Wu Jin-Lin, Zhang Liang, Qiu Jun-Tao, Yu Cun-Tao
Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Interact Cardiovasc Thorac Surg. 2018 Oct 1;27(4):555-560. doi: 10.1093/icvts/ivy110.
This study aimed to investigate the morphological characteristics of the dissected thoracic aorta and brachiocephalic arteries within the Chinese population.
A retrospective analysis of computed tomography scans of 387 patients with acute Type A aortic dissection was carried out. The dimensions of the thoracic aorta at multiple levels and other imaging characteristics were studied.
The patients with a maximum diameter ≥55 mm accounted for less than one-third of the population. Among those without Marfan syndrome (MFS) (n = 349), only 114 (32.8%) patients had a maximal aortic diameter ≥ 55 mm, whereas among those with MFS (n = 38), 20 (78.9%) had a maximal aortic diameter ≥ 45 mm. The predicted maximum aortic diameter is 88.46 - 0.81 × height (cm) + 63.02 × body surface area (m2) + 5.50 × (if diabetes, 1, if not, 0) - 6.63 × (if hypertension, 1, if not, 0). A positive correlation was established between a circular false lumen and the probability that brachiocephalic arteries were involved by dissection. The size ratio of false lumen to true lumen was greater in the circumferential group when compared with the crescent group. The independent predictors for the circumferential false lumen were age, atherosclerosis and smoking.
Herein, the morphological characteristics of the thoracic aorta among Chinese patients with acute Type A aortic dissection were described. The currently recommended criteria for prophylactic aorta surgery were applied to most patients with MFS but not to those without MFS within the Chinese population. Furthermore, the shape of the false lumen was identified as a putative risk factor that might affect the prognosis of the patients.
本研究旨在调查中国人群中解剖后的胸主动脉和头臂动脉的形态特征。
对387例急性A型主动脉夹层患者的计算机断层扫描进行回顾性分析。研究了胸主动脉多个层面的尺寸及其他影像学特征。
最大直径≥55mm的患者占比不到三分之一。在无马凡综合征（MFS）的患者（n = 349）中，只有114例（32.8%）患者的主动脉最大直径≥55mm，而在患有MFS的患者（n = 38）中，20例（78.9%）患者的主动脉最大直径≥45mm。预测的主动脉最大直径为88.46 - 0.81×身高（cm）+ 63.02×体表面积（m2）+ 5.50×（如果患有糖尿病则为1，否则为0）- 6.63×（如果患有高血压则为1，否则为0）。圆形假腔与头臂动脉被夹层累及的概率之间存在正相关。与新月形组相比，环形组假腔与真腔的大小比更大。环形假腔的独立预测因素为年龄、动脉粥样硬化和吸烟。
本文描述了中国急性A型主动脉夹层患者胸主动脉的形态特征。目前推荐的预防性主动脉手术标准适用于大多数患有MFS的患者，但不适用于中国人群中无MFS的患者。此外，假腔的形状被确定为可能影响患者预后的一个推定危险因素。
