Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167# Beilishi Road, Beijing, 100037, China.
J Cardiothorac Surg. 2020 Oct 17;15(1):319. doi: 10.1186/s13019-020-01356-z.
Acute type A aortic dissection with a dissection flap extending into the sinus segment often involves the commissures and the coronary ostia. In most cases, the intimal flap must be retained in order to restore aortic valve competence and reconstruct the coronary ostia. Residual dissection flap has the potential risks of proximal bleeding and adverse effects on long-term durability. We established a novel technique to reconstruct the aortic root using a pericardial autograft and significantly reduce remnant dissection tissues.
A 50-year-old female was admitted to our center with acute anterior chest pain and backache lasting about 10 h. Computed tomographic (CT) scans showed type A aortic dissection, with both coronary ostia being involved. Doppler echocardiography showed moderate aortic insufficiency. The dissection intimal flap was removed to the normal aorta wall near the annulus at the noncoronary sinus, leaving a 5 mm rim of intimal flap near the commissures and coronary ostia. Using a pericardial patch as a new aortic wall to reconstruct the root while preserving the aortic adventitia to fix and strengthen the new pericardial aortic wall. Ascending aorta and total arch replacement combined with frozen elephant trunk procedure was performed at the same time. The patient got an uneventful postoperative course.
Aortic root repair with a pericardial autograft is a safe and effective technique to treat acute type A dissection involving the sinus. Using this technique, residual dissection tissues could be significantly reduced, which subsequently decreases the risk of proximal bleeding and hence increases long-term durability.
急性 A 型主动脉夹层，夹层瓣延伸至窦段，常累及嵴和冠状动脉口。在大多数情况下，为了恢复主动脉瓣功能并重建冠状动脉口，必须保留内膜瓣。残余的夹层瓣有近端出血的潜在风险，并对长期耐久性有不良影响。我们建立了一种使用心包自体移植物重建主动脉根部的新技术，可以显著减少残余的夹层组织。
一名 50 岁女性因急性前胸痛和背痛持续约 10 小时就诊于我院。计算机断层扫描（CT）显示 A 型主动脉夹层，累及两个冠状动脉口。多普勒超声心动图显示中度主动脉瓣关闭不全。夹层内膜瓣被切除至非冠状动脉窦的瓣环附近的正常主动脉壁，在嵴和冠状动脉口附近留下 5 毫米的内膜瓣边缘。使用心包片作为新的主动脉壁来重建根部，同时保留主动脉外膜以固定和加强新的心包主动脉壁。同时进行升主动脉和全弓置换联合冷冻象鼻手术。患者术后恢复顺利。
心包自体移植物的主动脉根部修复术是治疗累及窦部的急性 A 型夹层的一种安全有效的技术。使用该技术，可显著减少残余的夹层组织，从而降低近端出血的风险，进而提高长期耐久性。
