Nishimoto Kota, Umegaki Takeshi, Ohira Sayaka, Nakajima Yurina, Soeda Takehiro, Kamibayashi Takahiko
Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
JA Clin Rep. 2019 Jan 11;5(1):4. doi: 10.1186/s40981-019-0223-4.
Acute type A aortic dissections have an extremely poor prognosis, and cardiac tamponade is a major cause of death in these patients. Here, we describe a case where congenital partial pericardial defect relieved cardiac tamponade caused by ruptured type A aortic dissection.
A 79-year-old woman was hospitalized after experiencing chest pains and respiratory distress. She developed out-of-hospital cardiopulmonary arrest and was resuscitated with no sequelae 5 days before admission. Computed tomography confirmed pericardial and left pleural effusions, and type A aortic dissection was diagnosed. We began emergency ascending aortic replacement surgery under general anesthesia with propofol and remifentanil and incidentally discovered a congenital partial left-sided pericardial defect that allowed drainage of the hemopericardium and relieved cardiac tamponade. The surgery was successfully performed, and the patient recovered without complications.
We experienced an extremely rare case where a congenital partial pericardial defect relieved cardiac tamponade associated with aortic dissection and contributed to the patient's survival.
急性A型主动脉夹层预后极差，心脏压塞是这些患者死亡的主要原因。在此，我们描述一例先天性部分心包缺损缓解了A型主动脉夹层破裂所致心脏压塞的病例。
一名79岁女性在出现胸痛和呼吸窘迫后住院。她在入院前5天发生院外心肺骤停，经复苏后无后遗症。计算机断层扫描证实有心包和左侧胸腔积液，诊断为A型主动脉夹层。我们在丙泊酚和瑞芬太尼全身麻醉下开始急诊升主动脉置换手术，术中意外发现先天性左侧部分心包缺损，该缺损使心包积血得以引流，缓解了心脏压塞。手术成功完成，患者康复且无并发症。
我们遇到了一例极为罕见的病例，先天性部分心包缺损缓解了与主动脉夹层相关的心脏压塞，并有助于患者存活。
