Patel Prakash A, Bavaria Joseph E, Ghadimi Kamrouz, Gutsche Jacob T, Vallabhajosyula Prashanth, Ko Hanjo A, Desai Nimesh D, Mackay Emily, Weiss Stuart J, Augoustides John G T
Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
J Cardiothorac Vasc Anesth. 2018 Feb;32(1):586-597. doi: 10.1053/j.jvca.2017.06.014. Epub 2017 Jun 7.
The functional aortic annulus offers a clinical approach for the perioperative echocardiographer to classify the mechanisms of aortic regurgitation in acute type-A dissection. Comprehensive examination of the functional aortic annulus in this setting using transesophageal echocardiography can guide surgical therapy for the aortic root by considering the following important aspects: severity and mechanism of aortic regurgitation, extent of root dissection, and the pattern of coronary artery involvement. The final choice of surgical therapy also should take into account factors, such as patient presentation and surgical experience, to limit mortality and morbidity from this challenging acute aortic syndrome. This review explores these concepts in detail within the framework of the functional aortic annulus, detailed anatomic considerations, and the latest literature.
功能性主动脉瓣环为围手术期超声心动图医生对急性A型主动脉夹层主动脉反流机制进行分类提供了一种临床方法。在这种情况下，使用经食管超声心动图对功能性主动脉瓣环进行全面检查，可以通过考虑以下重要方面来指导主动脉根部的手术治疗：主动脉反流的严重程度和机制、根部夹层的范围以及冠状动脉受累模式。手术治疗的最终选择还应考虑患者表现和手术经验等因素，以降低这种具有挑战性的急性主动脉综合征的死亡率和发病率。本综述在功能性主动脉瓣环、详细的解剖学考量及最新文献的框架内详细探讨了这些概念。
