Matsuura Ryohei, Tsutsumi Yasushi, Monta Osamu, Uenaka Hisazumi, Tanaka Kenji, Samura Takaaki, Ohashi Hirokazu
Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinbo, Fukui, 910-0833, Japan.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 E1, Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
J Cardiothorac Surg. 2018 Jan 15;13(1):6. doi: 10.1186/s13019-018-0694-9.
The long-term effects of some surgical treatment procedures of arch replacement for aortic dissection or aortic aneurysm are unknown.
The present study reports the case of a 68-year-old man admitted to our hospital for aortic arch anastomotic pseudoaneurysm with concomitant aortic root enlargement and coronary artery stenosis. Eleven years ago, at the age of 56 years, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed a second total arch replacement, aortic root replacement, and coronary artery bypass, using a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery, and femoral vein prior to re-sternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation; however, he was discharged in good condition on the fiftieth postoperative day.
This case suggests that island reconstruction has the potential to cause arch anastomotic pseudoaneurysms, particularly after a long postoperative period.
一些主动脉夹层或主动脉瘤的主动脉弓置换手术治疗方法的长期效果尚不清楚。
本研究报告了一名68岁男性因主动脉弓吻合口假性动脉瘤合并主动脉根部扩大和冠状动脉狭窄入住我院的病例。11年前，他56岁时因慢性主动脉夹层接受了带岛状重建的全主动脉弓置换术。我们在再次开胸手术前，通过右锁骨下动脉、股动脉和股静脉插管进行体外循环，实施了第二次全主动脉弓置换、主动脉根部置换和冠状动脉搭桥术。我们还采用了选择性脑灌注。术后，患者暂时需要再次插管；然而，他在术后第50天状况良好出院。
该病例表明，岛状重建有可能导致主动脉弓吻合口假性动脉瘤，尤其是在术后较长时间后。
