Kise Yuya, Kuniyoshi Yukio, Ando Mizuki, Inafuku Hitoshi, Nagano Takaaki, Yamashiro Satoshi
Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
J Cardiothorac Surg. 2017 May 19;12(1):32. doi: 10.1186/s13019-017-0601-9.
Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery.
A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis. The deep hypothermia was induced with bilateral infusion of cardiopulmonary bypass by femoral artery cannulation for the lower body and by transapical cannulation for the upper body because of easy access. There was no hemorrhagic tendency after deep hypothermic bypass. The patient was discharged uneventfully.
For upper body perfusion, transapical aortic cannulation was a simple and effective procedure during left thoracotomy.
在再次进行胸腹主动脉瘤手术期间,避免各种并发症是一项挑战。
一名56岁男性曾接受过4次I型主动脉夹层手术。切除了与肺实质严重粘连的残余胸腹主动脉瘤。由于近端吻合部位深埋于肺实质内,因此在近端吻合期间,深度低温对于避免肺组织分离和保护脊髓至关重要。由于操作简便,通过股动脉插管对下半身进行体外循环双侧灌注,并通过经心尖插管对上半身进行灌注,从而诱导深度低温。深度低温体外循环后未出现出血倾向。患者顺利出院。
对于上半身灌注,经心尖主动脉插管在左胸开胸手术期间是一种简单有效的方法。