Department of Radiology of the Erasmus University Medical Center, Rotterdam, The Netherlands; Postgraduate School of Radiology, University of Genova, Italy.
Department of Radiology of the Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology of the Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur J Radiol. 2017 Oct;95:332-341. doi: 10.1016/j.ejrad.2017.09.001. Epub 2017 Sep 8.
The Bentall procedure is associated with several complications often accompanied by accumulation of fluid around the aortic graft. CT is the imaging modality of choice to detect these complications. Since these early complications are, however, not easily distinguished from physiological postoperative changes, our aim was to compare the appearance and amount of peri-aortic fluid on early CT scans following Bentall procedures with either an uncomplicated or a complicated course and follow-up.
Ninety-four scans performed within 3 months of a Bentall procedure were retrospectively included. Patients were divided into either the uncomplicated or the complicated group based on occurrence of Bentall-related complications or death up until 1-year after surgery. Diffuse fluid ("stranding") was distinguished from organized, more clearly delineated fluid collections such as haematomas, and was graded both subjectively and quantitatively.
Forty-seven patients were assigned to each group. Stranding was found on most of the scans, both in the uncomplicated (7.7±3.9mm, range 0-17mm) and complicated (6.9±5.5mm, range 0-19mm) groups (p=0.32). There were, however, significantly more fluid collections (6 vs. 28; p <0.001), particularly haematomas (1 vs. 17; p<0.001), in the complicated group. When looking at isolated stranding, there was still no significant difference between the two groups (7.8±3.6mm vs. 9.2±3.7mm; p=0.22).
Isolated stranding of up to 17mm is a common finding on postoperative CT within three months of a Bentall procedure, regardless of the occurrence of complications during the procedure or within a 1-year follow-up. Fluid collections are more worrisome indicators of complications that may require closer monitoring.
贝顿手术常伴有多种并发症，常伴有主动脉移植物周围积液。CT 是检测这些并发症的首选影像学方法。然而，由于这些早期并发症不易与术后生理变化区分，我们的目的是比较贝顿手术后 3 个月内早期 CT 扫描中主动脉周围积液的外观和量，与无并发症或并发症的过程和随访。
回顾性纳入 94 例贝顿手术后 3 个月内的扫描。根据贝顿相关并发症的发生或手术后 1 年内的死亡情况，将患者分为无并发症组或并发症组。弥漫性积液（“缠结”）与有组织的、更清晰界定的积液（如血肿）区分开来，并进行主观和定量分级。
将 47 例患者分配到每组。无并发症组（7.7±3.9mm，范围 0-17mm）和并发症组（6.9±5.5mm，范围 0-19mm）的大多数扫描均可见缠结（p=0.32）。然而，并发症组的积液（6 例 vs. 28 例；p<0.001），尤其是血肿（1 例 vs. 17 例；p<0.001）明显更多。当单独观察缠结时，两组之间仍无显著差异（7.8±3.6mm vs. 9.2±3.7mm；p=0.22）。
贝顿手术后 3 个月内，术后 CT 可见达 17mm 的孤立缠结是一种常见表现，无论手术过程中是否发生并发症，还是在 1 年随访期间。积液是并发症的更令人担忧的指标，可能需要更密切的监测。
