Casarotto D, Pugliese P, Brunelli M, Camassa N, Silvestre G, Gerosa G, Zanini M, Fabbri A
Cattedra di Chirurgia Cardiovascolare, Università degli Studi di Verona.
G Ital Cardiol. 1987 Apr;17(4):295-9.
This study analyses the clinical course of five patients who developed acute ascending aortic dissection 45.8 months (17-87 months) after aortic valve replacement (AVR) and underwent reoperation in our Department. All except one had aortic insufficiency with mild dilatation of the ascending aorta. No evidence of aortic wall degeneration was present at the time of AVR. Prostheses implanted were: Hancock 2, St. Jude 2, Bjork-Shiley 1. Associated procedures (coartectomy, coronary artery by-pass) were carried out in two patients. The dilated aorta was managed at the first operation by longitudinal resection in 3 of them. Emergent aortic dissection repair was performed: in 3 cases with composite graft according to the Bentall procedure, in one case with non valved dacron conduit and in the last case with teflon patch. Histological examination of the dissected aortic wall showed elastic fiber degeneration like cystic medial necrosis. Three patients survived surgical repair and are doing well at 22.4 months of mean post-operative follow-up. Surgical strategy of this complication is discussed; particular emphasis is given to the method of treatment of ascending aorta dilatation during AVR.
本研究分析了5例在主动脉瓣置换术（AVR）后45.8个月（17 - 87个月）发生急性升主动脉夹层并在我院接受再次手术的患者的临床病程。除1例外，所有患者均有主动脉瓣关闭不全并伴有升主动脉轻度扩张。AVR时未发现主动脉壁退变的证据。植入的人工瓣膜有：Hancock 2型2个、St. Jude 2型2个、Bjork - Shiley 1型1个。2例患者进行了相关手术（动脉缩窄切除术、冠状动脉搭桥术）。其中3例患者在首次手术时通过纵行切除处理扩张的主动脉。急诊进行了主动脉夹层修复：3例采用Bentall手术方式植入复合移植物，1例采用无瓣涤纶人工血管，最后1例采用聚四氟乙烯补片。对夹层主动脉壁的组织学检查显示有类似囊性中层坏死的弹性纤维退变。3例患者手术修复后存活，术后平均随访22.4个月，情况良好。本文讨论了该并发症的手术策略；特别强调了AVR期间升主动脉扩张的治疗方法。
