Chard R B, Nunn G R, Johnson D C, Cartmill T B
Westmead Hospital, NSW.
Aust N Z J Surg. 1987 Dec;57(12):943-9. doi: 10.1111/j.1445-2197.1987.tb01299.x.
Ten consecutive cases of acute ascending aortic dissection operated on using the USCI intraluminal prosthesis from 1983 to 1986 were reviewed. Diagnosis was achieved by conventional angiography in six cases, by intraarterial digital subtraction angiography in one case, by computerized tomography (CT) scan in two cases and by echocardiography and abdominal ultrasound in one case. An entry site was seen in only five out of six conventional angiograms. At operation six of the 10 had a degree of tamponade. Aortic regurgitation was seen five times, due to dissection in four cases and to Marfan's disease in one. The entry site was controlled in eight cases. Repair using intraluminal prosthesis only was achieved in five cases. Aortic valve repair was added in four out of 10 cases, and in one of these an aorta-to-right coronary graft was also added. One case required aortic valve replacement. A method of aortic valve repair is presented. There were nine survivors, 1-36 months postoperatively. Of these, eight were asymptomatic on no medication. One had severe aortic regurgitation noted 2 months postoperatively and has mildly reduced exercise tolerance. Surgical treatment can be planned if the presence of dissection is proven and involvement of the ascending aorta is demonstrated. Early surgery is important, since six of the 10 cases in this series had tamponade. The intraluminal graft will reliably redirect flow to the true lumen and exclude the dissection from the pericardium. Aortic valve repair can be successful though late replacement may be necessary in some cases. Control of the entry site is not essential to achieve a good clinical result.
回顾了1983年至1986年期间连续10例使用美国外科公司腔内假体进行手术的急性升主动脉夹层病例。6例通过传统血管造影确诊，1例通过动脉内数字减影血管造影确诊，2例通过计算机断层扫描（CT）确诊，1例通过超声心动图和腹部超声确诊。6例传统血管造影中仅5例可见入口部位。手术时，10例中有6例有一定程度的心包填塞。发现主动脉瓣关闭不全5次，4例因夹层，1例因马方综合征。8例控制了入口部位。仅5例使用腔内假体进行修复。10例中有4例加做了主动脉瓣修复，其中1例还加做了主动脉至右冠状动脉移植。1例需要置换主动脉瓣。介绍了一种主动脉瓣修复方法。术后有9例存活，时间为1至36个月。其中8例未用药且无症状。1例术后2个月发现有严重主动脉瓣关闭不全，运动耐量轻度下降。如果证实存在夹层且显示升主动脉受累，可规划手术治疗。早期手术很重要，因为本系列10例中有6例有心包填塞。腔内移植物能可靠地将血流重新导向真腔，并将夹层与心包隔开。主动脉瓣修复可能成功，不过在某些情况下可能需要后期置换。控制入口部位对取得良好临床效果并非必不可少。
