Yavuz Sadan, Arikan Ali Ahmet, Ozbudak Ersan, İrkil Serhat, Hosten Tulay, Gumustas Sevtap, Berki Kamil Turan
Department of Cardiovascular Surgery, Kocaeli University, Kocaeli.
Department of Anesthesiology, Kocaeli University, Kocaeli.
Heart Surg Forum. 2015 Oct 28;18(5):E188-91. doi: 10.1532/hsf.1265.
Many thoracic aortic aneurysms are discovered incidentally, and most develop without symptoms. Symptoms are usually due to sudden expansion of the aneurysm, which can cause a vague pain in the back, or sometimes a sharp pain that may denote the presence of impending rupture. Other symptoms are related to pressure on adjacent structures, such as pressure on the bronchus that can cause respiratory distress, or pressure on the laryngeal nerve causing vocal hoarseness. Pressure on the esophagus can cause difficulty in swallowing. Currently, open surgery and thoracic endovascular aneurysm repair (TEVAR) are the choices of treatment for descending thoracic aneurysms (DTA). The decision to intervene on a DTA depends on its size, location, rate of growth and symptoms, and the overall medical condition of the patient. The indications for TEVAR should not differ from those for open surgery and typically include aneurysms larger than 6 cm in diameter. Saccular and symptomatic aneurysms are often repaired at a smaller size. It is also suggested that aneurysms with a growth rate more than 1 cm per year, or 0.5 cm in 6 months should be considered for early repair.Despite the close proximity of the aorta and left main bronchus, atelectasis caused by thoracic aortic aneurysms is rare. We review the case report of a patient with concomitant persistent left pulmonary atelectasis causing acute respiratory distress due to complete compression of the left main bronchus after TEVAR of a descending thoracic aortic aneurysm.
许多胸主动脉瘤是偶然发现的，大多数在无症状的情况下发展。症状通常是由于动脉瘤突然扩张，可引起背部隐痛，有时也可能是剧痛，这可能预示着即将破裂。其他症状与对相邻结构的压迫有关，例如对支气管的压迫可导致呼吸窘迫，或对喉返神经的压迫导致声音嘶哑。对食管的压迫可引起吞咽困难。目前，开放手术和胸主动脉腔内修复术（TEVAR）是降主动脉瘤（DTA）的治疗选择。对DTA进行干预的决定取决于其大小、位置、生长速度和症状，以及患者的整体健康状况。TEVAR的适应症与开放手术的适应症不应有差异，通常包括直径大于6 cm的动脉瘤。囊状和有症状的动脉瘤通常在较小尺寸时进行修复。也有人建议，每年生长速度超过1 cm或6个月内生长0.5 cm的动脉瘤应考虑早期修复。尽管主动脉与左主支气管位置紧邻，但胸主动脉瘤引起的肺不张却很罕见。我们回顾了一例降主动脉瘤TEVAR术后因左主支气管完全受压导致持续性左肺不张并引起急性呼吸窘迫的患者的病例报告。
