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主动脉缩窄修复术后主动脉瘤导致大量咯血的延迟表现(一例报告)

Delayed presentation of massive haemoptysis from aortic aneurysm after aortic coarctation repair (a case report).

作者信息

Elghoneimy Yasser Farag, Makhdom Fahd Abdulrahman, AlSulaiman Reem Shehab, Alshaik Mohammed Ibrahim, AlShehri Saud Abdulaziz

机构信息

Cardiac Surgery Unit, Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal, Saudi Arabia.

Cardiac Surgery Unit, Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal, Saudi Arabia.

出版信息

Int J Surg Case Rep. 2021 Oct;87:106398. doi: 10.1016/j.ijscr.2021.106398. Epub 2021 Sep 13.

Abstract

INTRODUCTION

Massive haemoptysis refers to coughing and losing a huge amount of blood in a 24-hour period. It's a life-threatening condition with high mortality rate.

CASE PRESENTATION

We report a rare case of massive haemoptysis in a 60-year-old female patient who had aortic coarctation repair 30 years ago. Her Computed tomography (CT) angiography showed huge aneurysmal dilatation and dissection of the descending thoracic aorta at the site of the repair. Thoracic endovascular aortic repair (TEVAR) was done, but the patient had recurrent massive haemoptysis due to extension of the aneurysm to the aortic arch. The patient then underwent one stage surgical right to left carotid artery shunt followed by TEVAR to the aortic arch covering the left common carotid artery. The procedure was successful, and haemoptysis was controlled without any complications.

DISCUSSION

In this case the high index of suspicion for thoracic aortic aneurysm in patients presenting with haemoptysis and prior history of coarctation repair were demonstrated.

CONCLUSION

massive haemoptysis in patients who had aortic coarctation repair is an alarming sign, and surgical intervention is required. TEVAR has become one of the best approaches for managing aortic aneurysm and has replaced open repair.

摘要

引言

大量咯血是指在24小时内咳嗽并咳出大量血液。这是一种危及生命的状况,死亡率很高。

病例报告

我们报告一例罕见的大量咯血病例,患者为一名60岁女性,30年前接受过主动脉缩窄修复术。她的计算机断层扫描(CT)血管造影显示,修复部位的胸降主动脉出现巨大动脉瘤样扩张和夹层。进行了胸主动脉腔内修复术(TEVAR),但由于动脉瘤扩展至主动脉弓,患者反复出现大量咯血。该患者随后接受了一期手术,即右向左颈动脉分流术,然后对覆盖左颈总动脉的主动脉弓进行TEVAR。手术成功,咯血得到控制,且无任何并发症。

讨论

在该病例中,对于出现咯血且有缩窄修复既往史的患者,显示出对胸主动脉瘤的高度怀疑指数。

结论

有主动脉缩窄修复史的患者出现大量咯血是一个警示信号,需要进行手术干预。TEVAR已成为治疗主动脉瘤的最佳方法之一,并已取代开放修复术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/442b/8461370/38633d1c221c/gr1.jpg

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