Li Ying, Li Jia, Chen Jia, Zhao Pei Qun
Department of Digital Medicine, College Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing 400038, China.
Department of Emergency, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400030, China.
Eur Heart J Case Rep. 2024 Nov 19;8(12):ytae613. doi: 10.1093/ehjcr/ytae613. eCollection 2024 Dec.
Few studies have investigated the effect of the intimal morphology of type B aortic dissection (TBAD) on the blood flow after rupture. We report a case of a 30-year-old male with complicated TBAD, who underwent assessment with 4D computed tomography (4D-CT).
Patient presented with chest tightness for 14 days, a heart rate of 67 b.p.m., regular rhythm, and 2 years of hypertension. Precisely 14 days prior, he had been diagnosed with aortic dissection by ultrasound at another hospital. 4D-CT showed thoracoabdominal aortic dissection (Stanford type B), left haemothorax, multiple dissection tears, an initial tear located at the large curvature side of the aortic arch, a proximal tear entrance >15 mm, and a descending aorta exit >5 mm. 4D-CT analysis and visualization of the intimal flap showed a parallel three-lumen spatial morphology of true-false-true, and the lumen showed partial thrombosis in the false lumen. Further quantitative analysis of the area of the initial and re-entry tear during the cardiac cycle revealed that the ratio of the initial tear to re-entry tear was consistent with the expansion ratio of the false lumen to the true lumen of the re-entry tear. The patient improved and was discharged 1 week after undergoing thoracic endovascular aortic repair (TEVAR) for descending aortic dissection.
The complex triple-lumen TBAD, characterized by multiple tears and blood flow channels, poses challenges for TEVAR. 4D-CT facilitates the visualization of intimal flap spatial distribution and enables a thorough assessment of interlayer dilation risk within a realistic and complex haemodynamic context, thereby refining the risk stratification for the progression of complicated aortic dissection and its associated complex complications.
很少有研究调查B型主动脉夹层（TBAD）的内膜形态对破裂后血流的影响。我们报告一例30岁男性复杂TBAD患者，其接受了四维计算机断层扫描（4D-CT）评估。
患者因胸闷14天就诊，心率67次/分钟，心律规整，有2年高血压病史。确切地说，14天前他在另一家医院经超声诊断为主动脉夹层。4D-CT显示胸腹主动脉夹层（斯坦福B型）、左侧血胸、多发夹层破口，初始破口位于主动脉弓大弯侧，近端破口入口>15 mm，降主动脉出口>5 mm。4D-CT对内膜瓣的分析和可视化显示真假真平行三腔空间形态，假腔内有部分血栓形成。对心动周期中初始破口和再入口破口面积的进一步定量分析显示，初始破口与再入口破口的比例与再入口破口处假腔与真腔的扩张比例一致。患者在接受降主动脉夹层腔内修复术（TEVAR）后1周病情好转并出院。
复杂的三腔TBAD以多发破口和血流通道为特征，给TEVAR带来挑战。4D-CT有助于可视化内膜瓣的空间分布，并能在真实复杂的血流动力学背景下全面评估夹层扩张风险，从而完善复杂主动脉夹层进展及其相关复杂并发症的风险分层。
