Geana Roxana Carmen, Stiru Ovidiu, Raducu Laura, Tulin Adrian, Parasca Catalina, Chioncel Ovidiu, Bacalbasa Nicolae, Iliescu Vlad Anton
Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania.
Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania.
Int J Surg Case Rep. 2020;74:86-90. doi: 10.1016/j.ijscr.2020.07.085. Epub 2020 Aug 15.
We present a case of open surgical repair of an aortic arch pseudoaneurysm (AAP) without the use of hypothermic circulatory arrest in a patient with low ejection fraction and associated coronary artery disease (CAD) and discuss some issues regarding the management of this case.
A 69-year-old male with multiple pathologies and history of angina pectoris was transferred to our center from a local hospital with an initial diagnosis of non-ST-segment elevation myocardial infarction. Coronary angiography revealed stenotic lesions affecting all three coronary arteries. Multislice 3D contrast-enhanced computed tomography (CT-scan) revealed a 36 × 27 mm AAP. Endovascular stent-grafting was deemed to be unsuitable due to hostile landing zone. Therefore, the heart team decided for simultaneou treatment of the AAP and percutaneous therapy of CAD. The AAP was excised, and repair was performed with a Dacron patch on beating heart. After the surgical procedure, PCI with drug-eluting stents (DES) was performed on the right coronary artery (RCA) and the left circumflex artery (LCx) in the operating room. The patient's postprocedural course was uneventful and after thirteen days, he was discharged in good shape. 3D CT-scan performed after three month showed no residual AAP.
We established this approach as being the most suitable for our case based on favorable circumstances such as: stable CAD, beating heart procedure with low impact on myocardial ischemia, the impossibility of successful placement of an endovascular stent-graft, the presence of a pseudoaneurysm neck with minimum calcification.
We consider the best approach for individual cases is tailoring the treatment plan and the procedure to the patient's specific anatomy and pathology.
我们报告一例主动脉弓假性动脉瘤（AAP）开放手术修复病例，该患者射血分数低且伴有冠状动脉疾病（CAD），手术未使用低温循环停止，并讨论该病例管理的一些问题。
一名69岁男性，有多种疾病史及心绞痛病史，从当地医院转至我院，初步诊断为非ST段抬高型心肌梗死。冠状动脉造影显示三支冠状动脉均有狭窄病变。多层3D对比增强计算机断层扫描（CT扫描）显示一个36×27mm的AAP。由于锚定区不佳，血管内支架植入术被认为不合适。因此，心脏团队决定同时治疗AAP和对CAD进行经皮治疗。切除AAP，并在心脏跳动时用涤纶补片进行修复。手术后，在手术室对右冠状动脉（RCA）和左旋支动脉（LCx）进行了药物洗脱支架（DES）的经皮冠状动脉介入治疗（PCI）。患者术后病程顺利，13天后康复出院。术后三个月的3D CT扫描显示无残余AAP。
基于以下有利情况，我们确定该方法最适合我们的病例：CAD稳定、心脏跳动手术对心肌缺血影响小、血管内支架植入术无法成功放置、假性动脉瘤颈部钙化最少。
我们认为针对个别病例的最佳方法是根据患者的具体解剖结构和病理情况制定治疗计划和手术方案。
