Frist W H, Miller D C
Cardiovasc Clin. 1987;17(3):263-87.
Recent chapters in the relatively brief history of surgical treatment of patients with ascending aortic aneurysms and aortic arch aneurysms continue to be punctuated by substantial clinical improvements. More precise diagnostic methods, increased awareness of the dismal natural history of patients with these aneurysms, improved methods of myocardial and cerebral protection, refined vascular grafts and prosthetic valves, widespread availability of specific coagulation components, more sophisticated anesthetic and postoperative management, and more timely referral of patients (prior to rupture or irreversible deterioration of left ventricular function, or both) have all been instrumental in promoting these improving results. The thrust of future efforts should be directed to the appropriate identification, diagnosis, and treatment of remote aneurysms and atherosclerotic disease in the cerebral and coronary circulation, detection of patients predisposed to aortic dissection, and ultimately to the development of pharmacologic methods to prevent aortic dissection and atherosclerotic aneurysm development. Eventually, it is hoped, more complete understanding of the genetics, molecular biology, and biochemistry of both acquired and congenital degenerative thoracic aortic aneurysms will also lead to preventive measures for these patients.
在升主动脉瘤和主动脉弓瘤患者外科治疗相对短暂的历史中，近期各阶段仍不断取得显著的临床进展。更精确的诊断方法、对这些动脉瘤患者预后不良自然史认识的提高、心肌和脑保护方法的改进、血管移植物和人工瓣膜的完善、特定凝血成分的广泛可得性、更复杂的麻醉和术后管理，以及患者更及时的转诊（在破裂或左心室功能不可逆恶化之前，或两者兼具之前），所有这些都有助于取得这些不断改善的结果。未来努力的重点应指向对脑循环和冠状动脉循环中远端动脉瘤和动脉粥样硬化疾病进行适当的识别、诊断和治疗，检测易发生主动脉夹层的患者，并最终开发预防主动脉夹层和动脉粥样硬化性动脉瘤发展的药物方法。最终，希望对获得性和先天性退行性胸主动脉瘤的遗传学、分子生物学和生物化学有更全面的了解，这也将为这些患者带来预防措施。
