Kehara Hiromu, Takano Tamaki, Komatsu Kazunori, Terasaki Takamitsu, Okada Kenji
Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan.
Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumto, Japan.
Heart Surg Forum. 2015 Aug 30;18(4):E143-5. doi: 10.1532/hsf.1371.
We discuss a rare case of an ascending aorta pseudoaneurysm fistulating into the right atrium following prior aortic and mitral valve replacement. Transthoracic echocardiography and computed tomography revealed a pseudoaneurysm of the ascending aorta attached to the right atrium with fistulous communication. The pseudoaneurysm arose from the center of the former aortotomy. Emergency remedian sternotomy was performed without aneurysmal injury and with exposure of the left femoral artery and femoral vein. Aneurysmal resection and ascending aorta repair were performed without complication. Exposing peripheral vessels, and initiating cardiopulmonary bypass only after reentry, might be effective in resternotomy to approach ascending aorta pseudoaneurysms.
我们讨论了一例罕见病例，患者在先前进行主动脉和二尖瓣置换术后，升主动脉假性动脉瘤破入右心房。经胸超声心动图和计算机断层扫描显示，升主动脉假性动脉瘤与右心房相连并有瘘管相通。假性动脉瘤起源于先前主动脉切开处的中心。急诊再次正中开胸手术顺利进行，未损伤动脉瘤，并暴露了左股动脉和股静脉。进行了动脉瘤切除和升主动脉修复，未出现并发症。暴露外周血管，并仅在再次开胸后启动体外循环，可能对再次开胸处理升主动脉假性动脉瘤有效。
