Tokic Tomislav, Hasnas Lea, Mikulic Lovro, Markovic Pavel, Gustek Stella, Kucina Anamarija, Jurca Ivana, Sipus Dubravka, Mihaljevic Martina Zrno, Gasparovic Hrvoje, Burcar Ivan
Department of Cardiac Surgery, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
Department of Surgery, School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia.
J Surg Case Rep. 2024 Nov 16;2024(11):rjae707. doi: 10.1093/jscr/rjae707. eCollection 2024 Nov.
Stanford A aortic dissection is one of the most devastating acute medical conditions due to its high morbidity and mortality. We describe a 77-year-old male patient with a medical history of surgical aortic valve replacement with a still functioning Starr-Edwards caged-ball valve 40 years prior. The patient was promptly diagnosed with an ascending aortic aneurysm and dissection, and an emergency Bentall procedure in deep hypothermic circulatory arrest was performed. This is, to the best of our knowledge, the first Stanford A dissection case described in the literature in a patient with Starr-Edwards valve, and the longest still functioning caged-ball valve to have been replaced with the Bentall procedure. We also discuss the caged-ball valve's unfavorable hemodynamics as a potential predisposing factor of the dissection, as well as the patient's supposed initial bicuspid aortic valve disease which could also predispose to aortic aneurysm formation and dissection.
斯坦福A型主动脉夹层是一种极具破坏性的急性病症，因其高发病率和高死亡率。我们描述了一名77岁男性患者，他有40年前接受主动脉瓣置换手术且斯塔尔-爱德华兹笼球瓣仍在正常工作的病史。该患者被迅速诊断为升主动脉瘤和夹层，并在深低温循环停搏下进行了急诊Bentall手术。据我们所知，这是文献中描述的首例患有斯塔尔-爱德华兹瓣膜的患者发生斯坦福A型夹层病例，也是接受Bentall手术置换的仍在正常工作时间最长的笼球瓣。我们还讨论了笼球瓣不利的血流动力学作为夹层的潜在诱发因素，以及患者推测最初的二叶式主动脉瓣疾病，这也可能易患主动脉瘤形成和夹层。
