉夹层接受了升主动脉置换术。66岁时，她因严重主动脉瓣狭窄且主动脉瓣环狭窄，接受了机械瓣膜主动脉瓣置换术，并使用马心包补片扩大主动脉瓣环。在主动脉瓣环扩大术中使用马心包补片，以从升主动脉血管假体到主动脉瓣无冠瓣构建主动脉根部。我们在中度低温体外循环下再次进行正中胸骨切开术。由于假性动脉瘤导致上腔静脉和升主动脉周围粘连紧密，对升主动脉进行了球囊阻断。在主动脉根部发现马心包补片有一处撕裂。患者接受了假性动脉瘤切除，并使用双层Hemashield加固牛心包补片修复主动脉根部。应进行计算机断层扫描常规随访，以便早期发现异种心包补片的并发症。
