Zhou Xiao-Yu, Xu Jing
Third Department of Cardiac Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Third Department of Cardiac Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Chin J Traumatol. 2018 Aug;21(4):243-245. doi: 10.1016/j.cjtee.2018.02.006. Epub 2018 Jun 28.
It is estimated that 15% of traffic accidents cause trauma to large vessels. In about 70%-95% of cases, aortic rupture took place in the distal ligament of the left subclavian artery, whereas in the remaining cases rupture occurred in the ascending aorta above the aortic valve. Trauma to the aortic sinus and coronary arteries is rarely found in traffic accident victims. Therefore, coronary artery trauma is often misdiagnosed as coronary atherosclerotic heart disease. The present case is a 42 years old male who survived from a traffic accident. He presented with aortic sinus and left coronary artery trauma. He was misdiagnosed as having coronary atherosclerotic heart disease, and therefore wrongly given antiplatelet medicine, such as aspirin, in another hospital. Definite diagnosis was achieved in our hospital, and the patient underwent Bentall and mitral valve replacement, as well as tricuspid valvuloplasty. The aortic occlusion time during surgery was 47 min, and the total cardiopulmonary bypass time was 63 min. After surgery, transthoracic echocardiography confirmed that all the artificial valves worked sufficiently. The patient felt good and symptoms such as asthma and decreased exercise tolerance disappeared. This case taught us that acute aortic syndrome cannot be ignored when patients present with pectoralgia; antiplatelet medication should not be given before definite diagnosis.
据估计，15%的交通事故会导致大血管创伤。在大约70%-95%的病例中，主动脉破裂发生在左锁骨下动脉远端韧带处，而在其余病例中，破裂发生在主动脉瓣上方的升主动脉。交通事故受害者很少出现主动脉窦和冠状动脉创伤。因此，冠状动脉创伤常被误诊为冠状动脉粥样硬化性心脏病。本病例为一名42岁男性，在交通事故中幸存。他表现为主动脉窦和左冠状动脉创伤。他在另一家医院被误诊为患有冠状动脉粥样硬化性心脏病，因此错误地服用了阿司匹林等抗血小板药物。在我院确诊后，患者接受了Bentall手术、二尖瓣置换术以及三尖瓣成形术。手术期间主动脉阻断时间为47分钟，体外循环总时间为63分钟。术后，经胸超声心动图证实所有人工瓣膜功能良好。患者感觉良好，哮喘和运动耐量下降等症状消失。该病例告诉我们，当患者出现胸痛时，急性主动脉综合征不能被忽视；在明确诊断之前不应给予抗血小板药物。
