From the Department of Anesthesiology and Critical Care Medicine.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
A A Pract. 2020 Nov;14(13):e01333. doi: 10.1213/XAA.0000000000001333.
Iatrogenic aortic injury is a rare but potentially lethal complication of cardiac surgery. While sometimes resulting in aortic dissection or intramural hematoma, injury more frequently results in subadventitial hematoma, a more benign pathology. Here, we describe a case where intraoperative transesophageal echocardiography (TEE) identified such a hematoma but was unable to rule out dissection. Epiaortic ultrasound was subsequently performed, which definitively demonstrated the absence of a dissection flap or extraluminal flow. Per our review, this is the first report documenting the successful use of epiaortic imaging to identify subadventitial hematoma in the setting of inconclusive TEE findings.
医源性主动脉损伤是心脏手术罕见但潜在致命的并发症。虽然有时会导致主动脉夹层或壁内血肿，但更常见的损伤是外膜下血肿，这是一种更良性的病变。在这里，我们描述了一例术中经食管超声心动图（TEE）发现这种血肿但无法排除夹层的病例。随后进行了主动脉外膜超声检查，明确证实不存在夹层瓣或管腔外血流。根据我们的回顾，这是第一份记录成功使用主动脉外膜成像在 TEE 结果不确定的情况下识别外膜下血肿的报告。
