Long Yanli, He Bihui, Tsao Naiwen, Liu Hongyan
Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, China.
Catheter Cardiovasc Interv. 2023 Apr;101(5):943-946. doi: 10.1002/ccd.30628. Epub 2023 Mar 15.
Patients with Marfan syndrome who present with a dual aortic aneurysm are not uncommon in clinical practice; however, the management of these patients is a significant challenge. We present a unique case of aortic root aneurysm and challenging infrarenal abdominal aortic aneurysm (AAA) with a short and angulated neck. We performed simultaneous repair using the Bentall procedure and ascending aortobiiliac bypass. Endovascular obliteration of the AAA neck and bilateral common iliac arteries was also performed. The perioperative process was uneventful. Normal functioning of the mechanical valve and complete thrombosis of the AAA sac were confirmed on follow-up computed tomography and echocardiography. This report suggests that combined ascending aortobiiliac bypass and endovascular obliteration with the Bentall procedure for dual aortic aneurysm is a useful surgical strategy for patients with Marfan syndrome. Life-long follow-up and medication ought to be mandatory to prevent incomplete exclusion and bypass occlusion.
患有马凡综合征且出现双主动脉瘤的患者在临床实践中并不少见；然而，对这些患者的治疗是一项重大挑战。我们报告了一例独特的主动脉根部瘤合并具有短而成角颈部的挑战性肾下腹主动脉瘤（AAA）的病例。我们采用Bentall手术和升主动脉 - 双髂动脉旁路移植术同时进行修复。还对AAA颈部和双侧髂总动脉进行了血管腔内闭塞术。围手术期过程顺利。随访计算机断层扫描和超声心动图证实机械瓣膜功能正常且AAA瘤腔完全血栓形成。本报告表明，对于马凡综合征患者的双主动脉瘤，联合升主动脉 - 双髂动脉旁路移植术和Bentall手术的血管腔内闭塞术是一种有用的手术策略。必须进行终身随访和药物治疗以防止不完全隔绝和旁路闭塞。
