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[急性Stanford A型主动脉夹层升主动脉置换术后三个月主动脉根部再次解剖;病例报告]

[Redissection of the Aortic Root Three Months after Replacement of the Ascending Aorta for Acute Stanford Type A Dissection;Report of a Case].

作者信息

Someya Takeshi, Oishi Kiyotoshi, Shirai Toshizumi

机构信息

Department of Thoracic Surgery, Ome Municipal General Hospital, Ome, Japan.

出版信息

Kyobu Geka. 2017 May;70(5):373-376.

Abstract

We report a case of redissection of the aortic root after graft replacement for acute aortic dissection using BioGlue to approximate the false lumen. A 49-year-old man underwent graft replacement of the ascending aorta for acute aortic dissection. In this operation, BioGlue was applied to the false lumen of the aortic root. Three months later, computed tomography revealed an ulcer-like projection and an intramural hematoma in the aortic root. Aortic root replacement was performed, in which operative findings showed a new intimal tear and a patent false lumen contained with hematomas and a fragment of BioGlue. Histological examination showed no evidence of adhesion between the intimal media and the adventitia of the aorta, or toxic effect of BioGlue. We conclude that care should be taken in applying the BioGlue to a false lumen and that cautious follow-up is mandatory not to overlook redissection.

摘要

我们报告了一例在使用生物胶封闭假腔行急性主动脉夹层移植置换术后主动脉根部再次夹层的病例。一名49岁男性因急性主动脉夹层接受了升主动脉移植置换术。在该手术中,生物胶被应用于主动脉根部的假腔。三个月后,计算机断层扫描显示主动脉根部有溃疡样突起和壁内血肿。遂进行了主动脉根部置换术,术中发现有新的内膜撕裂,假腔内有血肿和一块生物胶碎片。组织学检查显示主动脉内膜中层与外膜之间无粘连迹象,也无生物胶的毒性作用。我们得出结论,在将生物胶应用于假腔时应谨慎,必须进行密切随访以免遗漏再次夹层。

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