Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
J Card Surg. 2020 Dec;35(12):3581-3584. doi: 10.1111/jocs.15009. Epub 2020 Sep 9.
We report herein the successful treatment of a case of acute type A aortic dissection complicated by cardiac tamponade and mesenteric malperfusion. The patient was a 60-year-old man with back and abdominal pain and in shock, who was transported to our hospital 2 h after symptom onset. Computed tomography revealed DeBakey type I dissection with massive hemopericardium and obstruction of both the celiac artery and superior mesenteric artery. After emergency pericardiotomy and removal of the hematoma, superior mesenteric artery-external iliac artery bypass was constructed with a vein graft, and this restored mesenteric perfusion. Open distal hemiarch replacement was then performed. The postoperative course was uneventful. Superior mesenteric artery revascularization achieved immediately after release of the cardiac tamponade prevented further mesenteric ischemia and paved the way for the aortic repair.
我们在此报告一例急性 A 型主动脉夹层并发心脏压塞和肠系膜灌注不良的成功治疗案例。该患者为 60 岁男性，有背痛和腹痛，并伴有休克，在症状发作后 2 小时被送往我院。计算机断层扫描显示为 DeBakey Ⅰ型夹层，伴大量血心包和腹腔动脉及肠系膜上动脉阻塞。行急诊心包切开术和血肿清除术后，采用静脉移植物行肠系膜上动脉-髂外动脉旁路术，恢复了肠系膜灌注。然后进行了开放的远端半弓置换术。术后过程平稳。心脏压塞解除后立即进行肠系膜上动脉血运重建，防止了进一步的肠系膜缺血，并为主动脉修复铺平了道路。
