Division of Cardiovascular Surgery, Second Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Japan.
Eur J Cardiothorac Surg. 2017 Oct 1;52(4):825-826. doi: 10.1093/ejcts/ezx130.
A case of an unusual iatrogenic aortic dissection is reported. A 77-year-old male patient in shock status due to acute type A aortic dissection underwent emergency surgery. Systemic perfusion was started via the femoral artery, but another dissection appeared in the descending aorta detected by transoesophageal echocardiography. However, the flap was unusually thin, and there was no change in the pre-existing thrombosed false lumen. These findings suggested subintimal development of dissection. After systemic perfusion was promptly switched to antegrade perfusion, the new dissection could no longer be detected. Since there was no malperfusion or aortic rupture, the ascending aorta was repaired. His postoperative course was uneventful, and there were no significant complications. Unless the aorta is carefully observed at the right time during the operation, such vanishing aortic dissection may be missed and potentially result in 'organ damage of unknown cause'.
现报告一例罕见的医源性主动脉夹层病例。一位 77 岁的男性患者因急性 A 型主动脉夹层处于休克状态，接受了紧急手术。通过股动脉开始全身灌注，但经食管超声心动图发现降主动脉出现另一个夹层。然而，夹层的瓣片异常薄，且先前血栓形成的假腔没有变化。这些发现提示夹层内膜下发展。在系统灌注迅速切换为顺行灌注后，新的夹层不再被检测到。由于没有灌注不良或主动脉破裂，仅修复了升主动脉。他的术后过程平稳，没有出现明显的并发症。除非在手术过程中及时仔细观察主动脉，否则这种消失的主动脉夹层可能会被遗漏，并可能导致“不明原因的器官损伤”。
