Oricco S, Perego M, Poggi M, Tursi M, Biasato I, Santilli R A
Centro Veterinario Imperiese, Via Dott. Augusto Armelio 10, Imperia, IM, 18100, Italy.
Clinica Veterinaria Malpensa, Via Guglielmo Marconi 27, Samarate, VA, 21017, Italy.
J Vet Cardiol. 2019 Oct;25:52-60. doi: 10.1016/j.jvc.2019.09.001. Epub 2019 Sep 28.
Aortic dissection (AD) is characterized by bleeding within the aortic wall or a tear in the intimal layer of the aortic wall, resulting in the passage of blood from the aortic lumen into the tunica media. In cases of AD, a floating, intimal flap in the aortic lumen divides the lumen into a true portion, with flow present, and a false portion, with no flow. We describe a series of 4 cats with AD of the ascending aorta and moderate aortic insufficiency. Three cats had an acute onset of clinical signs with pericardial effusion and cardiac tamponade, whereas one cat showed a chronic onset without pericardial effusion. Detailed gross and histopathological characterization is available for two cats, which revealed the typical features of AD. One cat also showed connective tissue abnormalities, microscopically resembling Marfan-like syndrome. Concomitant detection of hypertrophic cardiomyopathy in 2 cats represents a novel finding in the veterinary literature. Feline AD is generally associated with systemic hypertension. In all the cats of this case series, blood pressure was normal at presentation, although systemic hypertension before the acute dissection cannot be ruled out. In humans, hypotension is more common with AD of the ascending aorta, so the anatomical location could also play a role in cats. Hypertrophic cardiomyopathy in cats could have been a potential trigger of AD through shear stress. Transthoracic echocardiography, as herein demonstrated, can be considered as a rapid, non-invasive and useful method for the diagnosis of dissection at the level of the ascending aorta.
主动脉夹层（AD）的特征是主动脉壁内出血或主动脉壁内膜层撕裂，导致血液从主动脉腔进入中膜。在AD病例中，主动脉腔内的浮动内膜瓣将管腔分为有血流的真腔部分和无血流的假腔部分。我们描述了4只患有升主动脉AD和中度主动脉瓣关闭不全的猫。3只猫临床症状急性发作，伴有心包积液和心脏压塞，而1只猫表现为慢性发作且无心包积液。有2只猫可进行详细的大体和组织病理学特征分析，结果显示出AD的典型特征。1只猫在显微镜下还表现出结缔组织异常，类似于马方样综合征。2只猫同时检测出肥厚性心肌病，这在兽医文献中是一个新发现。猫AD通常与系统性高血压有关。在本病例系列的所有猫中，就诊时血压正常，尽管不能排除急性夹层形成前存在系统性高血压的情况。在人类中，升主动脉AD更常伴有低血压，因此解剖位置在猫中可能也起作用。猫的肥厚性心肌病可能通过剪切应力成为AD的潜在触发因素。如本文所示，经胸超声心动图可被视为诊断升主动脉夹层的一种快速、非侵入性且有用的方法。
