Nokagomi E, Mizuno A, Ikeda K, Sudo K, Hamada Y, Mizunuma H, Morita H, Unno T, Hayashi N, Kobayashi M
Kyobu Geka. 1989 Apr;42(4):311-5.
This is a case report of the successful surgical treatment of acute dissecting aneurysm of the ascending aorta. The patient was a 65-year-old female, who admitted to the hospital 3 hours after the onset of severe back pain. Enhanced CT of the chest and abdomen revealed acute dissection of the ascending aorta from its origin to the bilateral common iliac arteries. Thirteen hours initiation of the symptoms, operation was carried out using pump-oxygenator with hypothermia. Transverse incision of the ascending aorta revealed acute dissection in anterior aspect extending to two third of the circumference. The proximal small intimal tear was found 3 mm apart from the right coronary artery ostium. Upon closure of the tear resulting in obliteration of the right coronary artery, it required bypass procedure between the right coronary artery and the innominate artery using the saphenous vein graft. The aortic incision was directly closed using Dacron felt bolsters. Postoperative studies revealed disappearance of the proximal aortic dissection, patency of the bypass graft and existence of distal aortic dissection. Patient is in active life 6 months after operation.
这是一例升主动脉急性夹层动脉瘤手术治疗成功的病例报告。患者为65岁女性，在严重背痛发作3小时后入院。胸部和腹部增强CT显示升主动脉自起始部至双侧髂总动脉急性夹层。症状出现13小时后，采用体外循环和低温技术进行手术。升主动脉横切口显示前壁急性夹层，范围达圆周的三分之二。在距右冠状动脉开口3毫米处发现近端小内膜撕裂。缝合撕裂口导致右冠状动脉闭塞，需用大隐静脉移植在右冠状动脉和无名动脉之间进行搭桥手术。用涤纶毡垫直接缝合主动脉切口。术后检查显示近端主动脉夹层消失，搭桥移植血管通畅，远端主动脉夹层仍然存在。患者术后6个月生活正常。
