Li Guanhua, Chen Yingzhen, Wang Haikuo, Liu Yanping, Liu Hangyu, Sun He, Wang Zhiping
Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Front Cardiovasc Med. 2023 Feb 24;10:1091303. doi: 10.3389/fcvm.2023.1091303. eCollection 2023.
Large mural thrombi in the relatively normal ascending aorta are extremely uncommon conditions that may lead to major adverse cardiovascular events due to new embolism. Because of their changeable variations, the management of these unstable thrombi is challenging and controversial. The size, morphology, location, embolic involvement, and patients' conditions are all crucial for therapeutic decision-making. Treatment options include anticoagulation, thrombolysis, surgical thrombectomy, and endovascular stenting. Therefore, surgical strategies should be highly individualized. Herein, we present a rare case of a huge thrombus from the ascending aorta to the arch in a 43-year-old man. Considering the high risks of catastrophic embolic events, surgical removal of the aortic mass, thromboendarterectomy, and reconstruction of the arterial wall were performed with a satisfactory outcome. This report illustrates our experience of surgical strategies and perioperative treatments for this challenging case, and contemporary surgical management for mural thrombi in the ascending aorta was also thoroughly discussed.
相对正常的升主动脉内出现大的壁血栓是极为罕见的情况，可能因新的栓塞导致重大心血管不良事件。由于其形态多变，这些不稳定血栓的处理具有挑战性且存在争议。血栓的大小、形态、位置、栓塞累及情况以及患者状况对于治疗决策都至关重要。治疗选择包括抗凝、溶栓、外科血栓切除术和血管内支架置入术。因此，手术策略应高度个体化。在此，我们报告一例43岁男性从升主动脉至主动脉弓的巨大血栓的罕见病例。考虑到灾难性栓塞事件的高风险，我们实施了主动脉肿物的手术切除、血栓内膜切除术及动脉壁重建，结果令人满意。本报告阐述了我们针对这一具有挑战性病例的手术策略及围手术期治疗经验，同时也深入讨论了升主动脉壁血栓的当代外科处理方法。
